CCHIT Organizational Teleconference
Date: 7-10-2009 10:00 EDT
The following persons announced their presence on the telephone call:
Sena Palanasami - Visolve
Karthik - Visolve
Selvie - Visolve
plus 3 development team members - Visolve
“Adi” Rampal – MMF Systems
Mehendra – MMF Systems
Jude Pierre - Phyaura
Chris Lucena – EHRLive
There were numerous others who listened in the call but did not announce their names as they listened in.
1) Welcome and opening remarks - Dr. Bowen. Introduced Dr. Michael Brody.
Dr. Brody is a physician, HIPAA consultant, PHP developer and an OpenEMR user. He is a strong proponent of open source software and tools. He is a member of the Healthcare Information Technology Standards Panel (HITSP). The HITSP is largely responsible for the development of the meaningful use criteria that is currently being adopted by Health and Human Services (HHS) and will likely be adopted by CCHIT. Dr. Brody was recently named a physician member of CCHIT and he will be meeting in Chicago next week with the CCHIT where "Meaningful Use" will be a hot topic.
2. Michael Brody – Dr. Brody initially discussed the “meaningful use” document published by HHS. This document is at:
The “Meanigful Use Matrix:”
The “Meaningful Use Preamble:
Currently CCHIT is the only group authorized by HHS to certify health information products. At this time there will be three levels of certification:
“Comprehensive” which is the same as what is currnelty by CCHIT certified.
“Modular” - some of the modules meets CCHIT requirements but the software depends on outside vendors to provide all the requirements for meaningful use.
“Site certified;” The local clinic has a vraiety of software programs that are used to satisfy the meaningful use criteria. The medical group or doctor asks for certificatioon. They must still meet the “Meaningful use” criteria the. The practice will pay a fee of $200 per provider. This will allow the site to apply ARRA benefits.
I would recommends “S” first. This will be easier to meet the requirements but still allow the addition of modules that will eventually lead to “M” and eventually “C” or comprehensive certification.
Sena Palanasami: Has “C” certification been finalized since the first draft on June 1st, 2009?
Dr. Brody: The “Meaningful Use Matrix” is what will be defining this. There differrent levels that become effective in different years “2011”, “2013” and “2015”. This spelled out in the “Meaningful Use Matrix”
Dr. Jude Pierre: It is my understanding that CCHIT is not in agreement with HHS about the time frame?
Dr. Brody: It is HITSP that makes recommendations to HHS. HHS developed the “Meaningful Use Definition”. It is the job of CCHIT to do what HHS dictates. Ultimately, this disagreement cause the definition to be watered down. One thing causing some of this is the number of lab orders that need to encoded properly.
Sena Palanisami: Should we have a fall back plan?
Dr. Brody: There are modules that will definitely be required. I would recommend doing these modules first. Questionable modules can be done later. You have to remember that after you apply for certification ther is usually a 3 month delay period.
What difference is there between “c” and “s”.
Dr. Sam Bowen: Do you know what modules are part of “C” but not “S”?
Dr. Brody: I'm working on that. I am working on a spreadsheet on which modules are “meaningful use”. I am hoping to get this finished with in 1-2 weeks.
Sena Palanisami: I would like the URL if you could supply me with one.
3) Needs analysis – Dr. Bowen: This analysis has been performed by Sena Palanisami, Selvi Palanasamy and the Visolve OpenEMR CCHIT certificaiton team in Coimbatore, Tamil Nadu province, India. Visolve has applied all 400 CCHIT criteria against the existing OpenEMR code base. This was summarized and forwarded to the group earlier as the OpenEMR-CCHIT Report. Selvi has also been working on an estimation of the time involved in completing the project to meet these 400 criteria. Sena and Visolve.com have been doing this at my request. While these estimates may be rough, I hope to use this information to break up this large body of work into smaller more manageable chunks. I am hoping to use the time estimates to try to distribute the work load among the different developers. As we all know this type of estimation is difficult and widely variable depending on the skill, individual speed of the developers and frequently due to unforeseen difficulties with the software itself.
Sena Palanisami: I graduated in Computer science from the University of Minnesota 35 years ago. I worked with Hewlett-Packard doing security and working with open source tools since that time. About ten years ago I started Visolve to use those open source tools. Our main business has been helping school systems with their internet systems and web pages. We have had a lot of experience in open source development and have been the main developers behind the open source Squid web accelerator. We believe that these open source tools can be very powerful in the health care environment.
My team started studing the open source health care arena and felt that OpenEMR had the most functionality and that we could make a meaningful contribution. As part this we have examined all of the CCHIT criteria and run all of the 400 scripts against OpenEMR.
Selvi: The CCHIT ambulatory certification has 400 criteria. 312 failed. When broken up into the main areas: Functionality has 250 criteris and 188 fail. Interoperability has 58 criteria and 54 fail. In Security there are 52 and 44 fail. Privacy 22 criteria and 21 fail.
4) MMF commitment
Sam Bowen: MMF.com has a lot of resources including 6 developers that they can commit to the project. They are eager to get started.
Dr. Nathan Capoor was not present due to a family emergency.
5) Project design - Rod Roark
Dr. Sam Bowen:Rod Roark has been a software developer since 1985 and actively developing with the OpejnEMR project since 2004. He has been the lead developer on the OpenEMR project since March 15, 2005. He has extensive knowledge of the existing code, its strengths and weaknesses. He has raised the issue of the need to design the broad "high level" descriptions of what is meant by "Meaningful Use" that we must turn into working code. I am hoping he will also comment on coding standardization and how communicate changes that your teams would like to make.
Rod Roark: I don't believe this is the venue to get into the detailed work of the design of this project but would like to getting the new developers involved.
