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OpenEMR: Electronic Medical Records and Medical Practice Management Software

open-emr.org

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Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#41

Post by darkmarmot »

fnovd wrote: post #17
jdhe wrote: post #13

As other comments mention, this project has been going for a while, the central reason it (or something like it) has not been robustly built out and deployed universally is because of the way congress chose to structure the funding for development of EMRs/EHRs. Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop s…

>affordable universal EMR would significantly enhance the ability to deliver care for almost all sizes of healthcare providers. Additionally, it would open the door for EHR-based research on a massive scale. Getting different hospitals' EMRs to play nice with one another is a huge barrier for large, retrospective cohort studies. Projects like the Million Veteran Program ( http://www.research.va.gov/mvp/ ) would be ju…

I work in this space in the private sector. From my perspective, the greatest impediment in the U.S. relates to our laws regarding PHI. I work on a system with petabytes of medical data -- but researchers can't access it because our laws and regulations don't support it (and thus provide no financial incentive and only risk and lawsuits for the companies holding it.) It's abysmally sad.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#42

Post by keltor »

jasondc wrote: post #7

There is even open source dental software, open source is seriously eating the enterprise (and healthcare) software world! I run OpenDental for my wife's practice in North Beach, SF. It's licensed as AGPL, but I'll still take it :)

I think the one nice thing about the dental world is that "for now" there are still far more independent entities without the ties into hospital groups like doctors and practice groups all have.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#43

Post by keltor »

kevinmannix wrote: post #4

This is huge. I previously worked for a healthcare startup, and it seems like for every other healthcare startup we worked alongside or networked with, all roads lead to EMRs. It was (felt like) an impossibly large task without a clear path to execution due to the tangled web of healthcare IT & regulations. Something like this is huge, especially to potential competitors that now have a target to aim for.

Unfortunately most of the time you end up having to individualize so much data structure for each deal it's a gigantic pain.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#44

Post by mcphilip »

cmiles74 wrote: post #35
mcphilip wrote: post #27

Earlier quoted context omitted.

>Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop systems, then subsidize the purchase cost to providers to encourage adoption. Then, only once everyone has invested in their own proprietary system will they begin trying to universalize the system by developing cross compatibility. This is misinformation. Inter…

I don't think we will ever see HL7 messages exchanged between organizations. Each product has it's own list of message types that they support, and even then they will vary in terms of which segments have data and in some cases, even what that data will be. Patient identifiers also vary between organizations, making it hard to know which patient goes with which piece of data. Alternative methods for passing data betw…

I work at a top 10 EMR on the interface engine team. Messages between products require a lot of custom work to align message types and IDs, establishing a compendium of identifiers for external labs and identifiers, but it's not uncommon.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#45

Post by triangleman »

throwanem wrote: post #36
jdhe wrote: post #13

As other comments mention, this project has been going for a while, the central reason it (or something like it) has not been robustly built out and deployed universally is because of the way congress chose to structure the funding for development of EMRs/EHRs. Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop s…

> This methodology is perfectly in line with the free-market approach that the US has championed for decades. Not really a libertarian myself, but were I to pretend for a moment that I was, I'd say that this statement of yours could not possibly be less accurate, and that federal interference of this sort is the precise, diametrical antithesis of what is meant by the phrase "free market".

Ah, but then you ignore the many years of deliberate effort by politicians to equate "privatization" and "public/private partnerships" with "free markets", to the point where OP's statement is perfectly reasonable in light of history.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#46

Post by dharma1 »

JusticeJuice wrote: post #38

I'm currently working on my thesis, I'm trying to design a radically different take on EMR/EHR systems - http://barnett.surge.sh/ I've come to realize healthcare software is a significantly trickier problem than most realize. Not in terms of technical possiblity, but other factors. Building healthcare software is really hard - which seems like such a paradox, because surely ensuring highly trained individuals have ha…

looks good, how far are you with it? is it open source?

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#47

Post by clueless123 »

jdhe wrote: post #13

As other comments mention, this project has been going for a while, the central reason it (or something like it) has not been robustly built out and deployed universally is because of the way congress chose to structure the funding for development of EMRs/EHRs. Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop s…

If the government has to get involved, it should be on helping (forcing) to define a flexible/complete vendor agnostic data interchange model that patients can carry along wherever they may go. The rest is just GUI, bells and whistles.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#49

Post by angersock »

criley2 wrote: post #15
jdhe wrote: post #13

As other comments mention, this project has been going for a while, the central reason it (or something like it) has not been robustly built out and deployed universally is because of the way congress chose to structure the funding for development of EMRs/EHRs. Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop s…

As a programmer for an American EHR firm -- all of the market share already belongs to one of those companies you malign. You could not have had the government sponsor some new software which would eliminate a billion dollar software market. It's a non-starter. All the hospitals already are signed on multi-year contracts with those large providers. Some of the EHR providers began writing medical software for hospital…

> The crux you may not realize is how customized every major hospital system expects their EHR software to be.

The crux that you may not realize is that this customization was done mostly to boost profits and promote vendor lock-in. This was aided by the .gov failing to make public and standardized requirements for things like medical records (and no, referring to an AAMI or whatever doc that costs serious coin to view doesn't count!).

> . There was no "one-size-fits-all" solution unless your solution includes "Destroy the entire industry, and use force of government to destroy a half dozen major software companies in favor of the government mandated and almost assuredly inferior option"

BULLSHIT. Epic is built on MUMPS, arguably one of the worst languages ever designed. Hyperspace is garbage. Their systems are garbage. They get by because they've attached like gigantic leeches to hospitals. Cerner, Allscripts, and others aren't much better.

> Many hospitals used paper-only system with very little software even into the 2000's and 2010's.

Feature not bug--notice how much more physicians and nurses seemed to like those systems.

~

Look, your entire industry is fucking cancer and the sooner the .gov decides to use truly open standards the sooner some hungry companies can clean out all the garbage you and others have managed to clog institutions with. You should be ashamed.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#50

Post by angersock »

megiddo wrote: post #30
mcphilip wrote: post #27

Earlier quoted context omitted.

>Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop systems, then subsidize the purchase cost to providers to encourage adoption. Then, only once everyone has invested in their own proprietary system will they begin trying to universalize the system by developing cross compatibility. This is misinformation. Inter…

HL7 interop is a joke.

To elaborate for the uninformed:

HL7 is literally just a syntax, and one that isn't reliably followed at that. It makes no solid guarantees about the semantic structure of the messages, and so is next to worthless.

For a simple analogy, consider that two companies have agreed to write contracts in English--and little else.

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