Lubbock Children's Health ClinicCustomer Case Study

RESOLUTION SYSTEMS SOFTWARE

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Lubbock Children's Health ClinicCustomer Case Study

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PriceLowest Initially.

Medium Long term.Proposal One (Medisoft / SOAPWare)

All Had Similar Features. Three Support Vendors.

Highest Initially.Highest Long term.

Proposal Two (DoctorsPartners)

All Had Similar Features. Two Support Vendors.

Medium Initially.Lowest Long term.

Proposal Three (Open Source)

All Had Similar Features. One Support Vendor.

Features Support

Overview

Proposal Phase

UTILIZING OPEN SOURCE IN A MEDICAL CLINICAnthony PresleyLubbock Children's Health Clinic, a non-pro�t organization with a history dating to the Great Depression, provides immunizations, compre-hensive acute and preventive health care to children in two medically underserved areas of Lubbock regardless of a family's ability to pay. �ey are a United Way agency and over the years have treated more than 6,500 children a year in the Lubbock area. Like most non-pro�ts, every penny counts for the Lubbock Children's Health Clinic. Resolution So�ware delivered a highly customized solution which provided superior services to the clinic.

Lubbock Children's Health Clinic (LCHC) is a recognized area leader in children's health care and one of Lubbock's oldest non-pro�t organiza-tions. �ey are a United Way partner and treat more than 6,500 children every year at their two locations in the Lubbock area. LCHC's Technology Steering Committee �rst approached Resolution So�ware (Resolution) to procure, con�gure, and support Mediso�, a commercial Physician Management so�ware product, at both of their Lubbock locations. LCHC was also interested in building a computer network at each location, complete with printing and �le sharing services, email, and remote access. LCHC had already approached two other vendors to provide a similar setup, one vendor for the so�ware and another vendor for the hardware. However, the committee was concerned with the potential costs and the complexity of dealing with multiple vendors. �e Steering Committee requested that Resolution present alternative options.

Like many business IT decisions, LCHC's decision was dependent on three key factors: price, features, and support.

A�er examining LCHC's business and growth plans, Resolution prepared three di�erent proposals for LCHC's Technology Steering Committee:

1) �e �rst proposal selected a suitable commercial Physician Management (PM) and Electronic Medical Record (EMR) to meet the clinic's requirements. �e proposal included PM so�ware, Mediso�, from Per Se (now McKesson) and EMR so�ware, SOAPWare, from yet another vendor. Since most of the commercial o�erings are Windows-based, Resolution would setup a network consisting of primary and secondary Microso� Windows servers, remote access, and Microso� Windows desktops. However, LCHC would require support from all three vendors. Additionally, other PM and EMR products were considered, including eMDs, NextGen, and MedStar.

2) �e second proposal was an Application Service Provider (ASP) solution from DoctorsPartners to provide a combined Physician Management and Electronic Medical Record product. DoctorsPartners would handle all backup and server management for the PM and EMR so�ware. �is proposal included two networks using Microso� Windows technology installed by Resolution, but also utilized the so�ware and support from DoctorsPartners. Uni�ed Medical Informatics was among the other ASP-style solutions considered.

3) �e third proposal was a customized Open Source option with a mix of Open Source medical so�ware and custom so�ware written speci�cally for LCHC's business practices. Several Open Source medical projects were considered, including ClearHealth, OpenEMR, and FreeMED. Two networks would be installed, using Microso� Windows on all desktop computers, but all of the servers on the network would be Linux based.

“...the committe was concerned with the potential costs and the complexity of dealing with multiple vendors.”

Lubbock Children's Health ClinicCustomer Case Study

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LCHC's Steering Committee quickly gravitated toward Proposal �ree. Although cost was a deciding factor, LCHC felt that a single support vendor was an equally important consideration. �e Steering Committee additionally requested that Resolution host their server o�-site (similar to Proposal Two). �is would allow LCHC to focus on their business rather than be distracted with support, upgrades, hardware failures, and backups.