Code is almost exclusively in PHP. We getting away from complexity, such Smarty Templates. We don'y want to add unecessarily complex code and trying to keep the code easy to read. I recommend staying away from intimidating features.
It is very important for developers to use the Developers Forum at SourceForge. We use this as our main coimmunication tool on what modules we are planning and to coordinate changes with the other developers.
The process for new developers is to submit code to one of the developers who have been in the project for a while. This is form of mentoring for the help the new developers to learn our recommended coding style and a period for the new developer to get used to our working methods.
Selvi: Do we have to get approval to develop different modules?
Rod: No. Most developers just pick a section of the code that they are interested in and start with their development there. It is important to annouce what you are planning to do on the SourceForge forum and what areas of code that you expect to be making changes to. This will allow the other developers who might possibly be making code changes on the same areas to coordinate with what you are doing.
Sena: make sure that we have the most current version
Rod: Try to make small pieces and frequent updates. This way if there are conflicts, they will be easier to work out.
(Unknown speaker): We ought to make a nightly build to check for broken code.
Rod: There is a automatic nightly build to check for broken code. This is operated by Brady Miller using his VMware Developers Server.
Dr. Jude Pierre: There has been a problem with OpenEMR not being very well tested prior to relase. We need much more aggressive testing.
Sena: “very good point”. There should be a development release and stable release.
Dr. Jude Pierre: Doctors don't like to do this.
Rod: I agree with this.
Tony McCormick: It is not that hard to create duplicate installations with mutli-instance servers environment. One can be used for live data aand the other for testing of the development branch.
6) Interoperability and Mirth - Dr. Jude Pierre
Dr. Sam Bowen: Jude Pierre and Bill Himmelstoss have been busy working with the OpenEMR code and have been running a busy muti-clinic practice in he Tampa Bay, Florida area. The main area of their work has been in interoperability and multi-facility use.
Dr. Jude Pierre: Phyaura is a physician support company partnered. We partnered with RelayHealth to do e-prescribing. We have been working with MIRTH is a GPL licensed open source software used to make HL-7 connections. We have been using the MIRTH HL-7 engineers to make connections to laboratory compaines.
E-Prescribing is necessary for the meaningful use criteria. We have a laboratory connection in alpha-testing with Axiom laboratories here in Florida. We hope to release this in the next 4 weeks. MIRTH corporation is also configuring connections to hospitals in our area. This happens to be the HCA hospital system. In terms of the laboratory modules first there will be Axiom followed by Quest Diagnostics, and then LabCorp.
Rod Roark: Are there any problems with non-disclosure agreements or restrictions from the lab company?
Jude Pierre: Connections must be certifiable. The standard is HL-7 but unfortunately institution has its own local flavor and each interface must be built separately.
7. Modules and committing code - Tony McCormick
Dr. Sam Bowen: Tony McCormick has been running the bug tracker and has some great ideas on increasing the efficiency of committing code to the main project.
Tony McCormick: I have been involved in medical practice management & EMRs since late 80s. Build and release of code base. Clients were reticent to upgrade in fear of a hiccup. The code has to be testable, and serviceable. We need to lay out source code to allow overlay modular development. This is very doable. I did this with much larger products involving several million lines of codes and several hundred developers.
We need to be very careful in the modular design. The end users will be able to install the base code and then add in modules as needed. This also allows for rollback in case that particular module does not work out. It will be necessary to add a section for patches that can be used this way. Brady Miller's virtual machine is very usaeful for this.
Rod Roark: I have a few clients who have been very willing to be testers for the new sections of code.
Sena:We could really use a Requirement Document and a Testing Document. In particular we need the workflow.
Tony: That is the “Holy Grail”. We have documentation available but is is a beginner's guide.
Rod: We need to develop a narrative of what needs to be done for “Site certificaiton” and “Meaningful Use.” Initially we need a high level of description of what is missing and then how this will done.
We discussed briefly when to scheduladule a follow up meeting. The general consensus was two weeks from today/
Dr. Bowen then adjourned the meeting at 11:05 AM EDT.
The CCHIT general areas:
Organizing patient data
Receiving and displaying information
Administrative and billing support
Maintaining documents and guidelines
Disease and drug management
Electronic medication prescribing
Exchange summary of documents
Encryption (while data transmission)
Project Developer Directory:
- Rod Roark rod at sunsetsystems.com
- James Perry, Jr. tekknogenius at gmail.com
- Brady Miller brady at sparmy.com
- Mark Leeds drleeds at gmail.com
- Jason Morrill morrillj at cfapress.org
- Jude Pierre japierre at phyaura.com
- Bill Himmelstoss whimmelstoss at phyaura.com
- Tom Weber
- Sena Palanisami sena.visolve at gmail.com
- Selvi Palanisamy selvi at visolve.com
- vicare_support at visolve.com
- vicare_engg at visolve.com
- Partial list available at this time.
- Nathan Capoor mnc at mmf.com
- Adi Rampal aditya.rampal at mmf.com
- Daniel Nelkenbaum daniel.nelkenbaum at mmf.com
- John Baird john.baird at mmf.com
- Jose Barranco jose.barranco at mmf.com
- Tony McCormick tony at mi-squared.com
- Aron Racho aron at mi-squared.com
- Sara McCormick sara at mi-squared.com
- Michael Chung mike at mrsb-ltd.com
- Chris Lucena chris at ehrlive.com
- Joseff Betancourt
Indiviual OpenEMR Developers:
- Justin Doiel jdoiel at youthbridge.com
- Alfonso Perez aperez at netmedicpr.com
Project Admin (inactive):
- Andres Paglayan andres at paglayan.com