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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

#71

Post by nradov »

clueless123 wrote: post #47
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.

The Office of the National Coordinator has been helping on some aspects of that through support of the HL7 Consolidated CDA (C-CDA) initiative. So we do have a vendor agnostic data interchange format. But typically patient records are sent from one provider to another; there's still no good way for patients to "carry" their records.

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

#73

Post by sachinag »

mcphilip wrote: post #44
cmiles74 wrote: post #35

Earlier quoted context omitted.

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.

Yeah, but I can't take my data from Epic and move it all into Cerner via HL7, no matter what.

What we need are government standards for data at rest, similar to DICOM, for other data - and tied to Medicare reimbursement. Literally some functionary at CMS could write that rule and patients would be better off.

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

#74

Post by JusticeJuice »

fny wrote: post #69
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 providi…

> As far as I can tell, there's no economic incentive for health care systems to undergo these transformations willingly

Yes. Thing is, say you have shitty software and see 20 patients in one day. Say you have fantastic software - you'll probably still only see 20 patients a day. The cost of upgrading is usually not justified if it doesn't hit the bottom line.

I'm trying to tackle this by making a system where improving it isn't a huge risk, or cost. For example, it has an extensible user interface - imagine something like atom text editor, or even browser extensions. Say you look at the immunization screen all day, and hate it. Find / build a small extension to arange it how you want, without changing any of the back-end system, and then share it to a registry for other people in your situation. Easy win.

I'm actually designing this system within the context of primary care in New Zealand. We have a socialized healthcare system, which is honestly very effective. Everybody pays for it via tax, and resources are evenly distributed. We even bulk purchase generic drugs for the entire country.

There isn't so much of an evil incentive to ensure all their 'customers' stay sick, but instead funding is a bit hard to come by. Funding happens regionally, and building national healthcare software systems is a huge task nobody but the government is willing to try. The market is so small (population of 4mill) that vendors can usually make more money elsewhere - so getting NZ tailored solutions is rare.

This is why I think the opportunity is in making a crowdsourced system, as opposed to a 'product' to sell.

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

#75

Post by zupreme »

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…

So my startup hosts and supports a decent number of EHR/EMR solutions and I even seriously entered talks at one point for us to partner up with a large medical conglomerate to write a new platform. That idea died for the same two reasons most similar initiatives in healthcare die: Government and Insurance (called "Payers" in the healthcare industry).

You can write the absolute best EMR & PM (Practice Management) platform on the planet but if you can't get the payers to integrate with it you're dead in the water. The only practices who would even consider you without those integrations are ones not currently using an EMR, which means that your first hurdle with them has to be convincing them to go electronic - which means you own all the logistical hurdles associated with a large-scale chart-scanning operation, user training, mindset shifting, and much more.

And don't even get me started on the barriers to entry the Department of Health and Human Services have put in place....

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

#76

Post by JusticeJuice »

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…

https://en.wikipedia.org/wiki/Google_Health

They did try actually

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

#77

Post by swalsh »

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…

Google actually gave it a shot, and then eventually gave up. https://en.wikipedia.org/wiki/Google_Health

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

#78

Post by uzoodoo »

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…

Minor thing — your page title is "Page Title"

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

#79

Post by JusticeJuice »

zupreme wrote: post #75
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…

So my startup hosts and supports a decent number of EHR/EMR solutions and I even seriously entered talks at one point for us to partner up with a large medical conglomerate to write a new platform. That idea died for the same two reasons most similar initiatives in healthcare die: Government and Insurance (called "Payers" in the healthcare industry). You can write the absolute best EMR & PM (Practice Management) plat…

Interesting. I think there's a real argument that an integration platform for healthcare should be a government run entity - ensuring that all parties have a chance.

I'm curious about these barriers you speak of - I'm based in New Zealand, and I must admit I haven't run into many government based barriers to entry - just barriers created by privatized companies.

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

#80

Post by numbsafari »

JusticeJuice wrote: post #66
doughj3 wrote: post #58

Earlier quoted context omitted.

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, b…

Have you considered, in your model, how your system would work if a customer wanted to integrate with, as an example, a machine learning platform that attempts to predict the likelihood of a patient's readmission given their current status?
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