Feature idea brainstorms for LibreHealth EHR

Continuing the discussion from Meet the community: Introduce yourself here!:

What would be your top 5 enhancements/changes to the OpenEMR platform. We are developing the direction for LibreHealthEHR.


@Ana_Maria_Espinoza Wonderful to see you here! Isn’t this awesome! Personally, I want to see the business side of LibreHealth products (personal effort toward LibreHealthEHR) get more complete coverage for US businesses, as well as do some serious internationalization. Lower administrative burden means better patient care at a more cost-effective rate, which drives healthcare availability, which addresses the BIG issues of high population and poverty. I have noticed that poverty seems to be a pretty high risk factor for a lot of things.

That said, we have almost zero input for international business management tools, forms, processes, regulatory standards etc. It would be incredible if someone could say: “Here is what we need to run a practice in the Dominican Republic.”, or "Here is what Dominica would like for a national healthcare system." We need clinical form design for development in a wide range of social and geographic areas too, but you can’t do progress notes if the clinic doors are not open.

Allons-y! Allez! Allez! -Art

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Great questions and thanks for the chance to contribute. These are the top things on my mind so far - needs and technology are in constant movement, so…

  1. Database requires normalization or any other improvement process that makes the structure more flexible and easy to understand for developers (I am not one of those)
  2. A light version for mobile access, thinking on low resources setup or even places where internet connectivity are poor
  3. A reporting tool embedded on the system - more flexibility is required
  4. EMR - practitioners require more visualization and chance to draw on patient charts
  5. Multiple facility management. The current approach have some weaknesss in terms of data sharing and protection

Let´s talk more!



We are working on most all the items on your list. We really need input from the user base to help define the best overall direction for the software as Art stated we just have the US base to work from but really want to be a help to all.

  1. Our fight with the database has, at the moment been a factor of our release#1 plan, called “slash and burn”. There are hot proponents of database cleanup, some who don’t see it as all that big of a factor, but it has indeed moved forward. I have become expert at working with the previous project’s database…uh…structure, but yes, I find it exceedingly difficult to teach to someone else or even document. Field names, table names and all that have been treated exceedingly arbitrarily and are non-descriptive for the most part. It is mostly a “find data thing, tie into it” kind of hacks.
  2. A light version requires controls and limits on resources, especially when using certain javascript features. Poor connectivity is another problem, and the only thing you can really do about that is add in autosave features that take up more bandwidth. It is a big issue. Mobile display is important as well, but having strong LAN performance benefits the most clinics.
  3. We have tons of seriously weak reports. We need one report tool base, and lots of preconfigured report templates. This will be a big project in of itself. The other approach is to use a report form admin tool for installing or removing reports, making modular installations more effective.
  4. Reporting is a bit part of this. If “draw” means actual drawing, we have to keep in mind that empirical data is the goal, and hand annotation, while cool, should only be used sparingly.
  5. There is a facility-based access control tool that should get integrated into the project fairly soon. It is in use, but requires a LOT of admin tweaks, as it is possible to create a patient without assigning them to a facility, and then no-one can see them…so someone creates them again, and again. At that point you have to edit the database to assign them to a facility and delete the erroneous patient records. There are a few other issues with the interface for assigning facilities to users, but they are ALL just refinements. The system does give a level of access control not before seen. This is in addition to the “Tag” system…which is another conversation.

The database normalization is on our list. There are some form changes , called Annotate Diagram that will allow any PNG file to be used as a form. We are talking about a report module and what it will take to give the users the ability to create their own reports based on their needs. I would invite you to create a topic and continue this discussion. We always need great Ideas.

Great to hear that Terry. Now, if want to hear about the end users needs, here are a small list - from a biggest one

  1. Point of sale
  2. More user-friendly interface to manage the client record and visits, in a way to facilitate the practitioner to see a at glance the medical history & encounters
  3. Finance section: better way to manage sales and voiding invoices
  4. Price list - a tool that allows to apply changes in prices - there are many countries, LAC region for instance, where prices vary very oftern, so a mechanism to do this based on % or other criterio, keeping the price history would be nice
  5. Inventory side: improve the transactions management
  6. Human resources. Most of the organizations hire sesional doctors or clinic staff, so, would be good having the chance to manage the resource, allocations, timing and fees, based this latter on services provided or other criteriio

There are more… let´s talk!

This is really great. Point of sale , accounting and billing are big for me. That is were I make most of my changes.Can I ask what version of the software your users are using.

We use v4.1.4. This version meges the community one and other enhancements designed by one of the INGO who I work with.

Item No. 2 for me is one of the most relevants and required IF - and happens currently - the health facility is located in rural or similar areas. OpenMRS as well as other similar tools, like DHIS2 has addressed in some way this need. Perhaps the solution is more clear now, having the link among Opens´systems…

And let´s think in the report areas based on audience or user groups. In medical practice, patient traceability is a must, and responds to a very specific user groups: practitioners and medical audits, while patient follow up for certain services requires reports in a fashion of “alerts”

To be continue…

Yes, burying the history, lifestyle etc… is a dumb move. On the other hand, it is impossible to show everything all at once, especially when the mobile data consumers are whining that it doesn’t look like twitter. Too much data on one page, or even pre-loading too much is also a performance issue.