Open Source has a wealth of offerings across many different arenas of software, to date a great deal of the offerings out there are development tools, general purpose applications, and first generation vertical applications. In the medical market there has been a long history of development on first generation software such as OpenEMR, FreeMed, FreeB and others. For some users these applications have offered a productive and capable platform on which to run their practice, but it is apparent to most the first time they go to use them that there is not the level of richness and depth found in proprietary alternatives like WebMD’s Intergy, NextGen, or The Medical Manager. With the the release of ClearHealth 1.0 RC1 there is now a credible and full featured Open Source (under the GPL) offering that competes point for point in the big five areas of medical software:
- Scheduling
- Billing
- EMR
- HIPAA Security
- Accounts Receivable
Scheduling
Day to day operations in a medical clinic have a lot to do with the capabilities of the scheduling package used. ClearHealth was designed for clinics large and small, but has several features applicable to multi-facility organizations. An unlimited number of building, room and/or device combinations are supported so in the general practice case you can schedule providers to see patients as you expect or for a walk-in clinic case and especially the dental clinic case you can schedule patients for a particular room and a provider for that room. Security policies work with multiple practice organizations so you can have a single installation running both your dental and medical facilities while keeping patient data and information separate where appropriate.
The user interface for adding and editing appointments is very well evolved and takes advantage of some of the latest technology available for web based interfaces. Widgets from the Celini Open Source Toolkit make the patient selector an autocomplete box with real time response, no page reload required. This takes advantage of javascript to talk to the server without reloading the page. The underlying technology used is the excellent JPSpan library similar to the AJAX library also in vogue but more object oriented. Simply typing a few letters, a date of birth, record number, or ssn will yield a drop down box you can scroll through with arrow keys or the mouse. As ClearHealth continues to develop these rich UI components will play an increasingly major role in all future versions.
On the schedule display itself vertically colored columns give you an at-a-glance overview of who is in and when. Clicking 2 checkboxes yields an inline dialog that is pre-populated with the time and provider selected. The application will also confirm with a warning double booking or scheduling outside of a providers listed in time. We have had so much positive feedback on the scheduling package here that it is being rolled out as a standalone application called phCalendar.
Billing
A medical software suite isn’t much here in the US without support for billing. Myself and Fred Trotter (who created the original open source billing solution, FreeB) have worked painstaikingly to overcome the limitations and mistakes made in that first generation effort by creating FreeB version 2.0 which is bundled in with ClearHealth. This is nice for non-US users (everything in ClearHealth supports internationlization using IntSmarty, a spanish translation is coming in June) as it can be easily unbundled, there is a clean API which separates things as FreeB 2.0 is also available standalone.
For those unfamiliar with medical billing, thanks to congress, electronic billing uses the bleeding edge EDI standard known as X12 (circa 1976). In a nutshell this uses the UN numerical encodings for international trade as well as some semi-proprietary medical codings (such as CPT procedure codes from the American Medical Association) in a plaintext file with lot of :’s and ~’s separating the lot. There are also the fun to fill out HCFA and UB92 paper forms which are used a lot more than you would think. ClearHealth currently includes support for the X12 837P format which is used for general professional (not hospital or dental yet) claims, as well as the paper HCFA forms. X12 837I support for institutions and the UB92 paper form are already in the works and will be available later this year.
What would a national electronic standard be without at least one different version per state, if not per paying company. ClearHealth has support for about 10 variations across paper and electronic billing including the most common California and Texas payers. A lesson from FreeB v1 was to make it really easy to make new variations and that has been implemented in FreeB 2.0 using the Smarty template engine. Anyone with basic HTML and medical billing knowledge can adjust a format to make a new varitation and we would love the help, you can contribute them for now through the FreeB 2.0 site at http://www.freeb.org.
