We all know that OpenEMR is HIPAA compliant and that security, reliability, and availability are important to the development team. But I'm wondering why OpenEMR has never sought or achieved CCHIT certification? From the discussions we've been having with clients, CCHIT certification is becoming increasingly important (especially in public health) and would definitely give OpenEMR yet another competitive advantage should it achieve certification.
Is there any movement in seeking CCHIT certification? If not, why? Our company has considered working towards it but, again, we don't want to step on any on-going efforts by the core team.
OpenEMR HQ, Inc.
Clearly we want to have all the required features. But last I checked, formal certification is very expensive and I can't imagine who would want to pay for it.
You're very right in that the certification process if very expensive. But I think that the benefits reaped from achieving the certification could far outweigh the costs associated with pursuing it. At this point, we're looking at some funding options for CCHIT certification and have some pretty good leads on money sources we could tap to help our with getting certified. Not sure how it's going to turn out at this point though.
We've also thought about the 'community funded' option to achieve certification. That's something that would allow the active OpenEMR community to have a deep and real role in helping the software achieve certification. What do you think about that?
Either way, I think certification could be important. Like I said in my last post, we're seeing a LOT of interests in OpenEMR being CCHIT certified. I'm sure we're not the only ones so I thought I'd bring it up for discussion.
I think for OpenEMR to achieve wide spread acceptance among the US physician base the majority of practices are not going to bother looking at non-CCHIT certified software.
Doctors (and medical practices) deal with very severe legal risks and in general very risk adverse people. Most of the physicians would rather cough up the money for the proprietary software that is CCHIT certified than deal with the uncertainty of the non-CCHIT certified software.
While CCHIT certification may mean little to members of this community, as time goes by, this will become an ever larger problem.
The reason we have not yet sought CCHIT certification is that OpenEMR has operated as a totally volunteer organization. We only recently acquired a checking account, have no real source of revenue, and certainly don't have $35,000 for the certification fee.
I have been trying to get federal tax exempt status 501(c)(3) for four years. I have been dogging this for a long time and I have been working through my United States Representative office. We put raising funds for a long time trying to get the 501(c)(3) before pursuing fund raising. It has taken so dreadfully long that we recently decided to start raising funds through direct donations both on SourceForge and through http://www.oemr.org/.
I have also been investigating writing grants to help fund some of this. However most federal funds and lots of state and private foundations require the 501(c)(3) before you even apply. There are likely private foundations that do not require this.
There is also the real issue of relatively limited developer resources. The number of developers involved is growing but we have not had the resources to handle this.
The guidance committee meeting minutes (OSMS Board of Directors) are posted:
If you want to start pursuing CCHIT certification, you would not be stepping on toes.
Samuel T. Bowen, MD
Would it be completely off the wall to think that one of us could start up an alternative accrediting authority to CCHIT?
This could be a nonprofit group, or a small company, that examines software and certifies that it meets puplished requirements of CCHIT, even though it is not actually CCHIT certified.
It could have a mission of certifying only open sourse products.
Ronald, I like the way you think. We could call it certification of Open Source Healthcare Information Technology. Wait, not the best acronym, LOL.
Or more easily, we could get OpenEMR users to sign onto a document where they say that, in their opinion, OpenEMR meets the published requirements of CCHIT (when it does). I think with a good collection of medical professionals on board, that would carry a lot of weight.
But more important is to actually meet those requirements. I think that's where current efforts and fundraising need to focus. After that's done there are many options.
It's kind of what I think of when I read "CCHIT" (soft C of course). ;-)
Unfortunately, CCHIT is the "official" US government choice. This is similar to US governmental handling of electronic prescriptions. According to Andres this contract has already been handed to a single (for profit) company.
However, Being an all volunteer organization definitely puts at a significant disadvantage. Writing our US Senators and whining about unfair treatment of the underdog, getting beat up by President Bush and his privatization of what should be a US federally funded organization is going to have more mileage in this election year.
Sam Bowen, MD
As I talk to clients I'm finding two different issues regarding OpenEMR quality keep rearing their head:
1. CCHIT certification - this is something that we're hearing more and more about and, in public health agencies, we're almost meeting a closed door as soon as we tell them OpenEMR is not CCHIT certified.
2. Consistency of care - this is actually something we hear more about that even CCHIT certification. I've spoken to no fewer than 4 people this week who told me that they had contacted several other OpenEMR consultants and none of them have even called them back.
Personally, I think these two issues are creating an enormous hurdle for the widespread adoption of OpenEMR within both private and public health organizations. CCHIT is a no-brainer: there is going to come a time when OpenEMR is going to *have* to be CCHIT certified if it's to hold any traction at all in the marketplace.
