Open Source has a wealth of offerings across many different arenas of software, to date a great deal of the offerings out there are development tools, general purpose applications, and first generation vertical applications. In the medical market there has been a long history of development on first generation software such as OpenEMR, FreeMed, FreeB and others. For some users these applications have offered a productive and capable platform on which to run their practice, but it is apparent to most the first time they go to use them that there is not the level of richness and depth found in proprietary alternatives like WebMD's Intergy, NextGen, or The Medical Manager. With the the release of ClearHealth 1.0 RC1 there is now a credible and full featured Open Source (under the GPL) offering that competes point for point in the big five areas of medical software:
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What would be nice to see would be a comparison between ClearHealth and compatible software packages for features and cost.
I manage a medical practice and am responsible for IT (we are small) and this sounds great. Most EMRs are geared toward larger facilities and are prohibitively expensive for a small office.
Our facility has millions invested into meditech...if this or anyother EMR is close i'd like to know!
-nX
While the package looks sweet, and really well executed, the review was a little too full of jabs at the politicos. I can understand bitching about mandating outdated EDI. But HIPAA is a Good Thing for patients, and "rightfully weak" enforcement sounds like you actually want patient data being treated wrong.
If you're going to review software, then do so. If you're going to critique the environment that software has to serve, do it somewhere else. It might also help to really understand the reasons for the laws you're going to criticize.
One thing that I relized when converting my father in law practice over to lytec was that they were less efficient with the new program because of its dependency on the mouse. Although they could come up to speed quickly, having to take you hands off of the keyboard was a hassle. The keyboard short cuts are a important element in data entry.
Having your practice on an EMR is a great initial step, but without being able to collaberate with others on different EMR's you are looking where the real savings come in. I work for a company that specializes in linking EMR's and so I spend all day thinking about this linking issue. I believe you list you can import documents in, but what about exporting? Do you support the HL7 format for import/export?
I would comment more and offer to do some code buy my contract expliciately forbids me from working on EMR's or compeditor products.
If there's one industry that needs financial help in the form of free software, it's definitely the medical industry... oh wait.
how about better film softwarE?
So if I understand the GPL right, if I buy this software, I can give to anyone and everyone I want, legally ... for free?
So if I understand the GPL right, if I buy this software, I can give to anyone and everyone I want, legally ... for free?
I think you can only give the source unless the company says you can distribute binaries. I could be and am probably wrong though...
:-D Darius knows what the GPL means, he's just alluding to the fact that they sell this software. At an unknown price no less ("Call us for a quote") While under the GPL anyone who buys this has to have access to the source AND can freely redistribute it.
The point being, why sell it it the first place ? My guess would be that they charge concultancy fees for helping you migrate from your existing system as well as support afterwards.
The 'source code' link on http://www.op-en.org/ doesn't seem to point anywhere yet. Oh wel, as long as their customers get it i guess.
I think you can only give the source unless the company says you can distribute binaries. I could be and am probably wrong though...
The GPL, basically, demands that the company releases the sources under the GPL. I'm not sure, but I think the company could restrict the distribution of their binaries. However, it only takes one tech-savvy person with access to the code to build new binaries from source, and he would be free to freely distribute those.
In this case, though, the value of this company isn't only in the software itself, they appear to provide vital services for the deployment of the system.
Hi,
My name is Fred Trotter, and I am the project manager for the ClearHealth project. I just wanted to let you all know that we are listening and to try and address issues where possible.
Question: What would be nice to see would be a comparison between ClearHealth and compatible software packages for features and cost.
Answer: You can use the project releases for free. Smaller practices who have geek practicioners or other linux comfortable folk around are encouraged to do that. Or you can buy support for us. Standard Free Software business model. IF you buy support for us, then the initial costs are similar to a proprietary system, except we do not charge extra for multiple locations or providers. So for a large shop the savings costs are dramatic. For any shop TCO is much lower because upgrades are part of ongoing support, rather than whole new purchases. These arguments are going to be formalized soon and available as a whitepaper from Uversa.
Question: Our facility has millions invested into meditech...if this or anyother EMR is close i'd like to know!
Answer: This happens over and over again. For a fraction of the cost we could have installed ClearHealth, and then developed it to mirror the functionality of meditech. But now you are in a vendor locking situation. It takes some bravery to get out, but for the cost of your next minor upgrade, migration to ClearHealth could free you from that forever.
Question: ....The keyboard short cuts are a important element in data entry.
Answer: ClearHealth is designed to be as mouseless as possible given constraint of using a web browser as a thin client. For data entry tasks we are close to being 100% mouseless.
