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| Consolidation Proposal: ClearHealth, FreeMED and OpenEMR |
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 Posted by Fred Trotter on Tuesday June 14, 2005 @ 02:41 AM
from the Teamwork dept.
Hello,
My name is Fred Trotter and I am the project manager of ClearHealth and FreeB. I am formally proposing a consolidation between the ClearHealth, OpenEMR and FreeMED projects.
So far I have discussed this issue with the FreeMED BOD, and several OpenEMR community members. At this point, it is time to put the proposal to the community.
Read on for the full proposal. Digg this article
I am formally proposing a consolidation between the ClearHealth, OpenEMR and FreeMED projects. (To give extra background. FreeMED, OpenEMR and ClearHealth are the most popular PHP/Mysql/Linux Medical Practice Management/EMR applications)
Why should there be a consolidation?
To avoid duplication of effort. Because we are all developing very similar EMR systems using the same fundamental technologies. Each of the three projects is separately generating incompatible code to meet exactly the same requirements. If the three projects combined their efforts we would have a better EMR and Medical Practice Management System in far less time than we might working apart.
What does �consolidation� mean in this context?
That is something that the community needs to come to an agreement on. I think this could mean anything from the complete refactoring of codebases, to friendly and structured exchange of code. I think the optimal solution would be a period of collaboration and communication, followed by a consolidation of code bases and the development of legacy support projects (or migration scripts) for the old code bases. But that is just my opinion, what does the community think?
We, as a collective community, have been spinning our wheels for a long time. Each community has strengths and weaknesses. Why can't we combine strengths to eliminate weaknesses? First we need a candid assessment of what each project has and does not have. I do NOT mean this as hostile criticism, what I am trying to do is create an honest picture of what the real situation is, so that we as a community can figure out what to do next. I expect these criticisms to provoke strong feelings, and, hopefully, equally candid responses. I hope that the replies to this post will help us determine two things, where we are now, and given that status, where we should go. Feel free to disagree with my assessments, but to avoid a flame-war please try to back up your position with verifiable facts. At the beginning of your comments please introduce yourself, since you may not be known as well outside your community. I will cross posts relevant comments where possible. I believe the appropriate place for a central discussion is the new openhealth list, so that is where I will be talking most. I will leave out anything that I see as a positive or negative for all of the projects. This is intended to provoke discussion.
Here goes.
ClearHealth
ClearHealth is a young project funded by Uversa, Inc. Uversa has hired several of the key players to work on ClearHealth. I want to specifically mention three. The first is David Uhlman, who is well known in the OpenEMR community. The second is myself, Fred Trotter. There is a LinuxMedNews interview with me that explains who I am and what I think about things.
The third is Josh Eichorn, Josh and David are especially important because they are the primary architects of ClearHealth. Josh is well-known as the maintainer and author of phpDocumenter which is a standard within the PHP community. A look at Josh's website to see more about his programming background.
As a result of the fact that Josh and David are first class architects, and David and I have a deep background in the current architecture of FreeMED and OpenEMR, I feel ClearHealth has the cleanest layout and most progressive core features of any of the three projects.
Specifically, we have an advanced Calendaring system. We also have FreeB2 which has some features that cannot be found in any other Medical Billing System, like claim revision control. FreeB2 is the centerpiece of the ClearHealth collaborative strategy, and there is already commitment from some non-PHP projects. Eventually this collaboration will generate a wealth of billing formats, which is the only reason to use a separate billing engine.
Our architecture also has what we are referring to as EMR Extensions and Dynamic Reports. EMR Extensions are a method for extending the EMR without programing. Dynamic Reports allows you to create searchable and editable reports. So that you can both query and modify the data in the same system, again without programming.
FreeMED
FreeMED has a lot of features. It handles faxes and has a system for handling images. It is based on lots of trail and error over a long history. It has a small but loyal community. It has some valuable international relationships. FreeMED has a nonprofit corporation that operates in FreeMEDs interest. It is also the oldest project, so it has had a long evolution.
While the system is modular, it is not OOP. The project manager, Jeff Buchbinder, is the only person who is familiar enough with the code to make major changes. Over time several people have tried to contribute to FreeMED, and been frustrated. As a result, FreeMED has been forked several times. FreeMED does have a second generation billing engine (REMITT) but adoption by other projects has stalled because of a patent cloud.
OpenEMR
A large and vibrant community. There are several companies that provide professional support. The code base is slightly more modern than FreeMED, and as a result changes are more possible and the culture of the project seems to encourage this. As a result the project is moving forward.