As far as features go all of the usual billing capabilities are included as well as some nicities. A revision control system was implemented for each claim, you make a change and it saves a revision. As many claims need to be submitted more than once this offers a great way to see what has been going on. Each claim is snapshotted from the main demographics system so if you need to make a specialty edit due to a last name change (such as from a recent marriage) for a single payer you can easily do so without it effecting the patients normal record. Almost all of the obscure sections of electronic billing are supported as well, ambulance claims, 35 specialty dates, referals etc.
EMR
Electronic Medical Records have been a hot-topic in the medical community since the dawn of the computer age, in reality not too many practices are willing to do away with the good old paper chart. ClearHealth offers a lot of options from simply improving your paper chart process by printing on-demand populated forms or going all the way with a 100% electronic worlflow. The EMR really consists of 3 components, these are stored documents, EMR Extensions, and per visit reports. There is a complete document storage system bundled in with support for file uploads (through the browser or via filesystem batch) as well as integration with some document sending units for easier or higher volume use. All common formats are supported like images, PDFs, Faxes, and word processing docs. You can also attach meta information and notes to each.
Almost all of the first generation Open Source EMR systems have some kind of custom form support usually requiring some amount of programming to create new forms. In ClearHealth we have upped the anty with its EMR Extensions which allow users to create their own forms in HTML, cut and paste them in, and then the system autocreates the database and logic to use the form, no programming necessary. You can also attach the form to any screen in the application or to a menu. Reports are a similar story, it takes a little bit of SQL knowledge but you can easily create reports that offer nice grid displays (autogenerated) or that display in a Smarty template themselves. These reports can be attached anywhere too.
There are some reasearch and development plans in the works to include a Gantt like display showing patient treatments and offering decision support. Sort of the common business data mining and analysis but in a medical and clinical context. This will be particularly valuable in the management of chronic diseases like diabetes and offer an alternative to often loathed governmental reporting software like PECS or the twice as exciting PECS II which now fill this role.
HIPPA Security
Congress also saw itself fit to create a mind numbing number of privacy and security guidelines in a law called HIPAA. On the whole the result has been in improvement in how your data is treated. However the cost has been great to a lot of clinics to implement the sometimes too rigid policies needed for it. The law itself really only gets teeth (like fines or jailtime, although enforcement is anticipated to be rightfully weak) this year so it remains to be seen what the longterm outcome will be. Every practice still has its own uniqie set of circumstances and policies when it comes to security and access, lawsuits also play a big role sometimes creating complex per patient/provider security related exceptions. We chose to implement security using the fantastic PHPGacl toolkit. This offers a complete implementation of Role Base Access Control which, while complex to define initial security policies, offers a have your cake and eat it too longterm benefit. Through a somewhat clunky interface (look for a rewrite using the rich interface technologies in 2006) you can control on a patient, provider and input field level who has access to what. There are also audit and visualization tools to help get feedback on the tangible effects of those policies, you can see the entire ACL display in a traffic like grid, green means go, red means stop.
Accounts Receivable
Medicine for some reason loves to have and use psuedo-accounting systems to track their accounts receivable. Maybe because unlike other industries what you bill for is never what you actually get and aging routinely runs in to the 90-180 territory which sends a shiver down my spine. Rather than a full fledged accounting package we have bundled a medical specific AR system in to ClearHealth. This allows for easy tracking of outstanding balances and indicates on a patients dashboard if they owe right at checkin. There are the usual aging reports and patient account drill down. Using the very powerful Celini grid displays you can also reorder, sort, resort, multi-sort and filter information on a huge number of axes to get at what you really want. Comprehensive preferences are included so when you set a filter or a sort a certain way it will still be there when you come back.
Under the hood
ClearHealth and the bundled FreeB 2.0 are written entirely in PHP implemented using the Celini “framework” that we developed to make building Open Source applications faster. ClearHealth is really just getting started, in only 8 months since active development began it has become the only Open Source application that does the big 5 features discussed here as one integrated suite. On top of that there is now quite a bit of interest and development to further extend its burgening use of rich client interface technology.