Question: Do you support the HL7 format for import/export?
Answer: we should be doing some interesting things here soon as GPL available code fills out.
If you have any questions regarding ClearHealth feel free to contact me through Uversa, or my personal site..
http://uversainc.com
http://www.fredtrotter.com
Thanks,
Fred Trotter
In this case, though, the value of this company isn't only in the software itself, they appear to provide vital services for the deployment of the system.
The point here is that assuming you sell a software package like this under the GPL that doesn't demand deployment services, how are you going to make money off of it when the very first person who buys it is then free to give it away to whoever they want? Really, I don't see how you can, unless you have some service to go along with it. In which case, you're basically selling the service, not the software.
Does anyone know of any programs similar to this that help patients keep track of data pertinent to them? Stuff like doctor visists, med. doses, symptom history. I would imagine with all the people with health problems out there there would be an open source program which helps patients manage all the information they are inundated with on a daily basis. If anyone knows of software (free or proprietary) that does this, links will be much appreciated. I'm looking into developing something like this if there isn't anything credible out there that I can't build on. Thanks.
Johnfive
how are you going to make money off of it when the very first person who buys it is then free to give it away to whoever they want?
I've seen plenty of IT departements fork over money for a consultant to come install software (commercial think tens of thousands of $ worth) Either because they're to thick, too lazy or just can't be bothered with the inevitable little nagging complications that always turn up and you can't solve without a thorough and complete working knowledge of the software.
Also companies don't give their stuff away for free, not even if they got it for free. And an employee leaking the code is stealing.
I worked for Epic Systems Corp from 92 to 2000. In 92 we assembled their first GUI (had been do text based apps prior) Electronic Medical Record in VB. Since 92 they also assembled a GUI app for Scheduling and later Billing and various other specialities. By 97 we had web client access for key features - I'm sure by now (5 years later) they have complete web features.
Undertaking development of clinic apps like these is a huge task and requires a great deal of customizable modules. I'm impressed at the effort and say good luck.
@johnfive (What about something for patients?)
Epic has software called MyChart that does allow the patient to access parts of their charts as well as veiw their schedule and billing. In fact you can even send messages to your provider through a form that then becomes part of your record. Oh, and you can track your own health notes. Epic's software is high end stuff (not cheap) but its among the best. www.epicsys.com
Simply put, most Hospital or Medical practices aren't going to hire these guys, install the software, train for it, customize it, and implement it and then mount up a web site to distribute the code to the world.
The Hospitals basically Don't Care. They may want the source code for themselves, but have no motivation or call to distribute it from there, much less support it.
Now, it would be basically simple for an employee to grab the source and open up their OWN ClearHealth consulting agency, and that may well happen.
But the basic issue of "all they have to do is sell it once and the cat's out of the bag" is pretty much a non-issue.
Ok there seems to be alot of questions about GPL and the sales model. Try the "snapshot" link on op-en.org and you will find that you can download the sourcecode there.
To make it clear how Uversa makes money: We sell an AAdvantage edition of ClearHealth. There is no difference between the AAdvantage version and the ClearHealth project code, except that we take resposiblity for support and upgrades. You can read on Uversainc.com about what the AAdvantage version includes and does not include. This is basically the same model as RedHat has moved to with Fedora and RHEL.
The difference is that no right minded person is going to try to run a medical practice without having supported software. We are encouraging capable people to support themselves and we are providing support for those who are interested in professional level development and support. Like ubuntu we are keen on other companies supporting ClearHealth, so the employee leaving would not really be much of a hiccup.
As for johnfives question. There are two answers. One, allowing a patient to have access to thier medical record within ClearHealth is on the project roadmap. The idea of having a patient app that tracks that patients personal data is a fine one. ClearHealth could be changed easily to do that, but the real trick there would be to sync with other bits of patient data floating around. For that you would probably want to have some hl7 stuff which is also on the roadmap.
I hope this clears up some questions.
Fred Trotter
http://www.fredtrotter.com
HIPAA is a pita. We had a former Senator come into my father's office for an appointment, and when his turn was up, according to HIPAA, we had to call him by his first name (or else someone might figure out who he was oh noes! This after he shook hands with everyone in the room and said "don't worry I'm not running for anything today"). He finally figured out he was being called and I wish I could have thanked him and his colleagues for creating that situation 
I'd love to try this software out, but we are somewhat tied to the software the hospital uses since he spends half his time there. I'll certainly take a closer look though, it has to be better than some of the open source stuff I looked at a while ago.