The project seems headless. There are several versions of the code in parallel. While there is a lot of activity, there does not seem to be to much publicly available documentation. There is no discernible project manager, or definite direction. OpenEMR is also supporting the original perl based FreeB. Which I am no longer maintaining. This makes the system very difficult to install and maintain, because it is not possible to take advantage of the improvements of Jeff Bucbinders REMITT or FreeB2. To be a viable project OpenEMR needs a supported billing system. The choice is either to merge with ClearHealth, integrate with FreeB2 , sort out REMITTs patent issues, or start a billing system from scratch. Given that most of the OpenEMR-only features could be implemented in ClearHealth without programing by EMR Extensions, porting FreeB2 seems more and more wasteful.
There are also issues with the main codebase. The PHP coding practices which are based in PHP 3. This includes the evil register globals, which makes OpenEMR almost impossible to secure. The amount of code rewrite that it will take to make the codebase modern and secure is considerable. Given that these things are already working in ClearHealth, is this worth working on?
Although I loath to put forward any specific plan, I will ask a pointed question. Why don't we move toward using the clean architecture of ClearHealth, combined with the vibrant community of OpenEMR, and refactored feature set of FreeMED? The gap between OpenEMR and ClearHealth could be addressed using EMR Extensions. Some of the major features of FreeMED would need porting, but with an open invitation to Jeff Buchbinder to take a role as a developer on the combined project, those things could happen very quickly.
I am quite aware of that there are investments in current brands, companies and project mechanisms. I am not proposing any organizational merger, the various organizations should continue addressing their own priorities.
Many opportunities are being missed developing in parallel. Lets work together.
Regards,
Fred Trotter
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Re: Consolidation Proposal: ClearHealth, FreeMED a
by Tim Cook on Tuesday June 14, 2005 @ 06:01 AM
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My response can be found here: http://groups.yahoo.com/group/openhealth/message/79
I hope it stirs some technical debate that improves the quality of all FOSS healthcare offerings.
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Re: Consolidation Proposal: ClearHealth, FreeMED and OpenEMR
by P'kale Robinson on Tuesday June 14, 2005 @ 09:46 PM
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| I'm currently the Director of I.I. for a hospital in Atlanta. I have been asked many times by doctors to assist them in setting up their private practices. I see a lot of money-making potential.
About ten years ago, I received first I.T. job as a field engineer for a company named
Peachtree Associates located in downtown Decatur, Georgia.
There I was exposed to Medical Manager. I repaired dead SCO UNIX servers, and installed Medical Manager. I often thought would Medical Manager run on the current version of Red Had?(version 5.1 at the time). It was just a big headache getting Digi serial boards to "play right" with the other hardware. I used to say, "There has to be a better way".
I have had the privilege of installing FreeMED and OpenEMR. Also, I have also opened dialog with Alex Chigos of X-Med regarding setting up a demo box with his solution.
I think they ALL have a lot of potential. I just haven't made my mind up regarding which solution is best for my business venture.
My biggest issue is technical support and training. I really don't wanna get pinned down with support questions to the point that I have to hire an FTE.
By nature,, I'm just a geek. I figured a lot of FreeMED issues on my own, because of the lack of documentation.
I'm very interested in how this wil all play out.
I have even entertained the thought of engineering my own, or re-engineering an existing solution.
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Re: Consolidation Proposal: ClearHealth, FreeMED a
by pj on Wednesday June 15, 2005 @ 05:22 PM
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| I am about to personally evaluate the GPL-based EMR softwares and would like to offer the following thoughts on the matter:
Separate code for achieving the same goal does involve some duplication of effort, but it is not necessarily bad. It results in evolution through competition, and the fittest code will do better.
Excessive, pointless duplication of effort is naturally throttled by GPL. If there is a code that has a significantly much better way of doing things, the nature of GPL allows the people developing other codes to bring it into these other codes. This is one of the strengths of GPL - it tends to avoid excessive, pointless duplication, and speeds up code development.
If there is a bit of code that is horrible spaghetti, but the result is good, someone will rewrite the code to get the same result. A style manual (loose and informal at first anyway) tends to help. The better-written code will tend to do better.
If a code patch is hard to get in (due to bad code management - think of the X11free saga), the whole code will tend to fork and the fork with the best manager will tend to do better.
If the whole code stays too hard to install and run, and it remains like that for too long after the initial development phase, then it will fall behind others in the field in popularity, and will not be viable in the long term.
