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CCHIT Organizational Teleconference 2

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Teleconference number 2.

10:00 AM, 07-24-2009.

Selvie Kalthic & 3 others
Michale Brody
Richard Huffman
Chris Lucena
Road Roark
Sam Bowen
Sena Palanasami
Jason Morrill
Alfonso Perez
Tony McCormick


2. Dr. Brody has been to the CCHIT meeting. The 2009 Criteria has been pushed to 2011. The Meaningful Use Matrix has not been firmed up. Certain aspects will have to be defined to be measured better. We pretty much know everything tht we have to do but we may wind up doing extra work that we do not have to do yet. What we see here is everything and then some. The objectives for 2011 are not ornerous but some are not realistic in this setting. There are issues that relate more to work flow in the office than to functionality in the EMR. The ONC met last week and basically came out last week and endorsed. The agency that is going to be monitoring has endorsed this change.

One of the meaninful use requiements is checking eligibility. There are only 4 or 5 that can check Medicare eligibility. Need SDK. Individual subscribers will have to subscribe to a service to check eligibilility with a CURL. The estimate of 20 days seems unrealistically high. If someone is familiar, it can be done more quickly. Given what needs to be done, there is no way to meet the January time frame given the functionality that needs to be encorporated and a high quality. In order to get the certification, there are no quality control checks or anything built into it. Doing quality control checks and debugging later will allow for certification by January deadline. It seems the fuctionality is there but that the test scrips are not revealing that.

Tony doing the list of failed criteria. A fairly large number of the failed criteria didn't fail. They failed the scrip but the functionality was there. Corporate cathedral model. Opensource moves more quickly, but does not have less quality control. Quality control is more community man power based than formal script driven.

All you need to do is have a button to check eligibiliity. That goes to a 3rd party and sends the necessary information. The information comes up in a web browers. The specificiation is to check elibibility, not to enter it. The website of the 3rd party provider gives you the information needed. The screen is provided by the carrier that you are accessing. It is a 3rd party interface. You have no control over its design at all.

If we have the functionality, why did the script fail? Just because the script doesn't work doesn't mean we don't have the functionality. We just have to figure out why the script didn't work against our code.

My understanding is that script does not mean a set of code. It is a list of things someone does in order to get a piece of information. The person sits there and does the key strokes to show that an operater can get the desired result. An experienced user who is part of this team should go through the scipts and then show an evaluator what is done. When tested, the level of functionality was a lot higher than the estimate by Visolve. This is on the webpage at openemr.org. Dr. Ronald Emus after doing about 50 scripts or so, he gave up because no one was helping him. Practially all of it was working. He was not getting into the areas that we have been working on recently. Is it possible to get his feedback? He hasn't put anything on SourceForge for over a year. He might not want to come back due to the lack of help. If you are not using the program everyday, it's hard to get some of the thigns to work. Aobut 100 things to do for CCHIT. Could this be divided up between 4 or 5 people?

How do we go about subscribing to the service provider for eligibility. This will be checked into. Individual users will have to subscribe to this service and pay a monthly fee. Most of the clearing houses support exchange. This can possibly be done without having to subscribe to a service.


3.5 Main policies mentioned in meaninful use.

1A functionality to MMF systems New York 1B Phyaura

2 Rod Roark, James Perry, Mark Leeds

3. Jason Morrill, Chris Lucena, Justin Doiel, Alfonso Perez

4. MI-squared. Tony McCrormick,

5. Visolve


4 Criteria does not look like it is required until 2011. Can these people be moved to something else that is more pressing? We need to figure out which of the modules that we really have to have first. Improving population and public health is important. We need to pick out which modules need to be done first and leave others until later. The ones that say required in the Meaniful Use Matrix are going to be highest priority. The CPOE is a major issue. Computerized Physician Order Entry- right now we do not have an order entry system. We need something that will allow physicans to create various types of orders that become a part of the patient's chart. This needs to be prioritized immediately. Should this be tied into the billing module? Ordering something for inside of office versus ordering from an outside facility. Order entry does not necessarily have to meet with other parts of office since it is just entering the order.

Once you get to the orders, one of the measures is how many were ordered by the physicians versus the nurse. For CCHIT, you have to be able to check this. Something that works like CAMPOS where there is a form or screen where orders can be entered. Traditionally EKG, x-ray, etc are all entred on the same page and matched up with charge item and diagnosis code. If a referral, a referral slip is generted and sent to another facility. This is why it should be tied into the billing system. This is more of a workflow issue. Including the CPT and ICD-9 codes could be stored until the order is actually done. It would be appropriate to link CPT and ICD-9 codes.

Prescribing modules need to be dealt with.