Setup of the network included three locations: LCHC's two locations and Resolution's off-site location. The three locations are connected securely with VPN (Virtual Private Network) hardware devices, using a combination of DSL, Cable Modem, and T1 data lines. Like most of the clinic's hardware, the VPN devices were refurbished, providing a significant discount to the clinic. Refurbished Dell desktops were installed at both locations and each location utilizes a secure wireless and wired network. Networked laser and ink jet printers are on-site at each clinic location.

Fax servers connect directly to the fax lines and are able to send and receive faxes without any paper. Received faxes are converted into Adobe PDF's and emailed to LCHC employees, where they can be retrieved from anywhere, world-wide. Files are shared across both LCHC locations using file sharing software. Staff communicates across locations with instant messaging software, which frees the phone lines from intra-office usage.

All of the servers are located at Resolution's off-site facility. These servers (a primary and a secondary) are running a popular Linux distribu-tion, and are configured with nightly backups and redundant hardware. As a third level of redundancy, the installations are backed up to tape.

Resolution reviewed many Open Source projects, including ClearHealth, FreeMED, and OpenEMR. While all projects have live installations and boast thousands of downloads, Resolution encountered some serious problems installing and configuring some of the projects. FreeMED has the most polished interface of the software projects, but multiple attempts to contact the FreeMED foundation and Unified Medical Informatics (one of their support companies) failed. Furthermore, FreeMED's online forums are sparsely populated and weeks can pass between posts (implying a relatively small user base). The OpenEMR product is supported by the most helpful community of the three, with affordable support options from multiple companies. Unfortunately, OpenEMR is extremely complex to setup, and the interface is almost impossible to use.

After several weeks of evaluation, Resolution chose ClearHealth – the interface was usable without significant training issues, and members of the support forums are usually responsive. LCHC manages their practice with a customized version of ClearHealth, called ResolutionEMR. ClearHealth is an Open Source software project developed primarily by Uversa, Inc. ClearHealth includes an integrated billing solution, FreeB, which is another Open Source solution. The ClearHealth software also includes a custom reporting engine and form templating capabilities.

Uversa's ClearHealth solution does not allow other vendors to customize the software and still refer to it in sales literature using the trade-marked ClearHealth name. As such, Resolution's customized version of ClearHealth was renamed to ResolutionEMR.

ResolutionEMR required significant setup before it was usable by the LCHC staff. ResolutionEMR is based off of ClearHealth RC3, which has not yet been officially released. The initial setup took about four weeks and included the setup of all users, facilities, providers, fee schedules, and codes, the creation of nearly twenty new EMR forms, and the testing of automated backup procedures.

Additionally, data normalization and several bug fixes were completed to ensure that the code functioned properly. For instance, although users could add payers and insurance companies to the system, they could not ever be removed without manually modifying the database. We added several customizations to ensure that the software was more user-friendly.

Network Setup

Software

LCHC required some customization of the software to meet their requirements. This included:1. Customized “Super Bill” functionality, capable of doing more than the software's native capabilities.2. Setup of viewable forms within the saved EMR data.3. Addition of new Federal Poverty Levels to ensure record keeping for grants.4. Customized reporting, requiring an Extract, Translate, and Load from native data formats.5. Extension of some fields within the program, including “Race” and other fields.6. New billing CMS-1500 / HCFA-1500 forms for Texas Medicaid, FirstCare, and Blue Cross Blue Shield.7. Update of the code base to allow editing of payment dates and miscellaneous payments.8. Integration with THIN EDI (a national clearing house).9. New charting capabilities, including pediatric growth charts.

Software Changes

After several weeks of evaluation, Resolution chose ClearHealth...Resolution's customized version of ClearHealth was renamed to ResolutionEMR.

Lubbock Children's Health ClinicCustomer Case Study

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Up Front Costs Annual Support Costs 5-Year TCO

58% More Expensive(Medisoft / SOAPWare) 23% More Expensive

206% More ExpensivePowerMed 44% More Expensive

391% More ExpensiveMedStar 100% More Expensive

29% Less ExpensiveDoctorsPartners 23% More Expensive

424% More ExpensiveNextGen

8% More Expensive

23% Less Expensive

20% Less Expensive

44% More Expensive

0% Same Expense 124% More Expensive

“...with the use of refurbished hardware and customized software, the overall price of the entire setup, networking, equipment, and software customization was around $1,500 per desktop.”

