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OpenEMR: Electronic Medical Records and Medical Practice Management Software

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

#91

Post by ipunchghosts »

entee wrote: post #55
ipunchghosts wrote: post #51

As much as I would love this, I simply dont think it will work. Why? Epic is simply too big and has too much of the market and they are too far behind. I use picnichealth.com to deal with this EMR mess and I love it!

The pricing seems incredibly high, am I understanding correctly that they want ~$300 up front then $33/month thereafter? That said, working in this industry, I know exactly how hard it is to do this right. In many ways this is what it costs to do the job, if not more, but I'm not sure I'd pay it. There's the tragedy of the whole EMR/patient data story: bloody expensive, who pays?

That's weird, they changed their pricing plan. I only see the concierge service. Perhaps they have enough customers to be happy at the moment. I pay 10/month which is completely worth it in my mind. I can pull up pathology reports at my out of state docs office in real-time. Makes the best out of 3 hour trip to see the doc!

EDIT: I have also used this in conjunction with healthtap. EXTREMELY USEFUL! Doctors love it!

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

#92

Post by ipunchghosts »

nradov wrote: post #56
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…

That's not how the EMR market works. Insurance sales across state lines won't make much difference to EMRs either way. Google and Microsoft are horizontal vendors. They aren't likely to put a major effort into a vertical market, and even if they did there's no reason that they would do it any better than the existing vendors. It's not like Google and Microsoft have some sort of magic pixie dust that would allow them…

> It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market.

They have analytics, "moneyball" so to speak. There is a plethora of untapped data in these systems. I've worked with Gesinger in PA and you would not believe how far behind the curve they are and they are often touted to be on the forefront.

What needs to happen is getting google or MS into health insurance. They could utilize all the data collected to benefit the patients and make a big profit. Additionally, they have the know how to set up a pharm lab for drug development. Insurance companies really should drive drug development. It makes sense for them to develop drugs for conditions costing them the most amount of money per patient. Instead, they are middle men who have to work with whatever big pharma give them.

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

#93

Post by ipunchghosts »

lukas wrote: post #86
brianmartinek wrote: post #59

Does anyone know of a EMR system that could house my household/personal health data? One of the struggles I have is organizing my own health data in a singular place with structured data formats, document uploads, etc. The closest thing I have found is http://mymedicalapp.com/ but it appears to have been abandoned by the developer.

picnichealth.com

came here to say this. i use them. love it.

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

#94

Post by JusticeJuice »

numbsafari wrote: post #80
JusticeJuice wrote: post #66

Earlier quoted context omitted.

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?

Yeah, I have.

A health record is a collaboration - unlike a medical record, which just shows a slice of your health from the perspective of a single institution, a health record aims to show as many facets as possible. An EHR system should be agnostic about who access the record, and what they use it for - obviously gps, specialists, hosptitals, labs, the patient should all have access - but what about, as your said, software?

The ideal system would be,patient visits your system, goes through an OAuth flow, and your system has api access.

The tricky part is format. Its really hard to define a format which fits the entire world's use case. If you consider, what is healthcare information - you realize it's any data relevant to the patients health. So how can you even start to define that?

My compromise is a system where formats are promoted to become popular, regionally, and condition specific. So if you're building a machine learning readmission software, you can target a specific market - say British Primary care, or a specific condition, say diabetes. You can expand out to other markets by writing transformers to translate from one regional format to another.

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

#95

Post by yourapostasy »

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…

I strongly suspect that for the US healthcare system setting you are talking about, the incentives are misaligned for building a better EMR/EHR system. What we endure today satisfies those who profit mightily from it just fine, and improvements in health outcomes represent profit erosion, hence no true incentives to truly improve.

Could there be more room for improvements building from the ground up in alternative healthcare environments, like co-ops, hospitals where billing is in cash only and fees for standard procedures posted up-front, concierge, etc.? I don't think the mainstream US healthcare industry will change for the better unless it is presented with an immediate (Going down that path is absolutely more risky and less remunerative. Your post gives me the impression that while compensation ranks for you, I'm-On-A-Boat FU money at the expense of poor health outcomes for those you serve might not rank, so I thought I might throw out some outlier ideas and see what discussion falls out of that, if any.

To give an idea of how misaligned the US system is, this blog post [1] from my reading list today came up --- but to pick one at random out of a 3-second Google would be pretty easy --- describes how in the US a $5K MRI tab is not unusual. You can fly to NRT, pay in cash in Japan for an MRI and consult, fly back, about four times for that much. Cray cray.

[1] https://market-ticker.org/akcs-www?post=231917

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

#97

Post by Spooky23 »

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…

I don't see why any physician implements an EMR. My family doctor, who was part of a midsize practice was punished hard by adopting a system. They did it in 2007 thinking they would save money... which didn't happen as they were only able to eliminate 1/4 clerk positions and had to pick up an IT guy and a consultant. Then they really got the shaft when the solution they chose wasn't meeting Medicare guidelines. They ended up getting another system that is worse.

Now they got swallowed up by a regional medical system and have yet another EMR, plus they have 6 clerical staff versus 3 and whatever outsourcer handles IT for the hospital system.

My other doctor friend is a ophamologist. It's a small practice with 3 full time and 1 part time doctor. They pay the fine every year for not having an EMR and use paper and have a standalone system for sending prescriptions. He is enormously happy with paper and feels that's it better in every way, including cost. I agree -- I see zero value in the EMR systems.

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

#98

Post by brianmartinek »

lukas wrote: post #86
brianmartinek wrote: post #59

Does anyone know of a EMR system that could house my household/personal health data? One of the struggles I have is organizing my own health data in a singular place with structured data formats, document uploads, etc. The closest thing I have found is http://mymedicalapp.com/ but it appears to have been abandoned by the developer.

picnichealth.com

Thanks for the recommendation. It is what I am looking for except that it doesn't seem to offer any upload options if there are holes in the data they retrieve. Still, a step in the right direction and I'll give it a try.

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

#99

Post by Spooky23 »

Brybry wrote: post #28
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…

But most physicians don't work for hospitals. They work at small practices with 10 physicians or fewer (according to the AMA). There was a completely open market, made of the majority of physicians, regardless of existing provider contracts with hospitals. I know I talked to a few physicians (and other healthcare professionals) in the mid-2000s who lamented the paperwork they had to do every day and the lack of avail…

That's changing. Big hospital systems are swallowing up small practices. Old school medical practices are dinosaurs.
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