But...they are selling services:
http://clear-health.com/site/software/clearhealth/purchase.html
Things like this DO demand deployment, just like any significantly large project. Doctors want to pay someone to call and gripe at when they need a feature or a bug fixed, rather than figuring it out themselves. They want someone to come and deploy ClearHealth 1.1 or 2.0 upgrades for them. Most doctors do not want to become web services architects, they just want quick and easy access to their info. But those that do, or are, can add and change and customise as they see fit. Same applies to hospitals with large IT departments and development staff.
I personally believe they can make darn good money off this, even if they remain a niche player. And thanks to the GPL, they can't lock all the code away if they get bought by one of the big players.
Questions for Mr. Trotter:
1. This could be great for small or developing nations. How is i18n and l10n for other countries and THEIR standards? I'm guessing customising it is a little easier because there are so many web components and PHP gives you Unicode, but how is your support outside the USA? Any other countries express interest?
2. MacOS X. I have a friend with a dental practice using an EXTREMELY customised FileMaker solution for EMR. She is a Mac lover and does NOT want to buy x86, period. I ask the forum at large not to question her decision, as she won't bend and flaming me will solve nothing. Anyway, I shall assume there is no problem, since MacOS X has PHP, Java, and Apache running nice and native, but are there any caveats to using ClearHealth on OS X? Will your company support it? Do you support Safari like you support Firefox? You can just direct me to docs if you can't answer.
Thanks!
--JM
JM,
Your questions.
1. ClearHealth uses Smarty to do i18n specifically because they have a solution that supports unicode completely. Translations are pretty simple to do, and we are planning on investmenting in simplified procedures for this process. Hopefully it will take someone who is fluent in English and the target language no more than an afternoon to do a complete translation. Spanish is first on the road map.
2. ClearHealth runs fine on Mac OSX. We are planning on directly supporting (probably) Fedora/RHEL and Ubuntu/Debian. For any other platform we will support XAMPP so that we can reduce apache/mysql/php version issues. So ClearHealth will run fine on OSX and the project will pay attention to it. As for Uversa supporting it? Sure, we just need to cover the expense of doing so.
Thanks,
Fred Trotter
My prostate exam might get GPL'd!
Well Stallman has had his head up his own arse for a decade, there's no reason that valuable, real world experience shouldn't be shared.
:)
especially if you were a large org and had a slick IT guy to constantly develop it and tweak it into a into a highly customized handle it all application....
I have wanted to try and market some OSS to nursing homes and such but nothing has been professional and complete enough to consider. Would like to put a package together that cmae close to rivaling resource systems caretracker stuff... any thoughts or ideas?
But the basic issue of "all they have to do is sell it once and the cat's out of the bag" is pretty much a non-issue.
For this company, yes. But what about other, less 'ambitious' project? Is it manditory that if you want to make money this way, you must intentionally make your software hard to install and a pain in the ass to use in order to get money from the customer? I'm not saying that this company is doing this and I don't believe they are, but what if you've got an app that's easy to use and easy to install? Then what? Doesn't seem like a lot of hand-holding is required there.
I personally believe they can make darn good money off this, even if they remain a niche player. And thanks to the GPL, they can't lock all the code away if they get bought by one of the big players.
Actually, I'd say these guys aren't that smart, really. If you can program an app of this caliber, it seems to me that it would be much smater to wait for somebody else to write and sell a GPL'd app, then 'piggyback' off their efforts, and offer your support/customization services for cheaper than the original vendor. That way, you don't actually have to write the whole damn thing - all you gotta do is customize it.
who would you rather have "support" and "customization" from? the creator of the project or the piggybacker?
also the piggybacker has to realize that if they kill the developer then they just shot themselves in the foot as well...
and if I take the code and make sweeping improvements and some cool features then I in turn am REQUIRED to GPL it and then the original people can take it from me as well and "piggyback" off me as well...
my2cents
"But the basic issue of "all they have to do is sell it once and the cat's out of the bag" is pretty much a non-issue."
GPL software isn't the only one's doing the "You get source with binaries". Some proprietary software does that too.
"
Now, it would be basically simple for an employee to grab the source and open up their OWN ClearHealth consulting agency, and that may well happen.
"
Quote from www.gnu.org:
If someone steals a CD containing a version of a GPL-covered program, does the GPL give him the right to redistribute that version?
If the version has been released elsewhere, then the thief probably does have the right to make copies and redistribute them under the GPL, but if he is imprisoned for stealing the CD he may have to wait until his release before doing so.