Our company, as well as Dr. Bowen and others, are looking into various funding options. This was actually a topic of a lot of discussion and debate during our staff meeting on Monday morning and we're seriously considering simply setting aside a portion of our profits to either donate to the OSMS to help defray the cost of CCHIT certification or establishing a separate fund through our company specifically for CCHIT certification costs. Right now, I think we're seriously leaning towards regular donations and set asides to the OSMS as that will both help the organization and the community as a whole.
Next, we need to look at quality of service. While I'm not going to get into it in this thread since it's primarily a CCHIT discussion, I can say that there is a BIG problem with consultant quality that needs to be addressed. We're going to address it by developing an "OpenEMR Certified Consultant" program that we're launching soon. But I'm seriously interested in other ways we could improve the quality of service the community - and in particular companies working within the OpenEMR space - provides.
Lastly, and this is more addressed to Dr. Bowen than anyone else, I'm wondering if you'd be open to establishing a fund specifically to pursue and secure CCHIT certification. We're definitely open to contributing some of our profits on a regular basis to such a fund and I'm sure others here would be too.
What do you think?
OpenEMR HQ, Inc.
Ph: (918) 919-4624
I'm glad this issue has come up again. Check out this thread for a previous discussion:
I agree with Rod, once we fulfill the CCHIT criteria there will be options. Fulfilling these criteria will not be a simple task though, although it will then make OpenEMR a formidable EMR option for any practice. I'd suggest actually reading through the 67 pages of criteria at the below link. These criteria provides an excellent detailed roadmap of what OpenEMR's functionality should aspire to.
I really like Ronald's idea here. I think we've all given up on having only one great open source EMR project that all developers spent their resources on. However this open source EMR certification would provide the means for the open source EMR community to come together.
Of course, it would also be nice to come up with the $35,000.
I like Ronald's idea as well. However, if we really need the CCHIT, I would not be opposed to chipping in on the $35K fee. The way I see it, we are all getting a superior EMR system with OpenEMR for a fraction of what proprietary software companies are offering. Misys wanted to outfit our office for $100K. OpenEMR does everything we needed the Misys system to do for us. Plus with the cost savings we have reaped by converting our office to 100% open source, there is room in the budget to chip in for the certification.
As far as consultants, I have a feeling that the listing on oemr.org is out of date and it would be nice if someone would contact all of them to find out which ones are still in business and actively supporting OpenEMR, and what is their experience level with it. Those who claim experience should be able to point to code that they have contributed, and/or to satisfied clients, and if they can't show any of those thigns then they should not be listed. I don't much care for a "certified consultant" program that is controlled by a consultancy; such a thing needs to be (and appear to be) unbiased.
I have made regular attempts to contact the listed consultants. I generally leave them on the list if they state that they still support OpenEMR installation and maintenance, though I have my doubts about how active some of these groups really are.
I get a lot of calls and emails, for support and I try to direct these to groups that I know are active. In general, I try to make referrals to the consulting that is geographically the closet to the potential client.
Frequently, the caller is somewhat taken aback when I answer the "help line".
I also believe the CCHIT certification, whether we like it or not, will become increasingly important.
"Lastly, and this is more addressed to Dr. Bowen than anyone else, I'm wondering if you'd be open to establishing a fund specifically to pursue and secure CCHIT certification."
The accounting of Open Source Medical Software is typical of a not-for-profit. Most of the monies that come in are donated for a specific project or reason. The funds are accounted for separately. As an example Hickory Spring's Corporation donated $2,500 dollars for us to but a new server for the project. This money is held in its own account and is only used for this purpose.
Some funds come in undesignated. This would be typical for small cash donations. These funds are placed in a general account. This general fund is much less restricted and can be used for a number of purposes. OSMS has only one bank account, but all of the funds are tracked separately by keeping a designated funds in a separate account on or books.
I have personally been paying all power, telephone costs, internet connection fees, faxing and general office expenses out of my pocket. If the checking account gets too low, I donate cash to make sure we don't have to make minimum balance payments.
OSMS does not have any paid employees, so to date we do not have any payroll liabilities. We do try to track contributions of volunteer time by the developers, and the value of donated software. This currently runs around $500,000 or more per year.
To answer your question, if your company donates $35,000 specifically to cover CCHIT certification, then that is what it will be used for.
Are you paying for hosting for a website / server?
I will be glad to help with that. I have space in my rack and would be glad to donate space/bandwidth/power for server hosting to the project.