Internationlization
Thanks to the work by John Coggeshall on the IntSmarty internationalization plugin and the extensive use of Smarty templating through the system internationalization has been very straighforward. Almost all of the templates have been converted to use the language tokens and a spanish translation is about 50% complete. One catch is that for foreign character sets MySQL 4 will only let you run one language at a time, with 4.1 this limitation is though to be lifted. If you are interested in contributing to this effort help would be greatly appreciated and probably wouldn’t take more than a day of time.
Future Features
While the most important day to day operations are well covered right now there are some areas that will be developing over the next year. Electronic labs integration with the 2 most popular labs in the US is coming, more case management (i.e. social workers) is planned, and greatly enhanced prescription inventory, tracking, writing and filling is likely to happen. With this RC1 release we are eager to have the community a large, medical and technological, take a bigger interest in this crucial piece of infrastructure that is so often neglected and has never before been some promisingly implemented with Open Source. All forms of contribution are welcome and necessary from documentation, payer format variations, bug reporting and so forth. The easiest way to contribute is through the various links on the OP/EN site at http://www.op-en.org .
About the author:
David Uhlman is Customer Happiness Guru and CEO of Uversa a leading Open Source Development firm located in Phoenix, AZ. David has a long background with Open Source Software and medical software in particular (FreePM, OpenEMR, FreeB). David is a frequent speaker and author on Open Source technology and has previously spoken at many user groups throughout the West, php|Works, COSTT, SCALE, TEPR and others as well as speaking later this year at OSCON, and php|Works and his writing appears on OSNews and www.lintellect.org about general Open Source topics and Medical Open Source in particular.
If you would like to see your thoughts or experiences with technology published, please consider writing an article for OSNews.
What would be nice to see would be a comparison between ClearHealth and compatible software packages for features and cost.
I manage a medical practice and am responsible for IT (we are small) and this sounds great. Most EMRs are geared toward larger facilities and are prohibitively expensive for a small office.
Our facility has millions invested into meditech…if this or anyother EMR is close i’d like to know!
-nX
While the package looks sweet, and really well executed, the review was a little too full of jabs at the politicos. I can understand bitching about mandating outdated EDI. But HIPAA is a Good Thing for patients, and “rightfully weak” enforcement sounds like you actually want patient data being treated wrong.
If you’re going to review software, then do so. If you’re going to critique the environment that software has to serve, do it somewhere else. It might also help to really understand the reasons for the laws you’re going to criticize.
One thing that I relized when converting my father in law practice over to lytec was that they were less efficient with the new program because of its dependency on the mouse. Although they could come up to speed quickly, having to take you hands off of the keyboard was a hassle. The keyboard short cuts are a important element in data entry.
Having your practice on an EMR is a great initial step, but without being able to collaberate with others on different EMR’s you are looking where the real savings come in. I work for a company that specializes in linking EMR’s and so I spend all day thinking about this linking issue. I believe you list you can import documents in, but what about exporting? Do you support the HL7 format for import/export?
I would comment more and offer to do some code buy my contract expliciately forbids me from working on EMR’s or compeditor products.
If there’s one industry that needs financial help in the form of free software, it’s definitely the medical industry… oh wait.
how about better film softwarE?
So if I understand the GPL right, if I buy this software, I can give to anyone and everyone I want, legally … for free?
Uhh…Yeah. Free Software. Open.
So if I understand the GPL right, if I buy this software, I can give to anyone and everyone I want, legally … for free?
I think you can only give the source unless the company says you can distribute binaries. I could be and am probably wrong though…
😀 Darius knows what the GPL means, he’s just alluding to the fact that they sell this software. At an unknown price no less (“Call us for a quote”) While under the GPL anyone who buys this has to have access to the source AND can freely redistribute it.
The point being, why sell it it the first place ? My guess would be that they charge concultancy fees for helping you migrate from your existing system as well as support afterwards.
