posted by David Uhlman on Thu 2nd Jun 2005 17:41 UTC
IconOpen 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:

  • Scheduling
  • Billing
  • EMR
  • HIPAA Security
  • Accounts Receivable

ClearHealth Day to day operations in a medical clinic have a lot to do with the capabilities of the scheduling package used. ClearHealth was designed for clinics large and small, but has several features applicable to multi-facility organizations. An unlimited number of building, room and/or device combinations are supported so in the general practice case you can schedule providers to see patients as you expect or for a walk-in clinic case and especially the dental clinic case you can schedule patients for a particular room and a provider for that room. Security policies work with multiple practice organizations so you can have a single installation running both your dental and medical facilities while keeping patient data and information separate where appropriate.

The user interface for adding and editing appointments is very well evolved and takes advantage of some of the latest technology available for web based interfaces. Widgets from the Celini Open Source Toolkit make the patient selector an autocomplete box with real time response, no page reload required. This takes advantage of javascript to talk to the server without reloading the page. The underlying technology used is the excellent JPSpan library similar to the AJAX library also in vogue but more object oriented. Simply typing a few letters, a date of birth, record number, or ssn will yield a drop down box you can scroll through with arrow keys or the mouse. As ClearHealth continues to develop these rich UI components will play an increasingly major role in all future versions.

On the schedule display itself vertically colored columns give you an at-a-glance overview of who is in and when. Clicking 2 checkboxes yields an inline dialog that is pre-populated with the time and provider selected. The application will also confirm with a warning double booking or scheduling outside of a providers listed in time. We have had so much positive feedback on the scheduling package here that it is being rolled out as a standalone application called phCalendar.

A medical software suite isn't much here in the US without support for billing. Myself and Fred Trotter (who created the original open source billing solution, FreeB) have worked painstaikingly to overcome the limitations and mistakes made in that first generation effort by creating FreeB version 2.0 which is bundled in with ClearHealth. This is nice for non-US users (everything in ClearHealth supports internationlization using IntSmarty, a spanish translation is coming in June) as it can be easily unbundled, there is a clean API which separates things as FreeB 2.0 is also available standalone.

ClearHealth For those unfamiliar with medical billing, thanks to congress, electronic billing uses the bleeding edge EDI standard known as X12 (circa 1976). In a nutshell this uses the UN numerical encodings for international trade as well as some semi-proprietary medical codings (such as CPT procedure codes from the American Medical Association) in a plaintext file with lot of :'s and ~'s separating the lot. There are also the fun to fill out HCFA and UB92 paper forms which are used a lot more than you would think. ClearHealth currently includes support for the X12 837P format which is used for general professional (not hospital or dental yet) claims, as well as the paper HCFA forms. X12 837I support for institutions and the UB92 paper form are already in the works and will be available later this year.

What would a national electronic standard be without at least one different version per state, if not per paying company. ClearHealth has support for about 10 variations across paper and electronic billing including the most common California and Texas payers. A lesson from FreeB v1 was to make it really easy to make new variations and that has been implemented in FreeB 2.0 using the Smarty template engine. Anyone with basic HTML and medical billing knowledge can adjust a format to make a new varitation and we would love the help, you can contribute them for now through the FreeB 2.0 site at

As far as features go all of the usual billing capabilities are included as well as some nicities. A revision control system was implemented for each claim, you make a change and it saves a revision. As many claims need to be submitted more than once this offers a great way to see what has been going on. Each claim is snapshotted from the main demographics system so if you need to make a specialty edit due to a last name change (such as from a recent marriage) for a single payer you can easily do so without it effecting the patients normal record. Almost all of the obscure sections of electronic billing are supported as well, ambulance claims, 35 specialty dates, referals etc.

Table of contents
  1. "ClearHealth, Page 1/2"
  2. "ClearHealth, Page 2/2"
e p (0)    39 Comment(s)

Technology White Papers

See More