NOSH ChartingSystem

A new open source health charting system for doctors.

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Feature of the day: Patient Portal

NOSH ChartingSystem features a Patient Portal, as a standard feature.  Essentially, the patient has access to the NOSH ChartingSystem but has significantly different permissions and a different dashboard than other types of users.  So what type of features does the Patient Portal offer for patients?

First, patients have electronic access to their medical records.  This includes test results, encounters and other pertinent documents.

Second, there is intra-office messaging and direct messaging to the medical provider that is secure and HIPAA compliant.

Third, there is an online scheduling system that is nearly identical to the provider schedule.  The only difference is that other patient appointments are blocked out and there are no patient identifiers (obviously for HIPAA compliance).  NOSH ChartingSystem also has, built-in, the ability to remind patients via e-mail or SMS (text messaging) about their upcoming appointment 48 hours prior.

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NOSH ChartingSystem now available for Ubuntu 12.10 Quantal Quetzal

NOSH ChartingSystem v1.0 is now available for download from the Launchpad PPA if you are using Ubuntu 12.10 Quantal Quetzal, which was recently released.   There are no new features or bug fixes on this particular release, it is essentially the same release as before but just on a new platform, for those of you who have already upgraded to Ubuntu 12.10 in the past few days.

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Updates to the site

There are a few changes to this site, including a new Download menu, some aesthetic changes, and my promotional video on the side panel.

There are a few upcoming features that are underway regarding the NOSH ChartingSystem that I’d like to share with you.

  1. Changes in the HPI (History of Present Illness) and ROS (Review of Systems) tab where there will be future incorporation of a new system-wide templating engine.
  2. User interface improvements where if you click on the grid header (under Documents, for instance), it’ll open and close the grid rather than clicking on the right hand button for more user efficiency.
  3. Some minor code optimizations throughout.

I am considering a Kickstarter project so that I can gather funds to incorporate NOSH ChartingSystem into the SureScripts network for electronic prescribing.  The underlying functional code is nearly developed, but its a “pay to play” situation to actually send information into the network.

Thanks again for visiting this site and your support of the project!

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Commandment #10

Be optimistic about the future, supportive of good work that is being done, passionate in your commitment, but always guided by a fundamental skepticism.

This statement resonates with the spirit that is the NOSH ChartingSystem and the open-source ecosystem as a whole.  This project hopes to have a strong community of users and developers with the common goal of having the most user-friendly and highest quality electronic health record system around the world.  I’m optimistic that the NOSH ChartingSystem will achieve those goals with the hope that these community of NOSH users, in solidarity, can improve the delivery of our health care systems.  I also believe the model of open-source software will be the future, with NOSH ChartingSystem being at the forefront of innovation and an example of how an successful adoption of electronic health records can be for all medical providers, irregardless of their ability to afford a system.  The project is only as good as the community that supports it!

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Commandment #9

Innovation in computer technology is not enough; there must be a commitment to the potentials of radical change in other aspects of healthcare delivery, particularly those having to do with organization and manpower utilization

This is where my statement in my previous post that an EHR implementation is more than just a product.  A truly successful implementation requires taking stock in what your current infrastructure is, know what you want to do to improve it, know what the impact the EHR can do for the practice, and then redesign your infrastructure to meet those needs.   Sometimes, it takes a third party to see where there is the potential to change and to provide the tools and coping strategies to make it work as least traumatic as possible.

And when the practice is ready for change (that’s the commitment part), then this is when NOSH ChartingSystem Consulting can step in. For an hourly fee, I can evaluate existing infrastructure and technology and provide recommendations.  I can help implement these changes as the migration to NOSH ChartingSystem is eminent.  I can help with determining best practices so that you are able to efficiently manage your workflow as you’re using the system.  I designed this EHR so that I can focus on these important aspects to change rather than focusing on how to use the interface.  Most physicians with other EHR products are just barely getting by with that interface step alone!

Open source software gives providers and organizations the power to customize their implementations, because, frankly, everyone is different (and we should all value diversity!).

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Commandments #6, #7, and #8

Thou shall have duplicate hardware systems

This speaks to the importance of a robust backup system.  Although this is outside the scope of what NOSH ChartingSystem can do, the fact that it is installed on a Linux web server that has proven to be rock-solid in reliability and coupled with robust backup scheme (you can backup using remote services such as a cloud server, for instance), you’ll have a professional-class system that is within reach for the solo practitioner in rural America, not just for a hospital with a top research facility.

Thou shall build and implement your system in a joint effort with real users in a real situation with real problems

This is where the power of open source software really lies.  NOSH ChartingSystem is an open source project that is meant to build a community of physician users coupled with software developers whose mission is to create a system that allows physicians to practice medicine again.  The real users are the physicians.  The real situation is providing medical care.  The real problems include how to deliver quality care in the most cost efficient manner possible.  Not cost efficient being cheap care, but cost efficient meaning being effective and meaningful care that prevents skyrocketing medical costs in the future.


Thou shall be concerned with realities of the cost and projected benefit of the computer system

This particular commandment is so important to me as one of the hallmarks of current health IT trends is that the costs of implementing an electronic health record is so astronomically high.  In my view, the cost-to-benefit ratio tilts more towards cost than the actual or even perceived benefits.  A glimpse at physician forums and blogs reveal a large level of dissatisfaction towards existing electronic health record systems…examples of de-implementations and buyers regret are frequently seen.  It should not have to be this way.  Why can’t a physician get the best of both worlds…a friendly user interface, but is affordable to maintain, and their data belongs to them and not locked to another vendor?  I think it can be done.  And it starts with the NOSH ChartingSystem.

Why is NOSH ChartingSystem a low-cost system to maintain?  Here are the reasons:

  • NOSH ChartingSystem is open-source, so there are no licensing fees to use the system.  The code is open to anyone who uses it or wants to modify it.  There are no yearly or monthly fees to use NOSH ChartingSystem.
  • NOSH ChartingSystem is recommended to be installed on other open-source systems, such as Ubuntu Linux.  This reduces costs for the medical provider and their business.  Examples of organizations and businesses that use open-source operating systems: Google, the White House, E-Trade Financial are some that come to mind.  There has been an increasing trend to move away from closed-source systems, like Microsoft, to save costs plus increased reliability, adaptability, and security.
  • For those who choose to implement NOSH ChartingSystem on a HIPAA compliant cloud-server, like Amazon EC2, the time and cost of hardware maintenance goes down as the economies of scale go up with cloud service providers.  This is an attractive option for those who do not want to hire or actively maintain server hardware, especially for large-scale implementations of NOSH ChartingSystem.
  • NOSH ChartingSystem gives you a variety of low-cost options for installation.  It’s free if you want to install it on your own.  You can absolutely do it and I’ve made it fairly easy to one to be able to do so.  However, I’m not going to assume that most physicians or medical offices will know or want to do it all on their own and so the real value for most organizations is successful implementation and transition to NOSH ChartingSystem.  That is the value that is missing since the focus of most other EHRs is the cost of the software itself; successful implementation is not really their goal once they have already received payment for their software.  That is where NOSH ChartingSystem Consulting comes in.  Who else knows more about how NOSH ChartingSystem works than the one who designed it in the first place?  If you are interested in seeing how I can help your practice with the NOSH ChartingSystem, please contact me!