Interest in GNUmed

[Sebastian Hilbert]

Hi,

During the last 3 days I have received four inquiries about GNUmed. First
person wanted to replace a German EMR and billing application. He is a network
enginieer and his wife is the doctor. Second person is a Swiss national and
wanted to know how to use GNUmed in Debian. Third person was a urologist
(group of five) from the US who wanted to know how to implement GNUmed for
history taking, physical examination and billing.

All of them were set up with links to the Wiki as source of information, a
link to the Live CD as means to try it out as well as an invitation to ask
more questions. The last one was provided the Press kit done by Rogerio.

All of them replied but it becomes clear that without billing GNUmed will not
be implemented.

Looks like EMR software is all about billing :-) While all of them fully
understood that a FOSS project cannot implement and maintain billing it
becomes apparent that the adoption rate will remain low until someone starts a
business around GNUmed.

Sebastian


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[Slappinjohn]

Hi,

that's my problem too. I'm using GNUmed for a while now for managing my
patients. Bills are written with ooo-templates via the document-feature
(I don't have many different standard-bills). It's not the best way, but
it works fine for me.

So implementing a billing system is a very good idea. I think a
'private' billing system, where everybody can 'add' the items he needs
for his work, will do it. (I tried the swiss 'elexis' EMR software. The
private billing system implemented there, by importing an oo-calc
document with the items, prices, etc is a very good solution in my opinion).

Implementing a complete billing system, maybe for the german health
system, wont work without many, many hours of programming :( and it
won't work for other countries, but a billing system, everybody can
design the way he needs, is worth thinking about...

Greets

Marc

Sebastian Hilbert schrieb:

> Hi,
>
> During the last 3 days I have received four inquiries about GNUmed. First
> person wanted to replace a German EMR and billing application. He is a network
> enginieer and his wife is the doctor. Second person is a Swiss national and
> wanted to know how to use GNUmed in Debian. Third person was a urologist
> (group of five) from the US who wanted to know how to implement GNUmed for
> history taking, physical examination and billing.
>
> All of them were set up with links to the Wiki as source of information, a
> link to the Live CD as means to try it out as well as an invitation to ask
> more questions. The last one was provided the Press kit done by Rogerio.
>
> All of them replied but it becomes clear that without billing GNUmed will not
> be implemented.
>
> Looks like EMR software is all about billing :-) While all of them fully
> understood that a FOSS project cannot implement and maintain billing it
> becomes apparent that the adoption rate will remain low until someone starts a
> business around GNUmed.
>
> Sebastian
>
>
> _______________________________________________
> Gnumed-devel mailing list
> Gnumed-devel@...
> http://lists.gnu.org/mailman/listinfo/gnumed-devel
>

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[Jim Busser]

On 2009-10-17, at 9:22 AM, Slappinjohn wrote:

> Implementing a complete billing system, maybe for the german health
> system, wont work without many, many hours of programming :( and it
> won't work for other countries, but a billing system, everybody can
> design the way he needs, is worth thinking about...

There are many approaches, some of which we talked about before.

We do have on the wiki some descriptions of how a *separate* billing  
program can work with GNUmed. I have already emailed the list about  
that during the past few months.

There is a simple (very limited) functionality that -- once we would  
get printing more tidily handled -- could be completed as a small  
project inside GNUmed. However that functionality would IMO be  
suitable only for situations where a patient would pay directly,  
exactly for the individual charges *or* where the simple functionality  
would be enhanced to pass items *unidirectionally* to an outside  
program. This is because even before any complexity of electronic file  
transmissions to outside payers (or government) could be considered,  
the schema would have to handle multiple accounts and variable  
payments per patient.

If new usage of GNUmed awaits Karsten to write a billing program such  
new users would be waiting a long time.

Can these new interested people be helped to better understand the  
kind of dialog they need to open with their local vendors?


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[Karsten Hilbert]

Hello Marc,

> that's my problem too. I'm using GNUmed for a while now for managing my
> patients.

Great !

> Bills are written with ooo-templates via the document-feature
> (I don't have many different standard-bills). It's not the best way, but
> it works fine for me.