If the version in question is unpublished and considered by a company to be its trade secret, then publishing it may be a violation of trade secret law, depending on other circumstances. The GPL does not change that. If the company tried to release its version and still treat it as a trade secret, that would violate the GPL, but if the company hasn't released this version, no such violation has occurred. "
This employee wouldn't have the right to do that anyways. Another quote:
Is making and using multiple copies within one organization or company "distribution"?
No, in that case the organization is just making the copies for itself. As a consequence, a company or other organization can develop a modified version and install that version through its own facilities, without giving the staff permission to release that modified version to outsiders.
However, when the organization transfers copies to other organizations or individuals, that is distribution. In particular, providing copies to contractors for use off-site is distribution.
nothing you just posted would keep me from opening my own clearHealth consulting business....
that just has to do with whether something has been distributed or not...
I can legally use/modify any GPL product strictly "in house" and not release my changes and therfor not distribute it and you have no legal recourse and do not have the right to "steal" it....
however if I do distribute it then everyone has the right to it as well, even if they "steal" a cd of it off my desk
trust me i am the GPL cop.....
just ask Linsp---!
JT strikes again
The website is completely dead and badly built (404 and missing files). Someone should tell them about Mambo...
nothing you just posted would keep me from opening my own clearHealth consulting business....
Legally, nothing keeps you from that.
In practice, many people will choose to get support from Uversa, since they are the professionals that wrote the software. Even if you are cheaper, that weighs in a lot. And if your get some customers this way, too, well, good for you!
It seems this project has what it takes to be a successful commercial open-souce project. Solid software at the basis, but mainly making money from services. Plus they seem to actually understand how open-source works, and the fact that Trotter makes reasonable comments here is a good sign.
I'd say: good luck, and i hope to hear more from you!
Well Stallman has had his head up his own arse for a decade, there's no reason that valuable, real world experience shouldn't be shared.
If I could mod you up, I would
Having worked in the practice mgmt & emr space for the last 15 years with some of the largest vendors, I can say that this is all a great pipe dream. Ask yourself, if this was a great piece of software, or even if it was only a fair piece of software, which it barely is, why isn't it more popular?
I have and do work with hundreds of practices, large and small, across the country. Many with "geek" doctors. Most have come to their vendors for a reason, functionality and a good return on their investment. When you calculate the time someone will spend fixing, cleaning up this mess the ROI is gone. And as for functionality, try the demo yourself.
Sounds great but remember that you get what you pay for.
Not trying to be a jerk, but I think I have an easy answer to your question: ClearHealth is new, and not even out of beta. It will take time for them to gain traction in a market like this.
If anything, Uversa should be in it for the long haul.
--JM
Freely admitting he is not a medical IT geek.
why isn't it more popular?
As said above, it is new.
Most have come to their vendors for a reason, functionality and a good return on their investment. When you calculate the time someone will spend fixing, cleaning up this mess the ROI is gone.
Err, nobody is saying doctors should download the source and try to deploy this package on their own. Instead, they should hire Uversa to do that, just like you would with any other commercial package.
Doctors will not spend time fixing and cleaning up messes. Sure, just like with commercial software, there will be bugs. And just like with commercial software, Uversa will have to fix them.
And as for functionality, try the demo yourself.
I have absolutely zero experience in that field, so I can't compare. However, it sounds like this might become a nice, cost-effective product for some. I'm not saying it'll be the Best Choice Ever for Everyone, but it looks like there's a market for this.
"Sounds great but remember that you get what you pay for."
Often, you don't. The sale price on anything is based on the precieved value at the time it is sold. Value can but does not necessarily have anything to do with price.
For example, Apache and all of the Apache foundation tools are available at zero unit cost, though just like other web services platforms, the value in them is not in the base software but in the relationships surounding that base. For Apache and Apache tools, that set of relationships includes companies and individuals that gain from working together. In some cases, that includes service contracts (for example, a web services provider).
That's what Fred Trotter from Uversa is saying; they offer the software gratis and in an unabusable form (GPL). The hope is that not only will people use it, but will build around it. Along the way, either a medical practice or the consultants/contractors that assist the practice will ask for support from Uversa.
With open source, if you start with Uversa's support and decide that you either want to move off of ClearHealth (AAdvantage supported version or not) or get another group to support you, you can.
The medical doctors themselves aren't software specialists. They are medical doctors. Nobody is suggesting that they themselves would install, configure, and tweak ClearHealth themselves -- let alone code changes for it. Chances are, the biggest clients for Uversa will not be doctors but the companies that the doctors hire to do IT work and to suggest "solutions".
