Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

OpenEMR: Electronic Medical Records and Medical Practice Management Software

open-emr.org

Post reply on HN
Print view View original

121–130 of 214 posts

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

#121

Post by Skeletor »

I think it's great that there are projects like http://www.open-emr.org/ , https://oscar-emr.com/oscar/ , http://openmrs.org/ , and https://www.hl7.org/fhir/http.html ;

I think these tools would be even better if they released their code under LGPL (instead of GPL) so that lazy commercial EHR developers would reuse and help maintain some core modules to promote more interoperability.

I don't think it's going to ever be possible (or that it is even desirable) to ever have a "Universal EHR" that everyone is forced to use through either government intervention or through market/economic forces. We can all exchange emails with each other, but we aren't all forced to use the same email client

The reason that the entire healthcare system seems broken to most consumers is legacy EHR systems in large hospitals. These legacy enterprise vendors are essentially what Oracle was 20 years ago in the rest of the enterprise software market before companies like Salesforce.com came along. Another part of this "broken" feeling is the difficulty of exchanging data between different EHR systems; but this doesn't have to be the case.

"If you've seen one HL7 standard implementation, you have seen exactly one HL7 standard implementation." Which means most systems don't interoperates with anyone else's systems unless there is an existing commercial relationship that forced everyone to interoperate on a local scale.

For anyone looking to work on an idea to improve healthcare check out: https://www.drchrono.com/api/ and/or https://www.drchrono.com/careers/

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

#122

Post by JusticeJuice »

yourapostasy wrote: post #95
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 he…

Just to be clear, I'm actually designing this system with New Zealand in mind, which has a very socialised healthcare system. I've got no idea how to help the american healthcare system

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

#123

Post by Eugr »

darkmarmot wrote: post #41
fnovd wrote: post #17

Earlier quoted context omitted.

>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.

Well, PHI protection (HIPAA) is actually a good thing and doesn't really prevent researchers from accessing data as long as PHI is stripped (de-identified dataset). Now getting that de-identified data is not always easy...

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

#124

Post by wallace_f »

walrus01 wrote: post #107
wallace_f wrote: post #106

Earlier quoted context omitted.

I did some work for a company that had 100+ banks running accounting software developed in Visual Basic in the early 90s. Unfortunately, this experience, supporting obsolete, spaghetti-code-nightmare, opened my eyes to the world that business is done in a much dirtier way than how I imagined growing up.

Willing to bet you $5 that the spaghetti code accounting software written in VB in the early 1990s is actually a GUI front end on top of an AS/400 or an IBM system/360 thing that's now running in emulation on a "mainframe".

It was just a stand-alone application fully-coded in VB.

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

#125

Post by yellowapple »

jldugger wrote: post #112
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…

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.…

In my observation, I've found that there are quite a few larger healthcare providers, and that even the "smaller" hospitals are pretty big in terms of IT needs.

In my hometown alone, there's Kaiser Permanente, Sutter Health, and UC Davis. Sure, none of them are quite nationwide, but they're by no means "small", either.

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

#126

Post by nradov »

ipunchghosts wrote: post #92
nradov wrote: post #56

Earlier quoted context omitted.

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 hap…

I don't think you've been paying attention. All the major payers Health IT vendors have analytics as good as anything at MS or Google, to the point where it's almost becoming a commodity rather than a real differentiator. Yes provider organizations are behind the curve in actually using those tools due to misaligned incentives but adding another vendor to the market won't solve that problem.

Payers have no interest in driving drug development. It wouldn't give them any competitive advantage. It's not like they could restrict sales of a new drug to only their own members! And most payers are providing very little "insurance" now anyway. Mostly they just process claims on behalf of self-insured group buyers.

And the notion of those companies getting into medical insurance or drug development is just ludicrous. Their corporate boards would laugh the idea out of the room.

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

#128

Post by nradov »

Spooky23 wrote: post #101
nradov wrote: post #67

Earlier quoted context omitted.

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.

All enterprise customers are stupid about COTS customization. That doesn't change the fact that the software surrounding the entire medical industry is largely ridiculous legacy crap maintained by a little cartel of fat & lazy vendors with a captive market. With good reason btw... these systems were the earliest big data processing shops. Blue Cross and Medicare was doing centralized billing for healthcare since befo…

Labeling something as "legacy" is a lame basis for criticism. Customers don't care about the age of a product's code base. What matters is price, functionality, and support. If you want a non-legacy EMR just for the sake of novelty then there are plenty of options available. But they aren't necessarily any better.

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

#129

Post by nogaleviner »

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?

PicnicHealth CEO here. We did raise prices to keep quality super high as we scale, but here's a nice discount for our HN friends. Enjoy! https://picnichealth.com/friends-of-picnic

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

#130

Post by fny »

JusticeJuice wrote: post #74
fny wrote: post #69

Earlier quoted context omitted.

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 improv…

I have no idea what the market is like in New Zealand, so my insights there are limited, but a lot of EMR systems in the US have a similar notion of customizability built into the interface. Epic, the largest EHR vendor in the US, for example, doesn't sell a one size fits all solution. Hospitals develop their own GUIs and workflows within Epic, but again, hospital administrators make all the UX/UI decisions while optimizing for documentation that bolsters billing. Again, the doctors lose.

For small practices, this might be a viable solution, but then again, they'd probably rather purchase a complete IT solution than something that handles medical records alone.

Also, have you looked at OpenMRS?[0] They have a module system that allows you to develop extensions to the EHR.[1] If you're looking for your thesis to have a big impact, I'd really recommend getting in touch with an organization like OpenMRS or Partners Healthcare to see how you can extend their platforms. If you want an introduction, drop me a note: faraz dot yashar at the gmail.

[0]: https://openmrs.org

[1]: https://modules.openmrs.org/

Post reply on HN