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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

#61

Post by nradov »

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…

Your statement is factually incorrect. The US federal government has given little or no money directly to EMR vendors. Instead the HITECH Act grant funding went to providers to reimburse them for purchasing and implementing EMRs. And in order to receive that funding the providers had to demonstrate that they were actually using their EMRs in a meaningful way.

Most other countries don't have universal EMRs, and the ones who do aren't necessarily happy with them. One size doesn't fit all.

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

#62

Post by JusticeJuice »

dharma1 wrote: post #46
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?

It's essentially a giant design proposal - yes it's all open source, but theres nothing you can download and start using - yet :)

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

#63

Post by tunesmith »

ipunchghosts wrote: post #53

EMR is simply too messy for openEMR to put a dent in the issue. I truely wish it were different. If insurance carriers are permitted to operate across state lines in the future, i think there is a chance of a Google or Microsoft getting into the space which I think is the right way to go. Right now, the large companies managing EMR and huge monoliths that simply don't care about innovation. They are like defense cont…

Insurance companies are already allowed to sell across state lines.

http://www.modernhealthcare.com/article/20161010/NEWS/161019...

https://www.forbes.com/sites/brucejapsen/2016/10/10/sorry-tr...

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

#64

Post by nradov »

cmiles74 wrote: post #32
vanattab wrote: post #25

Earlier quoted context omitted.

I am actually not opposed to the "CD you have to buy" policy. If I was hospital network admin I would not want people just plugging in random usb sticks into my network.

I think the expectation is that these organizations should be able to send this data to each other. That they was put the data on a disk and then give that to a patient who the drives it over to another part of town and hands the disk over is a ridiculous waste of everyone's time. It also highlights how far the entrenched vendors and hospitals will go to keep their customers "locked in."

And in most cases they can send that data to each other, at least in the sense that their existing systems are capable of interoperating based on open standards. But to make it work the provider organizations often have to configure and test data interfaces with other organizations. That's an expensive process and no one wants to pay for it.

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

#65

Post by SteveNuts »

exception_e wrote: post #23
oomkiller wrote: post #19

Earlier quoted context omitted.

After sourceforge bundled malware with downloads, it's hard to trust a project that stuck with them, especially with health data, especially when there are numerous alternatives that are better.

It's just for our website and wiki. We've moved to Github for the most part. There is talk between myself and a couple of other contributors to move the site and wiki to AWS :). Feel free to volunteer to speed this up, of course. EDIT: Misread your comment. We are hosting downloads on the SF site. Really need to move to AWS...

How much traffic do you get? and is it all static?

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

#66

Post by JusticeJuice »

doughj3 wrote: post #58
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…

Your homepage there has a heavy focus on health records. Have you considered building upon the FHIR standard?

Yes, thats the main focus of the project. One of my critiques of healthcare systems is they do wayyy to much. Eg a practice management system (pms), handles appointments, records, invoicing, staff management, inventory, decision support - so much stuff.

I'm instead focusing on just health records - and the interfaces medical professionals use to work with them.

I've had a good look at FHIR and many other standards, but FHIR is built for an interoperability model - eg, your record is sent back and forth between your gp, hospital, specialist, labs, etc. I'm instead focusing on a central access model - so all of the parties interested in your record are all accessing one central point, so I'm doing something a bit different, it almost looks like NPM.

That being said, I'm all for any standard becoming the industry standard - I don't care what it is, anything is better than nothing. So I wish FHIR the best of luck :) http://standardhealthrecord.org/ is also a standard I really like

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

#67

Post by nradov »

angersock wrote: post #49
criley2 wrote: post #15

Earlier quoted context omitted.

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 vi…

That's simply false. Hospitals and other large provider organizations often do insist on extensive customization and non-standard configuration during EHR implementations. I've seen it happen. They'll spend weeks going around in circles about ridiculous issues like the placement of a logo and the format of a lab result document. You really can't blame the vendors for that.

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

#68

Post by entee »

doughj3 wrote: post #58
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…

Your homepage there has a heavy focus on health records. Have you considered building upon the FHIR standard?

Double bonus for this, we've been working with FHIR at Lumiata and it's quite good for certain things. Difficulty is that most EMRs as is work with tabular databases, and FHIR isn't quite organized that way. It does require some work to translate the tables people usually have into that format.

Still a native FHIR EMR would be really cool!

[EDIT]: https://www.hl7.org/fhir/ for the interested

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

#69

Post by fny »

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…

As far as I can tell, there's no economic incentive for health care systems to undergo these transformations willingly. Remember, the digital transformation didn't occur until the HITECH act in 2009, which mandated the use of electronic health records. Why digitize your operations and worry about maintaining tech infrastructure when you can do everything on paper with a handful of secretaries? You could argue providing better data-driven healthcare to patients, but guess what--most health systems don't care because they make money every time you get sick.[0]

With HITECH, the government forced them to transition to EHRs, and here's what hospital systems optimized for...

1. Reliability

2. Optimizing billing

3. Guaranteeing compliance with different protocols, particularly those related to billing

Openess? Interoperability? They don't care. You're piling on more technical and administrative costs without the promise of future returns.

> ensuring highly trained individuals have half decent tools would be a huge goal for society - but almost all healthcare software is still frankly, terrible.

You know who hates EHRs the most? Doctors. Do you know who loves them? Hospital administrators. Guess who pays for the EHR? ;)

[0]: An exception to this is Kaiser Permanente. They insure the patients for which they care, so they're incetivized to improve health to reduce costs over time.

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

#70

Post by nradov »

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…

You haven't been paying attention. I've been working on products which exchange HL7 messages between organizations for 20 years. It's very common now. Some configuration work is usually needed on each interface but that's mostly a solved problem.
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