LCHC was able to realize significant cost savings with the utilization of a customized EMR and PM solution. LCHC's costs include an up-front installation and configuration cost, as well as a monthly hosting fee for the software. All other solutions were significantly more costly. Relative to the ResolutionEMR solution, other competitors had the following pricing metrics:

Looking at a 5-year implementation, all of the competitive choices were at least 20% more expensive (MediSoft / SOAPWare, DoctorsPartners, and PowerMed), and some were more than double the cost (MedStar and NextGen).

In fact, with the use of refurbished hardware and customized software, the overall price of the entire setup, networking, equipment, and software customization was around $1,500 per desktop.

Although the system has only been in place for a few weeks, LCHC is already starting to see the advantages of a custom solution over a commercial out-of-the-box software package. All aspects of their network are serviceable by employees of Resolution, so there is no finger pointing between various vendors and problems are resolved in a timely manner. The EMR and PM software has been customized to work around their specific circumstances, not vice-versa. Costs were controlled, and the system was delivered within budget with significant cost savings to the clinic over comparable products. Although training was necessary, the familiar web interface enabled LCHC's staff to be proficient with the software very quickly; formal training took less than one day.

Cost Benefits

Sucessful Implementation, And Room To Grow

Lubbock Children's Health ClinicCustomer Case Study

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LCHC uses different software packages to perform their business activities, including Microsoft Windows and RedHat Fedora Core 5 Operat-ing Systems.

Each of the workstations is a refurbished Dell Optiplex GX240 or GX260, with 15-inch and 17-inch LCD screens. These machines, to speed user training, are all running Windows XP or Windows 2000. For increased functionality, additional software was installed on the computers, such as:

TrendMicro's Internet Security, which keeps viruses and spyware off of the networks OpenOffice, an Open Source office suite which is similar in functionality to Microsoft Office GAIM, another Open Source product which allows employees to communicate via a Jabber server

Firefox, an Open Source web browser to access ResolutionEMR 7-Zip, an Open Source compression software package

TDHConnect, a tool from the State of Texas to process Medicaid eligibility and electronic claims

All of the products work together to provide a coherent, low-cost package for the clinic's two locations. Commercial products (such as Trend-Micro and TDHConnect) are used where appropriate for the clinic. However, after several weeks of usage, most of the employees appear to prefer Internet Explorer for daily usage. This choice is mostly due to the State of Texas requiring Internet Explorer to access the eligibility portion of the TMHP website, to ensure that a patient is eligible for the service.

Linux-based fax servers running HylaFax (an Open Source fax software package) connect directly to the fax lines, and are able to send and receive faxes without using any paper. Documents are faxed by “printing” to the fax server. Received faxes are converted into PDF's and emailed to LCHC employees, where they can be retrieved from anywhere, world-wide. This distribution method for faxes ensures that the fax servers can easily be replaced if a failure occurs. The fax servers are each running Fedora Core 5.

The clinic's servers are virtualized Fedora Core 5 systems running on redundant hardware. The core of the system is two white-box servers (one primary and one secondary), which both run VMWare's free VMWare Server product, using Fedora Core 5. Each of the virtualized Fedora Core 5 servers run LAMPP. LAMPP is a single distribution of MySQL, PHP, and the Apache Web Server packaged with an easily installed package. To ensure compatibility with ResolutionEMR, the server uses MySQL version 5, and PHP version 4. For Jabber connectiv-ity, Resolution installed Jabber server, version 2, using PostgreSQL as a storage medium. Windows file sharing is accomplished with Samba, the premier Open Source file sharing software.

Many of Resolution's hosted clients enjoy the advantages of virtualized server infrastructure. Multiple clients can share a single physical server, which reduces the hosting costs. Backups can be made in under 7 minutes, including the compression and transfer of the data to our backup (secondary) server, and restoring a server from a backup can occur in under 10 minutes. Upgrades to the underlying system never affect the actual production software packages.

All three locations are connected via hardware VPN's, manufactured by NetGear. These devices are simple to configure, provide industry-strength security, and can easily be replaced if one fails.

Technical Specifications

Workstations

Fax Servers

Servers

VPN Connectivity