The ‘source code’ link on http://www.op-en.org/ doesn’t seem to point anywhere yet. Oh wel, as long as their customers get it i guess.
I think you can only give the source unless the company says you can distribute binaries. I could be and am probably wrong though…
The GPL, basically, demands that the company releases the sources under the GPL. I’m not sure, but I think the company could restrict the distribution of their binaries. However, it only takes one tech-savvy person with access to the code to build new binaries from source, and he would be free to freely distribute those.
In this case, though, the value of this company isn’t only in the software itself, they appear to provide vital services for the deployment of the system.
Hi,
My name is Fred Trotter, and I am the project manager for the ClearHealth project. I just wanted to let you all know that we are listening and to try and address issues where possible.
Question: What would be nice to see would be a comparison between ClearHealth and compatible software packages for features and cost.
Answer: You can use the project releases for free. Smaller practices who have geek practicioners or other linux comfortable folk around are encouraged to do that. Or you can buy support for us. Standard Free Software business model. IF you buy support for us, then the initial costs are similar to a proprietary system, except we do not charge extra for multiple locations or providers. So for a large shop the savings costs are dramatic. For any shop TCO is much lower because upgrades are part of ongoing support, rather than whole new purchases. These arguments are going to be formalized soon and available as a whitepaper from Uversa.
Question: Our facility has millions invested into meditech…if this or anyother EMR is close i’d like to know!
Answer: This happens over and over again. For a fraction of the cost we could have installed ClearHealth, and then developed it to mirror the functionality of meditech. But now you are in a vendor locking situation. It takes some bravery to get out, but for the cost of your next minor upgrade, migration to ClearHealth could free you from that forever.
Question: ….The keyboard short cuts are a important element in data entry.
Answer: ClearHealth is designed to be as mouseless as possible given constraint of using a web browser as a thin client. For data entry tasks we are close to being 100% mouseless.
Question: Do you support the HL7 format for import/export?
Answer: we should be doing some interesting things here soon as GPL available code fills out.
If you have any questions regarding ClearHealth feel free to contact me through Uversa, or my personal site..
http://uversainc.com
http://www.fredtrotter.com
Thanks,
Fred Trotter
In this case, though, the value of this company isn’t only in the software itself, they appear to provide vital services for the deployment of the system.
The point here is that assuming you sell a software package like this under the GPL that doesn’t demand deployment services, how are you going to make money off of it when the very first person who buys it is then free to give it away to whoever they want? Really, I don’t see how you can, unless you have some service to go along with it. In which case, you’re basically selling the service, not the software.
Does anyone know of any programs similar to this that help patients keep track of data pertinent to them? Stuff like doctor visists, med. doses, symptom history. I would imagine with all the people with health problems out there there would be an open source program which helps patients manage all the information they are inundated with on a daily basis. If anyone knows of software (free or proprietary) that does this, links will be much appreciated. I’m looking into developing something like this if there isn’t anything credible out there that I can’t build on. Thanks.
Johnfive
how are you going to make money off of it when the very first person who buys it is then free to give it away to whoever they want?
I’ve seen plenty of IT departements fork over money for a consultant to come install software (commercial think tens of thousands of $ worth) Either because they’re to thick, too lazy or just can’t be bothered with the inevitable little nagging complications that always turn up and you can’t solve without a thorough and complete working knowledge of the software.
Also companies don’t give their stuff away for free, not even if they got it for free. And an employee leaking the code is stealing.
I worked for Epic Systems Corp from 92 to 2000. In 92 we assembled their first GUI (had been do text based apps prior) Electronic Medical Record in VB. Since 92 they also assembled a GUI app for Scheduling and later Billing and various other specialities. By 97 we had web client access for key features – I’m sure by now (5 years later) they have complete web features.
Undertaking development of clinic apps like these is a huge task and requires a great deal of customizable modules. I’m impressed at the effort and say good luck.
@johnfive (What about something for patients?)