Problem list has start and end dates. Need to generate reports based on problem list.

Lab reports as discrete data elements.

Vitals as discrete data elements

need to take a lot of data stored as images and change to discrete data elements. This is already being worked on for the past couple of months. Working Alpha module. All the data is being put into the database as discrete elements that can be queriable. We just need the queries for BMI, etc.

Chris Lucena- apparently, LabCorp has a program that is able to work with EMR using hypersense. Need more investigation and documentation. There is a link where data is pulled from a folder where LabCorp puts patient data. hypersense@labcorp.com

all the patient specific eduction tools. Will need to encorporate into OpenEMR by selecting diagnosis or 3rd party tool where fee will have to be paid. Template forms that can be printed out and given to patient. Does not link to encounter, but can be given to patient. Patient specific education must be given, it does not matter how- internet, printed, etc.

In immunization, there is a link to CDC for vaccination information.

Will create document that details modules so that if people have something that meets the need it can be shared.. michael brody will create a document to prioritize modules. The site certification is you have to have the elements of meaningful use to get site certified but no specific program is required. You can cobble together multiple programs. Not sure of difference between site certification and full certification. Site certification- tools from multiple vendors. Full certification- 1 program does everything.

Need to document level of functionality and use. Discover where real holes are. Then decide how to fix for full certification. Identify 3rd party tools that can be easily linked to or referred to for indivudal provider to add for site certification.

Need additional modules to give to developers who would like to participate but do not have something to work on. The big chuck we gave out was the fucntional component. Need to make sure downloading CVS and looking at the code. Jude pierre hasn't been very open to work with Nathan Capore. Tony get involved in that. Nathan waiting on code base from Jude Pierre. Need to get Nathan Capore working on CVS independent of Jude Pierre.


4. Rod- A very broad issue.

Sam- are there things about the code that bug you or you wish you could make better.

Rod- not very modular. A lot of work can be done to make it more consistent and easier to work with.

Sam- can you generate punch list? If we want to make it fully modular and object oriented, what are the issues we would have to resolve?

Rod-I'd have to give it some thought.

Sam- Part of the design problem is amature programers that worked here and there at what struck their fancy. Not very modular and kind of a tangled mess. It may become the responsibility of who owns the module to fix background .

Refactoring.

Rod- come up with some better developing guidelines to help developers create code that is more consistent with each other.

Sam- Justin Doiel has a personal interest in this. Concerned about bug release. Wants to improve development guidelines. Need guidance from people who work with code the most. Jason and Rod to help Justin.

Sena wants requirement document (meaningful use matrix). High level document. Do not know how CCHIT will interpret. Meaninful use document put out by ONIC. CCHIT just states that software meets the requirement. The actual steps are not liekly to be available from CCHIT for 3 months. CCHIT has not had a chance to delve into them and determine what needs to be done. A requirements document is the system shall do X. the details of how is a spec. we can't do things quite at that level of detail. We have to fill this foggy middle where we are not told what to do. The testing document winds up being the final version of the test scripts from CCHIT.

Tony - CVS code. Just beginning to flux that out. Waiting on final conclusion as to plan. Recommend branching model. Base relies for given set of functionality followed by patch release. Primary stable relase with narrowly defined functionality. Create branch for bug fixes. Additional functionality goes to bug fixes and patch release. Want no more than 2 primary releases. Provide easy upgrade patch. Maintain previous release for a while. Bug fixes for at least 1 previously release. Most practices need some time to upgrade.

UTF8 and internationalization is ongoing complex project. Messes up for a while when add new features. Is multi-language project going to be ready for next small release? Completion goal August 15.

We have previously agreed to use GPL2. Do we need to convert from 2 to 3? Says you can use version 2 or later at your discretion. Would like everyone to use the same version if possible. It is better legal wise to have 1 single licensing that everyone is using.

Bill Lober has using openemr.org to sell stuff in Washington. OpenERM. Synetc stuck at 2.0. Change to OEMR, would fit in nicely with OEMR.org. Can very easily change company to OEMR. Can we refactor name from OpenEMR? If we make the program really popular, someone else will try to rip it off anyway. Add OEMR to openemr to keep it from being confused with other people's branches. Opensourcemedical softwarare to OEMR.org. Still working on taxfree status. Want to wait until it already goes through to change name. Once have status, can change name.

Remind to use SQL.inc to make database connections. Can use to help clean up code and prevent SQL injection. Jason agrees to drive everything through single library. Want to avoid injection issues. A lot of mental health facilities require forms.

Tony McCormick in Houston. Brody only on Friday. Sam Bowen all weekend. About 8 people total. No one has registered in the hotel.

Meet again in 2 weeks to discuss modules