Massachusetts has passed a law mandating that Hospitals and Clinics use EMR and that the EMR be CCHIT.
Here is a link to that law http://www.mass.gov/legis/laws/seslaw08/sl080305.htm
IMHO it is only a matter of time before CCHIT certification is required either through legislation or through insurance company incentives / penalties ( for reference the 2% boneus medicare is providing for using e-rx with future penalties if you dont).
In terms of being opensource, and therefore CCHIT is unfair, VistA (not the microsquish flavor but the opensource EHR written in mumps - find it on sourceforte too) is CCHIT. So an arguement that it is an unfair burden to the opensource community is not likely to work.
I therefore strongly believe that persuing CCHIT certification is very important for the future of OpenEMR, and that is something I will support with both my programming skills and financially. If 100 OpenEMR users and developers would each send in $350 toward the CCHIT certification we would be at the $35,000 amount easily.
Moving on to other topics. I was recently at a medical conference where I presented a workshop on the HIPAA security rule (kown as the Administrative Simplification - HAH !!), Electronic Prescribing, and Electronic Medical Records. The final 45 minutes of the workshop were spent demonstrating how to install and use OpenEMR. I believe that as a result of my workshop, there will soon be a number of new users in the OpenEMR community, and I have been asked to present my workshop at two additional CME meetings already. Every doctor at the workshop went home with a CD that contained Xampp, OpenEMR, a text editor, and an unzip utility with installation instructions for OpenEMR on a windows box.
Open Source Medical Software
c/o Samuel Bowen, MD
1470 9th Ave. Dr. NE
Hickory, NC 28601
Andres Paglayan is the treasurer and is accepting donations through his PayPal account:
andres at paglayan dot com
Thank you very much for your offer and I will be glad to personally match your offer.
Sam Bowen, MD
I would suggest that we contact CCHIT and ask for them to reduce their fee. We are not dripping with cash and are a not-for-profit. Perhaps they will reduce their fee.
I am going to write a letter to my U.S. Senator and ask for them to request a reduction in the fee on our behalf. Would you be willing to contact your Senators if I provide a suitable letter?
Here's a thought:
We can use the criteria published for CCHIT certification and put the various requirements into a spreadsheet and volunteers among our users can fill in the blanks describing how Openemr 2.9.0 meets or does not meet each requirement. Each volunteer would be assigned a column in the spreadsheet. Once the columns are filled, we'll know what is required.
Even if we don't spend $35,000, we will still have a group of knowledgeable users indicating how the product does or does not conform to CCHIT requirements.
Ronald Leemhuis MD
I love this idea and I definitely second it. Doing this not only spreads out the technical burden of evaluation and reporting but also allows everyone a deeper level of ownership and participation within the project.
OpenEMR HQ, Inc.
Here is a wiki page where OpenEMR users can contribute their evaluation of OpenEMR with respect to each of the CCHIT criteria:
The list of criteria is quite long. Can we recruit volunteers to divide up the various sections and work out their assessments on a paper worksheet so that they can be posted all together on the wiki?
I wonder if anyone has taken a look at the LAIKA Testing framework.
Here is a quote off their website:
"Technology (CCHITsm). Laika will be used by the Certification Commission to perform part of the interoperability certification inspection of EHRs in 2008."
I'm not an expert on CCHIT, but I've been told that certification is against a particular version of the product and that each version must be independently certified (ugh). You might want to check with the WorldVista folks. They got certified and they are freely distributed as well. Find out how they organized and paid for it.
Newbie here trying to get the lay of the land...I hope you don't mind my asking: 1) who are the major EMS players that are CCHIT certified? 2) What are the pieces that OpenEMR is missing that cost corporations $160k to add?
Thanks for your time
search for CCHIT on Google for their website(CCHIT). They keep a list of certified vendors on their website.
The more I read the stimulus package, the more I am convinced that certification through CCHIT is unnecessarily expensive and another standard organization may take over. The end result, like communicating with other docs, lab, immunization registry etc .etc should be the criteria for incentive payments from the stimulus package. May be some advocacy against CCHIT and for FOSS is needed.
I think there is a lot of pressure coming down from the DHS to force interoperability. This is the current focus of the CCHIT certification process this year.
I just don't think this is going away.
It is time to stop talking and start actually contributing.
I have donated $500 today to start the CCHIT certification fund and have already deposited the money in the OSMS account.
Sam Bowen, MD
Please remit your checks to:
Open Source Medical Software
c/o Samuel T. Bowen, MD
1470 9th Ave Dr NE
Hickory, NC 28601
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