[Gnumed-devel] Option to make Open-source EMRs billing-independent

[James Busser]

For comment, a possible strategy for billing support. I have already 
witnessed  hurdles, but if people think that the following or a 
revision is clearly the way to go, overcoming the hurdles will be a 
useful pursuit.

Phase I (i.e. until a serves-all billing solution is feasible):

- Users use their existing billing program & add an EMR (OSCAR, GnuMed etc)
- ONE serves as the "entry and update portal" for demog and billing data
- WHICH? - could be EITHER, could vary with the installation
- HOW?
- - - where feasible, the program that wants the data calls to the other
- - - otherwise, scripts are created to support export/import

Phase 2

- attract / enlist convergence among Open EMR project developers
- a common approach encompassing billing white paper (at wiki) plus 
good ideas not yet known to GnuMed but perhaps already factored into 
other Open EMRs
- target FreeB for "process", SQL Ledger for data warehousing & admin?


Below, for interest, I appended an exchange with another local 
physician which partly motivated the above posting. He, like me, is 
looking at using OSCAR at least for now, while trying to be smart 
about the big picture. I have anonymized  it to some degree as the 
specifics are less important.

> From: James Busser <address@hidden>
> To: <>
> Subject: RE:  billing
> Date: Tue, 11 May 2004 00:17:25 -0700
>
> > I have now successfully connected MyBillingProgram to OSCAR...
>
> Hello, I am interested in how you achieved the above. Do you use 
> OSCAR as the point of entry for new data, and have you arranged for 
> it to output data on either a scheduled or triggered basis, into a 
> data interchange format that Phoenix can read (perhaps the MSVA 
> format)  Or have you altered or added onto Phoenix, to be able to 
> directly query OSCAR for the data that you want / need for billing? 
> (I have not copied the oscar-bc list, believing most view OSCAR as a 
> one-stop shop, but if you think they too would be interested, feel 
> free to cross-post back to the list or to a developer list if you 
> are on one.)

At 6:38 AM +0000 2004.05.12, <> wrote:

Very simply, I register a patient in MyBillingProgram via swipe or 
data entry. Then when i need the data in Oscar, I just issue a sql 
call that puts the patient data via the ODBC driver into the 
demographic table. If I update the info in MyBillingProgram, then the 
record is found in OSCAR and the info is merely updated. I believe 
that providing billing in OSCAR is a needless waste of resources that 
could be better used to improve or extend OSCAR provincially or 
nationally. As a program that would be billing agnostic, it would be 
an attractive approach to other billing systems that do not have an 
EMR. There is no need for billing systems to be open sourced. Indeed 
where support is always urgent, you could argue that for urgent 
support it does not matter how slice it, you need to pay for support. 
As you do for OSCAR. Do you really as a user want an open source 
program which you could manipulate, break and then not get paid 
because the data getting to Medical Services Plan is screwed up? But 
it's not a popular view.

Additionally, most people are viscerally opposed to changing billing 
systems so staying with your billing system and extending it via this 
approach makes sense to me. Although this is not a sales pitch it may 
nonetheless may touch a raw nerve thus I kept it off the discussion 
group, but if you think it is worth discussing, I will leave it up to 
you as a disinterested party to bring up.

As an addendum, I then bill in MyBillingProgram. but if you were 
using OSCAR it would be a relatively trivial task to add a billing 
day sheet report that would simply report the chart number, patient 
name for verification, billing code and ICD9 ( plus referral etc ) 
then you could just bill in whatever program you wanted.