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Re: [Gnumed-devel] Gnumed license for the insurance??

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] Gnumed license for the insurance??
Date: Fri, 15 Jun 2007 16:20:02 +0200
User-agent: Mutt/1.5.13 (2006-08-11)

Hallo Philipp,

> As I am a GP in Austria I am asking, if Gnumed is planned to get the license 
> to be used for doctors who has a contract with the general local insurance 
> (AOK in Germany or Gebietskrankenkasse in Austria).

This question is not easy to answer.

The short answer is: Yes.

The correct answer is: No, because no such license exists.

The true answer is: It depends, sort of.

Let's see if we can this straightened out.

1) In Germany programs need to be submitted for review not   
   to the AOK but rather to the KBV (Kassenärztliche
   Bundesvereinigung) which is the head organ of the medical
   self-governance administrative bodies.

   Of course, they only (have to) enforce what the insurance
   companies demand - but this applies to all insurance companies,
   not just the AOK.

2) Mind you, even though we, as doctors, make up, elect, and
   pay for the work of the KBV the rules for program review are
   brain-damaging beyond imagination not to mention that getting
   a review done is a) mandatory and b) upwards of 2000 EURO.

All this aside - after all, many things are complicated and
need to be done properly - those rules change every quarter.
New regulations are invented, old ones are changed, coding
systems are modfied, etc. etc. All of which one needs to
follow not to lose the program license again.

To date no open source solution has been reviewed.

Yes, it would be possible for a FOSS solution to code all
the regulations but no it is not possible for our type of
(vertical) application to followup on all the necessary
regular changes.

Therefore we are in touch with two teams to alleviate the

a) one commercial proprietary EMR vendor who is sort of
   sympathetic to our cause,
   we have an interface for handing them patients so
   all the billing stuff can be done in their software

b) one formerly proprietary solution which is in the   
   process of being open sourced - which isn't as easy as it
   sounds - and which is likely to give us much better
   interfaces for billing etc

So, yes, we do pursue billing functionality in a pragmatic
sense but GNUmed itself isn't going to have all this built
in any time soon (apart from the interfaces which are
already there).

> In Austria the general insurance "Hauptverband", which manages all ensurances 
> of austria, will examine every program, which is used by docters (GPs and 
> Specialists). Not only the structure of billing datas (Abrechnungsdaten), but 
> even the workingflow will be checkt, as well as the outlook of every 
> formular. As well the working-flow regarding the eCard-System (at present 
> only management of patient-data, but in future electronic prescription ...).
Same here, just a different body who does it.

> At present I am using my own Program, which has been examined and licensed by 
> the "Hauptverband". At present the austrian programers are protesting against 
> this licensing, but certainly they will loose! When a newly license-process 
> is needed, which is very time-consuming, I am thinking it would be better 
> putting my time in Gnumed rather then in my own lonely program.
I would strongly suggest to think about how you could
leverage GNUmed to off-load parts of your work and focus on
what you really have to code specifically for Austria.

You might want to take a look at GNUmed again and see what
it can deliver and what you need to add on or rather
interface with. If you already have a licensed software I'd
strongly suggest holding on to that license and interface
the program from GNUmed.

We are certainly willing to discuss and help getting this
done. We can't do it for you, however.

> The problem is, that I did not get time till now to learn python.
Python is very easy to learn.

> The question is, how much work is left for that lisence. 
All the work.

> Then my work would have to be adaptation of the formulars
I think this may be a useful first approach. We are
currently getting into forms handling.

The first step will be letter writing (since on of our users
wants that) which will give us some code and experience on
how to implement forms. We will take a good look at NetEpi
forms, too.

What language is your program written in ? Exactly how do
you handle forms ?

> and possibly the 
> structure of billing-data (Datensatz der Abrechnungsdaten) for austria.
I'd encapsulate that in your already-licensed software !

> Otherwise It could be possible that I will have to buy a commercial programm, 
> with all disadvantages of dependency - horrible. 
We are working hard to get away from that but it's a lot of

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