Consolidating efforts between various codes at any stage is always possible, but the effort depends on the kind of consolidation is being done. UI changes done in the style of the remarkable gimpshop - gimp with a photoshop-style interface - are relatively easy. So are emacs-like-key-bindings in vi. On the other hand, architecture-based and design-based consolidation is vastly harder and would lead to unproductive religious wars (emacs and vi again).
When I view the GPL EMR software situation from the perspective based on these premises, what I see is that the survival, further take-up, development, and eventual success of a code depends on:
- how well it is accepted by developers as well as users (easy to develop, customize and install? quality and features of code)
- how well it is managed by the developers (new patches handled smoothly? Moving in sensible directions?)
All these aspects are important. So the most successful code will be the one that is most easily installed, customized and developed, as well as actively managed.
Now, EMR softwares are pretty hard to get going. Only the inner circle (people who are associated with the developer) tends to be able to install and support it relatively easily and quickly. The tendency, I suspect, is consciously or unconsciously to allow the code to remain like this because there is a perception that it will bring better monetary returns to people in charge of the code. This perception is incorrect.
If EMR software is made so easy to install and customize that everyone uses it, then there is going to be much, much more of it around. This means that there will be more development, more work and more money for everyone. Yes, most of the work will now be simpler, but the high-end-tweaks and stuff-to-do will always be there. So the economic incentive to do this is present, if not easy to see.
To get maximum economic value, a developer of the code must indeed to harness the fact that he knows the code. But the developer will get more demand for his skills, and greater reputation, if his code is popular rather than scarce. The demand and reputation the developer garners is proportional to the number of people using the code. So giving away good code under GPL not only benefits the code, but also benefits the developer economically, as people turn to him for consultancy and installation and tweaking for higher end stuff.
Bell Labs computer engineers many years ago were in a field where there were few people around, and made unix pretty open. They remain an elite in a field that has become enormous, and where most work is at the low-end. They continue doing their high-end stuff. Rob Pike doesn't go around installing Linux and showing people how to use a mouse. He goes to Google Labs to play around with other fun stuff.
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Re: Consolidation Proposal: ClearHealth, FreeMED a
by Dr Mabuse on Wednesday June 15, 2005 @ 07:30 PM
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Please take a look at the Debian-Med
project.
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Re: Consolidation Proposal: ClearHealth, FreeMED a
by William Lester on Tuesday June 21, 2005 @ 04:15 PM
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Fred,
I think your proposal is right on target and I applaud your honesty. Ultimately, we are reinventing the wheel, and could better use our valuable resources.
Rather than suggest a specific plan, why not just get the players to the (virtual) table for a frank discussion? There are lots of options, and at this point, no one idea should prevail.
The real benefits are to the end users. For those of us who use open source EMR products in low resource settings, we know that there are lives being saved. Isn't that what the work is all about?
Cheers,
Bill Lester
CTO - EngenderHealth
http://www.healthtoolkit.org
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Re: Consolidation Proposal: ClearHealth, FreeMED and OpenEMR
by Dr. Richard M. Cadwell on Thursday June 23, 2005 @ 04:02 PM
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I spent months looking at billing/EMP programs for our 2 doc office. If we were both MD's or Both DC's or DO's ... ad nausem, it would have been simple. I thought that Free-med would have been a viable solution. There were two major ddrawbacks. The first was a time frame I was n=being pushed at. The second and much more importantly is that I am not a programmer ( basic don't count here ). It was the second that forced us into what i still consider an ill considered purchase of PMSI from a company that will not honor their contract nor provide product training or support when a disagreement ensued. I mention this because like PMSI, Free-Med was programmer but not user friendly and the EMR was so far beyond my skills it was ludicrious ( like my spelling, ha, ha). I see the consolidation on THIS IDEA an excellent opportunity to turn a program that so far appeals best to the techie, not the doc who really needs simething that is user friendly, not impossible to adapt to another practice framework like Integrative Care or Chiropractic - the A&P is the same folks... I do engourage the seperate projects to work together and show the M$ types that open source community can and does do a better job. Together we ARE strong. Make it so with the code too.
Thank you for your patience in this and I welcome any help or feedback with PMSI, EMR templates.
In Service to Health,
Richard M. Cadwell, DC, Dip. NBCE
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MirrorMed
by Fred Trotter on Friday November 25, 2005 @ 05:24 PM
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Hi,
It is now many months later and Uversa and I have split. As a result I have taken a new trademark , MirrorMed to market the codebase.
Hopefully, this will mean that I can really move forward with the consolidation proposal, since I am free to make more of the concessions that OpenEMR wanted in particular.
Regards,
Fred Trotter
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