Epic has software called MyChart that does allow the patient to access parts of their charts as well as veiw their schedule and billing. In fact you can even send messages to your provider through a form that then becomes part of your record. Oh, and you can track your own health notes. Epic’s software is high end stuff (not cheap) but its among the best. http://www.epicsys.com
Simply put, most Hospital or Medical practices aren’t going to hire these guys, install the software, train for it, customize it, and implement it and then mount up a web site to distribute the code to the world.
The Hospitals basically Don’t Care. They may want the source code for themselves, but have no motivation or call to distribute it from there, much less support it.
Now, it would be basically simple for an employee to grab the source and open up their OWN ClearHealth consulting agency, and that may well happen.
But the basic issue of “all they have to do is sell it once and the cat’s out of the bag” is pretty much a non-issue.
Ok there seems to be alot of questions about GPL and the sales model. Try the “snapshot” link on op-en.org and you will find that you can download the sourcecode there.
To make it clear how Uversa makes money: We sell an AAdvantage edition of ClearHealth. There is no difference between the AAdvantage version and the ClearHealth project code, except that we take resposiblity for support and upgrades. You can read on Uversainc.com about what the AAdvantage version includes and does not include. This is basically the same model as RedHat has moved to with Fedora and RHEL.
The difference is that no right minded person is going to try to run a medical practice without having supported software. We are encouraging capable people to support themselves and we are providing support for those who are interested in professional level development and support. Like ubuntu we are keen on other companies supporting ClearHealth, so the employee leaving would not really be much of a hiccup.
As for johnfives question. There are two answers. One, allowing a patient to have access to thier medical record within ClearHealth is on the project roadmap. The idea of having a patient app that tracks that patients personal data is a fine one. ClearHealth could be changed easily to do that, but the real trick there would be to sync with other bits of patient data floating around. For that you would probably want to have some hl7 stuff which is also on the roadmap.
I hope this clears up some questions.
Fred Trotter
http://www.fredtrotter.com
HIPAA is a pita. We had a former Senator come into my father’s office for an appointment, and when his turn was up, according to HIPAA, we had to call him by his first name (or else someone might figure out who he was oh noes! This after he shook hands with everyone in the room and said “don’t worry I’m not running for anything today”). He finally figured out he was being called and I wish I could have thanked him and his colleagues for creating that situation
I’d love to try this software out, but we are somewhat tied to the software the hospital uses since he spends half his time there. I’ll certainly take a closer look though, it has to be better than some of the open source stuff I looked at a while ago.
But…they are selling services:
http://clear-health.com/site/software/clearhealth/purchase.html
Things like this DO demand deployment, just like any significantly large project. Doctors want to pay someone to call and gripe at when they need a feature or a bug fixed, rather than figuring it out themselves. They want someone to come and deploy ClearHealth 1.1 or 2.0 upgrades for them. Most doctors do not want to become web services architects, they just want quick and easy access to their info. But those that do, or are, can add and change and customise as they see fit. Same applies to hospitals with large IT departments and development staff.
I personally believe they can make darn good money off this, even if they remain a niche player. And thanks to the GPL, they can’t lock all the code away if they get bought by one of the big players.
Questions for Mr. Trotter:
1. This could be great for small or developing nations. How is i18n and l10n for other countries and THEIR standards? I’m guessing customising it is a little easier because there are so many web components and PHP gives you Unicode, but how is your support outside the USA? Any other countries express interest?
2. MacOS X. I have a friend with a dental practice using an EXTREMELY customised FileMaker solution for EMR. She is a Mac lover and does NOT want to buy x86, period. I ask the forum at large not to question her decision, as she won’t bend and flaming me will solve nothing. Anyway, I shall assume there is no problem, since MacOS X has PHP, Java, and Apache running nice and native, but are there any caveats to using ClearHealth on OS X? Will your company support it? Do you support Safari like you support Firefox? You can just direct me to docs if you can’t answer.
