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Open Source Medical Billing Software
tr0tt3r writes "There is a thriving community of people who are devoted to using Free and Open Source Software to run Medical Practices. While there are many projects that are capable of tracking patient data and scheduling functions, there has been no way to run a Doctors office using GPL software because there was no GPL Medical Billing. This is mostly due to the difficulty of handling HCFA 1500 alongside EDI formats like X12.Recently
several different projects have banded together to create FreeB the first GPL medical billing system."
For once, the old "Foxtrot" comic-strip joke is not off-topic.
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I got my start in security doing secure medical databases and so I have been tracking this for quite some time. The real issue is not dealing with the doctors (since they rarely make the descisions) but the head nurse, billing and office managers. Plus most medical billing systems or emr systems are incredibly proprietary. It just isn't worth their time. To get to see the actual descision makers is nigh impossible anyways, unless you are going to pay for an office visit. As for rich doctors, well maybe specialists but paying off student loans and the costs of running a practice tends to eat into the moneies that doctors make for quite a while. In the long run 1500 a year just is not much of a savings in the grand sceme of things for an office. To retrain the employees would easily cost more than this and with the multi year contracts most emr and billing systems have teh window is pretty narrow too. On a 5 year contract they will start pushing for a renewal after only 2-3 years. The only way this can really spread is virally. Get it into the schools ( where the systems are usually donated anyway so not much luck there) or into a doctor's office run by your family ( then you are limited to a single site). Research databases ( what I did for a couple of years) are different in that every system is custom and there open standards are very important so you can retrieve the data forever.
BTW the systems work well together and while freeb needs some polish its well on its way.
Sorry for the rambling post
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No free medicine, no free software.
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The first one is always free.
There is a lot of money in this niche market. Making a GPLd billing package would be the thin edge of the wedge to getting FOSS developers in the door.
FOSS developers don't work for nothing (some do). The ideal model is work for hire improving and releasing GPL'd source code. But yeah somewhere along the way in every FOSS project somebody has to give away the code to get the ball rolling. The code stays free but if an end user wants a custom change, they have to pay. The could pay the company who the bought the proprietary software to change their own system (big $$$'s since they have a monopoly on their own code), or they can go to the original developers of the GPL'd code, or even hire anyone else who is willing to learn the code base.
With FOSS development model it is true that we won't make megabucks off of royalty and license fees. But for the individual developer I think it has been that way for quite a while, anyway.
The ideal model is work for hire improving and releasing GPL'd source code.
Mmm, yeah.
Open source developer: So listen, doc, I will write a J2EE-compatible billing engine and will use Perl regexp instead of that horrible MFC mess you have for sending data to insurance company's WebSphere server. That will be $300.
Doctor: Mmm, what? Get the fuck out of my office. I don't even understand half of the words you are saying. I can hire a secretary for $6/hour to come weekends and do all that for me.
I recieved a quote for a WinOMS CS install in the $18,000 range last January. This was for an office of 5 people. We ended up turning it down and going with their local competitor's $15,000 offer, instead.
--Life may have no meaning, or, even worse, it may have a meaning of which you disapprove.
You do not understand how vertical markets work at all.
A software vendor who designs billing software for doctors, public utilities, car dealership management, etc doesn't give a shit about open source software. The software is generally accounting software that a 2nd year CS student and and accounting major could write and some sort of interface to send data to an EDI system (for billing and receivables) and whatever the accountants want to audit the books.
Plus, 1/2 of the time the "hard part" (ie EDI interface) is just some library licensed from another vendor.
We're not talking about complicated problems here... and collaborating with other developers doesn't add too much value.
The vertical market business model is to lock your customer into your software and violate him with license and support costs. And it works. If a small doctor's office gets 16,000 transactions per year, than an $8,000/yr licence "only" costs $0.50 per transaction.
If you were using open source software, the doctor could go to anybody for support... and the vertical software vendor would go out of business.