What can we do to try to improve this part of GNUmed for you ?

> So implementing a billing system is a very good idea. I think a
> 'private' billing system, where everybody can 'add' the items he needs
> for his work, will do it.

I think a reasonable goal would be to identify, and
interface with, an existing OSS invoice handling solution.

> (I tried the swiss 'elexis' EMR software. The
> private billing system implemented there, by importing an oo-calc
> document with the items, prices, etc is a very good solution in my opinion).

Given the above (interfacing invoicing) we can give some
support to making it easier to import the relevant data into
that application.

The desire and need for billing in healthcare is well
appreciated. However, even a reasonable and limited solution
needs quite some work. I am all in favour of attempting a
reasonable solution, however. So, anyone willing to work on
that - speak up !

Karsten
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[Jim Busser]

On 2009-10-20, at 3:33 AM, Karsten Hilbert wrote:

I think a reasonable goal would be to identify, and
interface with, an existing OSS invoice handling solution.

(I tried the swiss 'elexis' EMR software. The

private billing system implemented there, by importing an oo-calc

document with the items, prices, etc is a very good solution in my opinion).

Sounds like they built support into their EMR, wherein charge items are "picked" from an externally supplied list.

We had previously judged it reasonable for GNUmed to capture "billable items" and, in support of this, a plug-in could certainly assist capturing the per-patient items in a GNUmed table.

We still have the issue of what to *do* with the items. Options would include sending them to a printer (and then re-tagging them as "printed") or else transferring them to some other system. For any one installation of GNUmed I might advise doing one or the other because ideally you would not wish to lose track of the status of your billables.

Pending any connection to GNUmed of a program that can dispatch e-billings to one or more data brokers, the package "Simple invoices" was suggested:

From: Gour <gour@...>

Date: March 5, 2009 7:19:45 AM PST

To: gnumed-devel@...

Subject: [Gnumed-devel] Re: Simple Invoices for billing

Dave Cramer writes:

What issues specifically are there with Postgresql ?

See my post from Oct '08 in
http://simpleinvoices.org/forum/discussion/621/
thread.

I was waiting for a new release, but, unfortunately, now when it's out I
too busy to take a look :-(

Here are some instruction how to proceed:

Justin's replies from Jan 8th 2009 & Jan 19th 2009 in the thread below:

http://simpleinvoices.org/forum/discussion/688/

Would be great to have SI working with Postgres...

http://lists.gnu.org/mailman/listinfo/gnumed-devel

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[Rogerio Luz Coelho]

2009/10/20 Karsten Hilbert <Karsten.Hilbert@...>

Hello Marc,

> that's my problem too. I'm using GNUmed for a while now for managing my
> patients.

Great !

> Bills are written with ooo-templates via the document-feature
> (I don't have many different standard-bills). It's not the best way, but
> it works fine for me.

What can we do to try to improve this part of GNUmed for you ?

> So implementing a billing system is a very good idea. I think a
> 'private' billing system, where everybody can 'add' the items he needs
> for his work, will do it.

I think a reasonable goal would be to identify, and
interface with, an existing OSS invoice handling solution.

> (I tried the swiss 'elexis' EMR software. The
> private billing system implemented there, by importing an oo-calc
> document with the items, prices, etc is a very good solution in my opinion).

Given the above (interfacing invoicing) we can give some
support to making it easier to import the relevant data into
that application.

The desire and need for billing in healthcare is well
appreciated. However, even a reasonable and limited solution
needs quite some work. I am all in favour of attempting a
reasonable solution, however. So, anyone willing to work on
that - speak up !

Karsten
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[Rogerio Luz Coelho]

Sorry for the empty e-mail ... 

Billing is very region specific is it not? 

Is it even remotely possible for a ONE SOLUTION FITS ALL ?? 

Rogerio 

2009/10/21 Rogerio Luz Coelho <luz.rogerio@...>

2009/10/20 Karsten Hilbert <Karsten.Hilbert@...>

Hello Marc,

> that's my problem too. I'm using GNUmed for a while now for managing my
> patients.

Great !

> Bills are written with ooo-templates via the document-feature
> (I don't have many different standard-bills). It's not the best way, but
> it works fine for me.

