OpenEMR - At a glance

This will be a short summary of my first encounter with OpenEMR software package. I wish that I could say that I simply stumbled across OpenEMR, but in fact I had been supporting a joint business venture. At the time, the principal was actually resigned to use a turn-key or shrink wrapped electronic medical record. The rationale was that it would far easier to use a program that was specifically suited for their industry. There were a few pre-requisites, client scheduling, therapy notes, syncing calendars smartphones.

We immediately discovered that the shrink wrapped software, while quite polished and sexy looking did not afford us the ability to customize or provide the key features we were seeking. The idea of having the application share its data across applications was out of the question. Enter OpenEMR. I suppose it would be meaningful to explain the term electronic medical record. If you've been listening to the rhetoric that has been uttered by politicians and news media alike, the conversation of EMRs must have been discussed. In a nutshell, EMRs provide a unique to share, track and manage patient medical history. Perhaps most importantly, EMRs help empower the patient to actually manage their own medical history.
IMHO, EMRs help de-mystify the practice of primary care clinicians. Allow me to share a scenario... I decide to go skiing in Aspen. While on the ski trip, I suffer an awkward fall and brake my collar bone (not too far from the realm of possibility) and do not have access to my primary care physician. I get rushed off to the emergency room in CO. I get there and nobody can talk to me because I am unconscious and my wallet has been stolen. Wow, what a mess..

So, let's imagine for a second that I have USB flash drive or some other digital repository on my person. Additionally, the hospital or clinic has a electronic patient registry that contains information which would link my personal health record with that of my local physician. I know that this sounds futuristic and highly improbable, but this scenario is roughly the blueprint for the Patient-Centered Medical Home (PC-MH). The aforementioned link includes a short shockwave video clip that does a very good job of explaining the concept of PC-MH. At ~2.30min of the clip it mentioned electronic medical records (EMR). Anyway now that I've digressed, let's get back to OpenEMR shall we?


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At a high level OpenEMR is built atop a LAMP> stack. I'm not sure if OpenEMR is platform agnostic, so if you don't have a LAMP stack no reason to despair ;-) At its core, there are several scripts which interface with phpgacl and mySQL database. If you're security conscious like me, running apache in chroot environment is not a bad idea. For those who are not as paranoid as I, simply running apache with limited privileges will suffice. There are also a collection of perl scripts which help for backing up your OpenEMR environment. There are PHP scripts that can behave as SMS email reminders for physicians who are constantly late for patient appointments. Perhaps the most used feature of this software is the scheduling tool. Previously, we were using the Zimbra Collaboration Suite (ZCS) web based application. Though it works well for sharing group calendars and email organization, we experienced problems with scheduling. Somehow dates would get double-booked or would simply not get scheduled at all. Very perplexing and annoying. So, after I introduced the team to OpenEMR, the admins quickly noticed a difference in the scheduling package. Each clinician can either schedule their own patient encounters or simply allow the admin to manage their encounters. I do believe that you can push these calendars or schedules down to any mobile device, but at this point we have not yet configured OpenEMR to perform this task.

I would be remiss if I did not state that to customize certain features of OpenEMR, you will need to understand PHP. The administration of OpenEMR can largely be maintained from the web browser interface; however, for daily backups I chose to build my own ssh/rsync scripts in the shell environment. At the outset there was much acrimony (read I caught hell) because the interface wasn't "pretty", that is since the package was shrink wrapped with beautiful polish.. Most FOSS packages aren't pretty and that is fine with me. My utmost concern is security and functionality, the aesthetics can be worked out at a later date. Moreover, since the package runs on our Intranet, nobody but the staff will ever see it, so the point is rather moot. I like to think of free and open software as malleable. It comes raw, much like the earth from whence we came. You can shape the software as you are so inclined.

To date the package experiences heavy usage from all staff members. Methinks everyone is quite happy with the software which cost very little. OpenEMR is licensed under the GPL v2. One day soon I hope to give something back to this project because it really saved my butt. One of the more active developers, Rod Roark was very helpful in explaining the inner workings of the install and proper initial configuration.

I will share more as I discover more exciting aspects of OpenEMR.

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    This page contains a single entry by AG published on February 12, 2010 12:21 AM.

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