Conformity is the jailer of freedom and enemy of growth. -JFK
Just wanted to point out debian-med. A customized debian distribution cenetered around the tasks of a medical practice.
>You do not understand how vertical markets work at all.
Ah, disappointment... I was expecting you to disagree with me factually in some way...
Of course the existing vendors don't care about FOSS (other than to be afraid of it). Why should they? FOSS will disrupt their proprietary business model, as it is currently disrupting all proprietary software business models.
Yeah, FOSS software is how customers will be freed from being violated (to use your term) by license costs, although not support costs. There aren't going to be a bunch of developers giving out free support on IRC for this kind of specialty software. It ain't the fun stuff, that's for sure. As you say it's nothing complicated... that means boring work.
And well, it turns out that it is good for the doctor who can go to anybody for support. But if you've ever done any contracting you would know that once a customer has a vendor they trust who offers them a rate that fits their budget, they tend to stay with that vendor barring some cataclysm or bad service.
Think of it this way... FOSS gives the customer what they want... reasonable prices and no vendor lock-in. And it breaks the market wide open for anyone who wants to enter it since there are no complicated license deals/agreements. It's called "competition" and though the entrenched, established vendors would rather not have any, efforts like this seem to imply it is coming.
You missed the point.
The customers don't give a shit. A smallish medical practice has something like $2 million in "sales" per year. $5-20k is pissing in the ocean.
Doctors want their shit to work so the insurance companies pay for his services. That's it. They do not care about open source and likely prefer to deal with the vendors that they know about.
The other thing is that EDI and other standards that vertical applications must adhere to are not free. The standards and specs are not open and often cost signifigant sums of money.
Conformity is the jailer of freedom and enemy of growth. -JFK
Actually there is all kinds of incentive for doctors to choose an open source medical/billing database.
The number one is cost and ease of integration with other systems. Not all doctors are rich. Some doctors run their own private practices -- and frankly I think we need more of those doctors, and less of the "How many patients can I see in fifteen minutes?" kind.
The cost of running your own private practice is huge, and any way to cut the administrative costs would be a great boon. FreeB would cut the costs in two ways, one because it's free-as-in-beer and two because it's open source and therefore easier to integrate with other systems.
Seriously, I used to date a guy (IANAW) who ran his own private practice. It's great, he gets about a half hour with every patient, he handles all his own emergency calls and he leaves a few timeslots open each day for emergency visits. It's everything you want in your doctor, but he really did bitch about the absurd costs of running Microsoft everything, as well as the absurd costs of the medical database he had to run on top of it.
An Active Directory server plus a SQL Server plus Office plus two desktops, that's a ton of bullshit for a sole proprietor to be paying for. There wasn't an open source alternative for me to recommend at the time, but I'm glad there is now, it might encourage more like him to go solo.
This project can really fill a need for low-cost, small medical practices.
Wow, a lucrative publishing contract! I don't have to be evil anymore. --Meteor
> You missed the point. :-)
Well, this time you made some
>The customers don't give a shit. A smallish medical practice has something like $2 million in "sales" per year. $5-20k is pissing in the ocean.
Customers don't care about saving 20K in licensing fees? With each upgrade? I'll bet plenty of small practices do. Anyway, money is money.
>Doctors want their shit to work so the insurance companies pay for his services. That's it. They do not care about open source and likely prefer to deal with the vendors that they know about.
That's a good point: Doctors don't care about FOSS. What they do care about is getting a good product at a reasonable price, just like any business does. But I don't think FOSS implies crap. In fact, once it is stable the quality is typically high. I'm not buying the implied argument here that FOSS doesn't work.
>The other thing is that EDI and other standards that vertical applications must adhere to are not free. The standards and specs are not open and often cost signifigant sums of money.
Standards are not patents. You only have to pay once to get the standard, so buying all the standards necessary for a FOSS is possible. They could also be donated by third parties. Also there are typically publicly available drafts of standards leading up to the final standard which are public. These are normally sufficient for getting development 90% of the way along.