What can we do to try to improve this part of GNUmed for you ?

> So implementing a billing system is a very good idea. I think a
> 'private' billing system, where everybody can 'add' the items he needs
> for his work, will do it.

I think a reasonable goal would be to identify, and
interface with, an existing OSS invoice handling solution.

> (I tried the swiss 'elexis' EMR software. The
> private billing system implemented there, by importing an oo-calc
> document with the items, prices, etc is a very good solution in my opinion).

Given the above (interfacing invoicing) we can give some
support to making it easier to import the relevant data into
that application.

The desire and need for billing in healthcare is well
appreciated. However, even a reasonable and limited solution
needs quite some work. I am all in favour of attempting a
reasonable solution, however. So, anyone willing to work on
that - speak up !

Karsten
--
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E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346

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[Karsten Hilbert]

On Wed, Oct 21, 2009 at 06:41:25PM -0200, Rogerio Luz Coelho wrote:

> Billing is very region specific is it not?

It is. But there usually is at least 2 types of billing:

1) healthcare system specific billing

        this is typically enormously complex

2) "normal" billing

        this can be helpful in those situations where services
        rendered can simply be billed as items like on any
        standard invoice

> Is it even remotely possible for a ONE SOLUTION FITS ALL ??

I don't think so. That's why we try to minimize GNUmed's
*direct* involvement (but intend to build a good interface
(to other billing software or to billing modules)).

Karsten
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[Jim Busser]

On 2009-10-21, at 1:59 PM, Karsten Hilbert wrote:

It is. But there usually is at least 2 types of billing:

which could *both* be integrated under a common framework...

1) Simple:

Simpleinvoices demo seems clean and uncluttered:

http://www.simpleinvoices.org/demo/

and work on Postgres has been started

http://simpleinvoices.org/forum/discussion/877/

however some queries likely need reformatting to conform with postgres syntax using "switch"

http://simpleinvoices.org/forum/discussion/688/

and some available mysql-based "how to" installation instructions might need cloning and revising for Postgres

http://www.howtoforge.com/simple_invoices_debian_etch

2) Common framework:

If the above looks attractive for simple billing can I recommend that we build on the GNUmed proposal already in place for billing, in which GNUmed could capture basic information in a billable items table and secondarily pass this information to either a simple system (Simple Invoices) and/or to a complex system such as may be able to perform (e.g. United States) e-billing:

http://wiki.gnumed.de/bin/view/Gnumed/BillingProposal

If there is some possibility of funding to support the development of integration / interoperability between an EMR (GNUmed) and (United States) billing, can I suggest that any Americans interested in GNUmed be encouraged or even helped to identify American vendors of Billing and Accounts Receivable (BAR) software?

It is entirely reasonable (IMHO) that the maker of a closed-source, proprietary billing product might be just as happy to steer clear of trying to code and maintain an entire (clinically-oriented) EMR and only grasp the low-hanging fruit of being able to sell, and derive ongoing revenue from, the billing aspects. See for example Goole results from "billing hippa integration"

http://www.omnimd.com/html/softwareintegration.html

http://www.optimedsolutions.com/services.html

http://www.buzzle.com/articles/hipaa-compliant-medical-billing-services.html

http://www.spothealthcare.com/keyword,Medical+Billing+HIPAA/search.htm

http://www.binaryspectrum.com/industries/healthcare/healthcarecomponents.html

http://www.ezmed.info/hipaa-compliant-medical-billing-software.html

e.g. "EZ-Med medical billing and coding software provides a patient ledger with complete accounts receivable, HMO/PPO fee schedules, superbills, electronic medical records interfacing, customized coding and tracking, electronic remittances and claims submissions, and powerful reporting capabilities... EZ-Med Software will seamless integrate with any HL7 compliant  Electronic Medical Records Software."