Thanks!
–JM
JM,
Your questions.
1. ClearHealth uses Smarty to do i18n specifically because they have a solution that supports unicode completely. Translations are pretty simple to do, and we are planning on investmenting in simplified procedures for this process. Hopefully it will take someone who is fluent in English and the target language no more than an afternoon to do a complete translation. Spanish is first on the road map.
2. ClearHealth runs fine on Mac OSX. We are planning on directly supporting (probably) Fedora/RHEL and Ubuntu/Debian. For any other platform we will support XAMPP so that we can reduce apache/mysql/php version issues. So ClearHealth will run fine on OSX and the project will pay attention to it. As for Uversa supporting it? Sure, we just need to cover the expense of doing so.
Thanks,
Fred Trotter
My prostate exam might get GPL’d!
Well Stallman has had his head up his own arse for a decade, there’s no reason that valuable, real world experience shouldn’t be shared.
🙂
especially if you were a large org and had a slick IT guy to constantly develop it and tweak it into a into a highly customized handle it all application….
I have wanted to try and market some OSS to nursing homes and such but nothing has been professional and complete enough to consider. Would like to put a package together that cmae close to rivaling resource systems caretracker stuff… any thoughts or ideas?
But the basic issue of “all they have to do is sell it once and the cat’s out of the bag” is pretty much a non-issue.
For this company, yes. But what about other, less ‘ambitious’ project? Is it manditory that if you want to make money this way, you must intentionally make your software hard to install and a pain in the ass to use in order to get money from the customer? I’m not saying that this company is doing this and I don’t believe they are, but what if you’ve got an app that’s easy to use and easy to install? Then what? Doesn’t seem like a lot of hand-holding is required there.
I personally believe they can make darn good money off this, even if they remain a niche player. And thanks to the GPL, they can’t lock all the code away if they get bought by one of the big players.
Actually, I’d say these guys aren’t that smart, really. If you can program an app of this caliber, it seems to me that it would be much smater to wait for somebody else to write and sell a GPL’d app, then ‘piggyback’ off their efforts, and offer your support/customization services for cheaper than the original vendor. That way, you don’t actually have to write the whole damn thing – all you gotta do is customize it.
who would you rather have “support” and “customization” from? the creator of the project or the piggybacker?
also the piggybacker has to realize that if they kill the developer then they just shot themselves in the foot as well…
and if I take the code and make sweeping improvements and some cool features then I in turn am REQUIRED to GPL it and then the original people can take it from me as well and “piggyback” off me as well…
my2cents
“But the basic issue of “all they have to do is sell it once and the cat’s out of the bag” is pretty much a non-issue.”
GPL software isn’t the only one’s doing the “You get source with binaries”. Some proprietary software does that too.
”
Now, it would be basically simple for an employee to grab the source and open up their OWN ClearHealth consulting agency, and that may well happen.
”
Quote from http://www.gnu.org:
If someone steals a CD containing a version of a GPL-covered program, does the GPL give him the right to redistribute that version?
If the version has been released elsewhere, then the thief probably does have the right to make copies and redistribute them under the GPL, but if he is imprisoned for stealing the CD he may have to wait until his release before doing so.
If the version in question is unpublished and considered by a company to be its trade secret, then publishing it may be a violation of trade secret law, depending on other circumstances. The GPL does not change that. If the company tried to release its version and still treat it as a trade secret, that would violate the GPL, but if the company hasn’t released this version, no such violation has occurred. ”
This employee wouldn’t have the right to do that anyways. Another quote:
Is making and using multiple copies within one organization or company “distribution”?
No, in that case the organization is just making the copies for itself. As a consequence, a company or other organization can develop a modified version and install that version through its own facilities, without giving the staff permission to release that modified version to outsiders.