Keep in mind that $20K a year can be CHEAP for a medical billing system. And while most docs are likely to be gunshy about using FOSS before it's proven, they most certainly DO care about $20K -- let alone the $150K that some of the larger practices are shelling out. Some very good tech people are beginning to recomment FOSS wherever possible, and some of them will have earned the doctors trusts. We'll see some rollouts, and it'll be interesting to see how that affects the industry as a whole. Keep in mind that while it hasn't happened yet, some of the high dollar charges are going to go away, insurance companies are looking more and more closely at medical bills. It's an important step -- and it's a da*n good thing!
There are many non-profit clinincs that operate on shoe-string budgets with donated equipment and doctor time. I think many of these might be interested in a package like this.
Not all doctors make six figures and most doctors donate some time to work on indigint patients.
Cheap storage VM.
We are designing OpenEMR to be a replacement for applications such as Health Pro, Medical Manager and MegaWest. OpenEMR's practice management features include extensive patient demographics, ability to find the first available appointment for a provider, manage provider's by patient and multiple payers. For reporting we use phpMyAdmin, and clinics can create their own reports, or we can assist them with creating reports.
OpenEMR's electronic medical record features include creating encounters using on-line forms, prescribe drugs and save the drugs in the patients' history, and billing with ICD and CPT codes at the end of an encounter.
We have successfully submitted test data to Medi-Cal, and Medi-Cal has accepted that data as properly formatted. We have tied all of OpenEMR's fields to FreeB, and are now finalizing and testing OpenEMR for billing, and anticipate finishing these features in April 2004.
At OpenEMR.net we have videos showing OpenEMR's practice management and electronic medical record features.
Let's look at it from the perspective of the company providing the support. Earlier in this thread it was established that writing the actual software involved is a very easy task. You have two business options here:
1) Write the software yourself, with vendor lock-in schemes included, and generate revenue off both support and upgrades. As your software is proprietary, once a customer starts using it, there aren't really any other options for support.
2) Provide support for an open source product. The fact that it is open source means that your customer can go to anyone else for support whenever they feel like it. That makes open source both a strength and a weakness to your company.
If you were an investor, which most likely means you really don't care if software is open source or not, which would you choose? I know I'd consider the first option to be a more lucrative business plan. If we were talking about software that takes a huge investment to create (say, a web browser), I'd be much more likely to go with the second choice.
And one thing I can relay is, doctors are by and large, very, very cheap in the IT area and resistant to change and if what they have works, its fine, because any change potentially could screw up their currently working cash flow from insurance companies. Also this is usually due to the huge licensing fees they are charged to get their PMS software in the first place and the support package that goes with it. Maybe this is just in the NY/NJ/PA/MD area, but I've seen DOS machines on IPX BNC networks in beautiful modern offices, or crusty old SCO *gasp* or AIX boxes, while more relaible, the staff hates using the software on them. And usually the version of their billing software was at least 5-6 years and a good many versions old. If it works, fine, right?
Well these software frankensteins are basically all patchwork to conform to the latest changes in HIPAA and EDI and just bugs in general. And as long as the doctors money still comes in, they don't care, the billing staff may have to jump thru 80 hoops every month and run odd command line batch files and scripts and patches to the patches to make sure their money comes in, but if the money is there, the doc don't care.
Now, start having the cash come in slow or late and suddenly the sky is the limit for an overhaul. Or the PMS vendor basically plays hard-ball and tells them outright "your shit is 3 versions and 5 years old, we're not supporting it anymore"
Free open source seems a shoe-in but one thing that they don't mind paying for and feel is more important than the fact they are running old,old technology is the support, cause when something is on the fritz they need someones ass to ream and have fix it. So straight open source is nice because you forgo the software licensing, but without a vendor to provide them support, they'd never go for it.
Sounds like a classic:
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