---> not only could GNUmed optionally deliver billable info into BAR software as above, but GNUmed could also be driven by the BAR software as per

http://wiki.gnumed.de/bin/view/Gnumed/BillingSlaveMode

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[Jim Busser]

On 2009-10-21, at 3:26 PM, Jim Busser wrote:

If the above looks attractive for simple billing can I recommend that we build on the GNUmed proposal already in place for billing, in which GNUmed could capture basic information in a billable items table and secondarily pass this information to either a simple system (Simple Invoices) and/or to a complex system such as may be able to perform (e.g. United States) e-billing:

Strategic pieces to know about for US-relevant (and maybe internationally-relevant) development:

CCHIT opens modular certification program

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72018

“We are concerned that providers could not achieve meaningful EHR use in 2011 if they wait until spring 2010 – the expected date of HHS final approval of requirements – to begin adopting this technology,”

CCHIT proceeds with limited EHR certification

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72183

"Providers must demonstrate that they are meaningful users of health IT to be eligible for Medicare and Medicaid incentive payments under the stimulus. The Centers for Medicare and Medicaid Services will publish a proposed rule in December that describes what physicians and hospitals must do to meet meaningful use requirements and to receive increased payments starting in 2011"

Healthcare providers see certainty on meaningful use

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=71842

The goals for meaningful use are for providers to electronically capture data, report quality measures and use the data to track patients’ medical conditions.

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72159

"Eligible physicians can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified EHRs."

# the above may allow doctors to qualify as meaningful users of those modules GNUmed already supports pending anything more that the incentive payments could support to get built

**********************************************************************

Other pieces:

Health IT group approves standards and quality measures

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=71850

"A matrix of 27 quality measures and 12 standards capabilities, which are endorsed by HITSP, a standards organization formed by the Office of National Health IT Coordinator in 2005, build on each other for improved patient outcomes...

… To report the quality measures, the work group recommended that providers have implemented the 12 HITSP endorsed standard capabilities, including being able to transmit in-hospital and out-patient prescriptions, structured health data such as those for discharge summary and continuity of care documents, and lab test results.

… Providers who have not begun to adopt electronic health records and other health IT standards may use unstructured data such as documents in PDF format in 2011, but must by then be able to meet the structured data standard to report quality measures, Halamka said.

… The committee also recommended that providers be fully compliant with the HIPAA privacy and security rule in 2011 as part of meaningful use.

… … Dr. David Blumenthal, the national health IT coordinator, must craft an interim final rule on meaningful use criteria by December. CMS will issue a rule also in December defining meaningful use for the incentive program.

IS 107 - EHR Centric Interoperability Specification

http://www.hitsp.org/ConstructSet_Details.aspx?&PrefixAlpha=1&PrefixNumeric=107

IOM: Feds should add ethnicity and language measures to EHRs

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72061

Chopra seeks outside advice on health IT standards

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72210

"For instance, providers will have to migrate from using ICD-9 to ICD-10 to SNOMED CT by 2015 to record physician’s clinical observations in an electronic health record."

# GNUmed has been built to support any number of classification / coding schemes

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[Sebastian Hilbert]

Am Samstag 17 Oktober 2009 14:40:55 schrieb Sebastian Hilbert:
> Hi,

Since GNUmed made it on linuxtoday.com around 250 visitors came to
wiki.gnumed.de

One of those contacted me. He owns a linux shop in south France and wanted to
know if GNUmed was usable for a general practitioner there.

He asked what the state of the French translation was and if I could supply
more information.

What is the state of the French translation ? I know we had someone from
France looking at GNUmed and contributing a translation.

Sebastian


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[Karsten Hilbert]

> What is the state of the French translation ? I know we had someone from
> France looking at GNUmed and contributing a translation.

Yep, there's a partial translation - I can provide an up-to-date
file for translation anytime.

Karsten
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[Jim Busser]

On 2009-10-25, at 8:18 AM, Sebastian Hilbert wrote:

> What is the state of the French translation ? I know we had someone  
> from
> France looking at GNUmed and contributing a translation.

If he does not mind to create a Launchpad account, he can then correct  
or fill in missing strings online at

        https://translations.launchpad.net/gnumed/trunk/+pots/gnumed/fr/+translate

the alternative (for people with intermittent internet access) would  
be to download the .po files and email an amended file to Karsten  
however I would first check via devel list whether anyone else would  
be planning to also amend a /po file to cut down on having to merge  
multiple diffs.

