OpenEMR: Electronic Medical Records and Medical Practice Management Software

There's also some structural reasons. Why is it that larger practices don't write their own software? Well, maybe a few do, but:

a) nearly all states require that ownership in medical practice be restricted to those licensed to practice. This reduces access to capital, and more or less ensures that practices remain small businesses. b) nearly all care in the US is fragmented across specialists in different practices. c) healthcare in the US is largely paid for by parties fairly disinterested in actually transacting. While most folks on HN might A/B test UI improvements looking at click through rates, the implicit idea in insurance billing software is that submitting claims is someone else's expense to deal with.

When you look at places where there is a scale to medical practice, opportunity for software opens up. VA and DoD both operate and staff their own health care facilities, and have software systems they've implemented. But even DoD has problems receiving and retaining records from outside care providers (if Wikipedia is to be believed).

If there were fewer, larger medical practices in the US, it would both be easier to agree on standardized data sharing protocols, and more likely for patients to see multiple doctors working for the same employer, thus never necessitating a data transfer. Admittedly, it'd be harder entrepreneurs like yourself to break in. Perhaps you'd be an employee or Engineering manager working on the problem instead. Or perhaps you'd be selling a plugin to a larger EMR.

Slightly OT: I read somewhere that whenever you see "to disrupt" you should replace it with "to fuck up" as that is the true meaning of what is being said. Not that it's always a bad thing, but it is almost always destructive.

It turns out re. docs and nurses, not really. It's important to understand the who pays for what in healthcare, and how many links in the chain exist between payer, payee and who benefits. Physicians and nurses are not able to pick whatever software they want to view patient data because 1.) you need high security all around that data, and 2.) that data is primarily useful to someone else. It's useful to the doctor because they want to treat the patient. It's a lot more useful to the hospital because they want to get paid for what was done.

So the hospital is willing to shell out a ton of cash so that they have a Very Secure system that helps them better manage their cash flow. If you walk in as a doc with (for example) a nifty phone app that lets you track your patients in real time, you'll confront 2 problems: 1.) the hospital won't let you connect because it'll assume (possibly incorrectly) that it's a huge security hole. 2.) even if they did let you connect, their EMR is non-standard (basically all of them end up non-standard) and there's no lingua franca protocol for medical data, so your app is incompatible.

It's really really tricky to solve all those issues AND have it be cheap enough for a doc to be willing to shell out for it out of pocket. I personally you'd need that kind of consumer-side scale to get enough competition to get medical software to innovate more quickly. I will say a common interchange format would help a lot, that's one of the objectives FHIR had, and the industry has been slowly adopting it.

You accurately point out revenue personnel and practice managers as key players here, and yes they're the ones that usually push EMRs etc. But the front line workers are kind of disconnected from the design and functionality of the EMR.

Put another way you have software that's bought by one person (hospital/provider), it's used to collect data by a totally different person with different needs (docs/nurses), and it's paid for eventually by another person who has no idea how it works nor any direct pressing need for it (patient/but let's be real, insurance company/government).

Without a tight connection between who pays for the software, who uses the software and who benefits from the software (most consumer software is a pretty tight loop), it's hard to have a good virtuous cycle of innovation coming from customer/user insight/observation/needs.

So I am a physician with a large hospital system that uses Epic. I think your comments about poor communication (btw Epic systems) are outdated. For the last two years when I admit a patient I can easily access all Epic records not only in other hospitals in my state, but in the country through their system labeled "CareEverywhere". It is a game changer and is really the main reason why I rank Epic above other EMRs I've used.

I think it is easy to use, and yes it has the potential to nearly (if not completely) eliminate all paperwork in your clinic.

As far as safety, openEMR is fully HIPPA compliant as well as 2014 ONC Complete Ambulatory EHR certified (a/k/a Meaningful Use 2).