However, when the organization transfers copies to other organizations or individuals, that is distribution. In particular, providing copies to contractors for use off-site is distribution.
nothing you just posted would keep me from opening my own clearHealth consulting business….
that just has to do with whether something has been distributed or not…
I can legally use/modify any GPL product strictly “in house” and not release my changes and therfor not distribute it and you have no legal recourse and do not have the right to “steal” it….
however if I do distribute it then everyone has the right to it as well, even if they “steal” a cd of it off my desk
trust me i am the GPL cop…..
just ask Linsp—!
JT strikes again
The website is completely dead and badly built (404 and missing files). Someone should tell them about Mambo…
nothing you just posted would keep me from opening my own clearHealth consulting business….
Legally, nothing keeps you from that.
In practice, many people will choose to get support from Uversa, since they are the professionals that wrote the software. Even if you are cheaper, that weighs in a lot. And if your get some customers this way, too, well, good for you!
It seems this project has what it takes to be a successful commercial open-souce project. Solid software at the basis, but mainly making money from services. Plus they seem to actually understand how open-source works, and the fact that Trotter makes reasonable comments here is a good sign.
I’d say: good luck, and i hope to hear more from you!
Well Stallman has had his head up his own arse for a decade, there’s no reason that valuable, real world experience shouldn’t be shared.
If I could mod you up, I would
Having worked in the practice mgmt & emr space for the last 15 years with some of the largest vendors, I can say that this is all a great pipe dream. Ask yourself, if this was a great piece of software, or even if it was only a fair piece of software, which it barely is, why isn’t it more popular?
I have and do work with hundreds of practices, large and small, across the country. Many with “geek” doctors. Most have come to their vendors for a reason, functionality and a good return on their investment. When you calculate the time someone will spend fixing, cleaning up this mess the ROI is gone. And as for functionality, try the demo yourself.
Sounds great but remember that you get what you pay for.
Not trying to be a jerk, but I think I have an easy answer to your question: ClearHealth is new, and not even out of beta. It will take time for them to gain traction in a market like this.
If anything, Uversa should be in it for the long haul.
–JM
Freely admitting he is not a medical IT geek.
why isn’t it more popular?
As said above, it is new.
Most have come to their vendors for a reason, functionality and a good return on their investment. When you calculate the time someone will spend fixing, cleaning up this mess the ROI is gone.
Err, nobody is saying doctors should download the source and try to deploy this package on their own. Instead, they should hire Uversa to do that, just like you would with any other commercial package.
Doctors will not spend time fixing and cleaning up messes. Sure, just like with commercial software, there will be bugs. And just like with commercial software, Uversa will have to fix them.
And as for functionality, try the demo yourself.
I have absolutely zero experience in that field, so I can’t compare. However, it sounds like this might become a nice, cost-effective product for some. I’m not saying it’ll be the Best Choice Ever for Everyone, but it looks like there’s a market for this.
“Sounds great but remember that you get what you pay for.”
Often, you don’t. The sale price on anything is based on the precieved value at the time it is sold. Value can but does not necessarily have anything to do with price.
For example, Apache and all of the Apache foundation tools are available at zero unit cost, though just like other web services platforms, the value in them is not in the base software but in the relationships surounding that base. For Apache and Apache tools, that set of relationships includes companies and individuals that gain from working together. In some cases, that includes service contracts (for example, a web services provider).
That’s what Fred Trotter from Uversa is saying; they offer the software gratis and in an unabusable form (GPL). The hope is that not only will people use it, but will build around it. Along the way, either a medical practice or the consultants/contractors that assist the practice will ask for support from Uversa.
With open source, if you start with Uversa’s support and decide that you either want to move off of ClearHealth (AAdvantage supported version or not) or get another group to support you, you can.
The medical doctors themselves aren’t software specialists. They are medical doctors. Nobody is suggesting that they themselves would install, configure, and tweak ClearHealth themselves — let alone code changes for it. Chances are, the biggest clients for Uversa will not be doctors but the companies that the doctors hire to do IT work and to suggest “solutions”.