How are we maintaining sync between .po files in CVS and .po files at  
Launchpad?


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[Jim Busser]

On 2009-10-25, at 9:19 PM, Jim Busser wrote:

correct or fill in missing strings

Are the strings permitted apostrophes such as 

dummy-no-need-to-translate

into

feinte-sans-besoin-d'en-traduire

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[Jim Busser]

On 2009-10-25, at 9:19 PM, Jim Busser wrote:

If he does not mind to create a Launchpad account, he can then correct or fill in missing strings online at

https://translations.launchpad.net/gnumed/trunk/+pots/gnumed/fr/+translate

in fact, Launchpad's online translation support would be a *perfect* way in which a bilingual (English + native-speaker) medical office assistant could help!

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[Jim Busser]

On 2009-10-25, at 11:36 PM, Jim Busser wrote:

On 2009-10-25, at 9:19 PM, Jim Busser wrote:

If he does not mind to create a Launchpad account, he can then correct or fill in missing strings online at

https://translations.launchpad.net/gnumed/trunk/+pots/gnumed/fr/+translate

in fact, Launchpad's online translation support would be a *perfect* way in which a bilingual (English + native-speaker) medical office assistant could help!

In case it would be of interest, I located online a French presentation on the Patient Record

http://74.125.155.132/search?q=cache:X8MWYYcUjtsJ:www-sante.ujf-grenoble.fr/SANTE/medprod/prive/workgroups/c2i/cours/Paris/DANIEL_LE_BOZEC_Christel_P01/DANIEL_LE_BOZEC_Christel_P01.pdf+comment+appeler+weed+soap+medecin+-opera+site:.fr&cd=4&hl=en&ct=clnk&client=safari

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[Karsten Hilbert]

> If he does not mind to create a Launchpad account, he can then correct  
> or fill in missing strings online at
>
> https://translations.launchpad.net/gnumed/trunk/+pots/gnumed/fr/+translate
>
> the alternative (for people with intermittent internet access) would  
> be to download the .po files and email an amended file to Karsten  
> however I would first check via devel list whether anyone else would  
> be planning to also amend a /po file to cut down on having to merge  
> multiple diffs.
>
> How are we maintaining sync between .po files in CVS and .po files at  
> Launchpad?

We aren't currently. Using launchpad for that would indeed be
worthwhile for that, however. It'd be great if someone could
investigate what the suggested procedure for keeping in sync
actually is.

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[Karsten Hilbert]

> > correct or fill in missing strings
>
> Are the strings permitted apostrophes such as
>
> dummy-no-need-to-translate
>
> into
>
> feinte-sans-besoin-d'en-traduire

Surely so - *that* string, however, is expressly NOT
intended for actual translation :-)  (It won't hurt
but it's useless to do so).

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[Karsten Hilbert]

> in fact, Launchpad's online translation support would be a *perfect*  
> way in which a bilingual (English + native-speaker) medical office  
> assistant could help!

Maybe 2/3rds of the time. Translating isn't quite as non-technical
as it sounds (particularly for those 1/3 of strings not covered by
the first 2/3rds - duh :-)

Nonetheless it'd be a great boon to have 2/3rds translated.

Karsten
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[Karsten Hilbert]

> https://translations.launchpad.net/gnumed/trunk/+pots/gnumed/fr/+translate
> >
> > in fact, Launchpad's online translation support would be a *perfect*  
> > way in which a bilingual (English + native-speaker) medical office  
> > assistant could help!
>
> In case it would be of interest, I located online a French  
> presentation on the Patient Record
>
> http://74.125.155.132/search?q=cache:X8MWYYcUjtsJ:www-sante.ujf-grenoble.fr/SANTE/medprod/prive/workgroups/c2i/cours/Paris/DANIEL_LE_BOZEC_Christel_P01/DANIEL_LE_BOZEC_Christel_P01.pdf+comment+appeler+weed+soap+medecin+-opera+site:.fr&cd=4&hl=en&ct=clnk&client=safari

That might be of interest to translators if linked from nearby the
launchpad translation tool ?

Karsten
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