Bruce
and openhealth-list folks,
I can
speak to Primary Care Coalition of Montgomery County, MD -- I am a project
consultant for them. As the name states, PCC is in Montgomery County, MD,
a suburb of Washington, DC, so its not rural. We are winding up a HRSA
grant under which we developed an open source electronic health record system
(thin, as far as a true EHR is concerned, at least at this point, but it has the
basics, ICD9/CPT codes, appointment management, good reporting, etc). The
system, which we call CHLCare, is currently run in a hosted ASP model
and shared amongst independent safety net clinics in our county, as well as
one in DC. The shared model (its one instance, where a patient's records
can be shared amongst all clinics, provided the patient agrees) has significant
benefits for us now, but should really pay off when we link the system into a DC
Metropolitan RHIO since we've offloaded the interconnectivity work that the
clinics would normally have to do, and put that load centrally on
CHLCare.
While
we aren't in a rural setting, I'll offer thoughts on your other
questions:
1. The
particpants are all "minimal infrastructure" primary care
clinics.
2. We
replaced existing minimal patient record systems (all MS Access, so far) and
converted the existing data for use in CHLCare. CHLCare has about 1500
encounters added a month, and has about 35,000 patients and 110,000 encounters
in its database. Its been operational since July '03.
3.
Clinic start up was a very local thing, but support afterwards has been nearly
100% remotely done. The fact that CHLCare is open source has nothing to do
with this -- support is easy to do remotely because this is an ASP hosted model
where users are required to have browsers, broadband and that's about
it. The Internet access has been the primary reason for needing
local support. One clinic had a massive lightning strick
which killed their router, one is using broadband wireless (from a
mobile unit) and occasionally had intermittent connection, that kind of
thing. By the way, the MS Access systems had required considerably more
support than CHLCare does.
4. I would recommend an ASP hosted model and recommend
factoring into consideration how to interconnect whatever you choose with the
other healthcare providers in your region. While we know very little about
what eventually will be required to connect to a RHIO we do know that doing it
once for a logical grouping of clinics is far preferable than doing it
separately for each, so a shared model is imho worth considering. Of
course I would recommend open source.....:)
If you
want to see what CHLCare looks like, go to https://www.community-healthlink.org/training/index.php ,
select "Spanish Catholic Center -- Langley Park Adults" from the clinic
selection, and use "demo" as the user name and password to access our
training/demo instance. The code is available under GPL
license.
PCC
has recently been awarded an AHRQ planning grant to plan the interconnection of
CHLCare with area hospitals, specialty providers, labs, and pharmacies, so in
some sense AHRQ has accepted the notion that open source is a viable
approach for EHR's.
Bruce,
I hope this helps. If you would more info, please contact me
directly.
Guy Fisher
Project Consultant
Primary Care Coalition of Montgomery County
8757 Georgia Avenue, 10th Floor
Silver Spring, MD 20910
phone: 301-628-3423/fax: 301-608-2384
Project Consultant
Primary Care Coalition of Montgomery County
8757 Georgia Avenue, 10th Floor
Silver Spring, MD 20910
phone: 301-628-3423/fax: 301-608-2384
-----Original Message-----To the list,
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Tuesday, January 18, 2005 5:50 AM
To: [email protected]
Cc: [EMAIL PROTECTED]
Subject: Community Medical Record Exchange
Previously I posted an announcement to the list about a AHCQR grant concerning rural connectivity and health information exchange and requested information from the list. Thanks to all that responded and/or forwarded the announcement to interested parties.
I made a presentation to the grant committee and they wanted further details about projects using open source software. I am posting this list because they are specifically interested in open source solutions.
I mentioned contact with or some minimal knowledge of the following projects:
MA-Share - Massachusetts electronic prescribing project
Indiana Health Information Exchange
Primary Care Coalition of Montgomery County Maryland
ARCH SHARE - Alliance for Rural Community Health Securing Health Access and Records Exchange project in Mendocino California
Connecting for Health Framework of the Markle Foundation
Robert Wood Johnson Foundation Health e-Technologies Initiative
EHealth Initiative for National Information Exchange
Saskatchewan provincial health network and Toronto Health Network
Specifically the committee was interested in knowing:
1. Which of these projects were mostly rural or were designed with minimal infrastructure hospitals as participants?
2. Which projects included participants even if they had different proprietary hospital or office systems?
3. Comments on logistics of maintenance of open source systems in rural areas with minimal local expertise? How much can be done remotely? How much requires local presence?
4. Advice on how to evaluate and chose a system with these constraints.
Please respond to [EMAIL PROTECTED] as well as the list, if information is generalizable.
Thanks for your collaboration.
Bruce Slater, MD, MPH
Medical Director Computerized Decision Support
University of Wisconsin Hospital and Clinics
