OpenEMR: Electronic Medical Records and Medical Practice Management Software • Hacker News Board

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

#131

Post by ryanSrich » Fri, Mar 17, 2017, 4:14 AM UTC

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…

When patients are treated as consumers we'll see the wave of economic incentives. Value based care as part of the ACA is headed in the right direction.

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

#132

Post by nogaleviner » Fri, Mar 17, 2017, 4:16 AM UTC

brianmartinek wrote: post #98

lukas wrote: post #86

Earlier quoted context omitted.

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.

PicnicHealth CEO here. You won't have this problem because we don't miss any data :) But really, if you have old stuff we can't get anymore we can find a way for you to send it over.

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

#133

Post by doctorpangloss » Fri, Mar 17, 2017, 4:18 AM UTC

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…

> ...exception to this is Kaiser Permanente

They are notorious in the medical community for valuing efficiency above all else. Kaiser also doesn't serve extremely difficult cases, uninsured patients or patients on Medicaid. Academic hospitals do.

Kaiser can do a lot of things differently by virtue of being subsidized by the generosity of the state and the state's highly talented doctors. I don't know how much there is to learn from them.

> they make money every time you get sick

Nobody at an academic hospital makes money every time you get sick. Discharging patients is a high priority. Doctors are constantly trying to figure out how to do preventative care with the sorts of "frequent flyer" patients that tie up emergency rooms and hospital beds.

To be more blunt, you're not really describing reality. You're describing a particularly cynical point of view, common among people who are unlucky enough to be (or to know someone) rich, sick and not getting better. It's doctor as antagonist, and it tends to emerge in some kind of economic rationalization.

Here's reality: Mark Zuckerberg put his name on an academic hospital in San Francisco that has utterly dysfunctional EHR. Everyone in the system—especially the doctors, contrary to what you say—hates it and wishes the money would have been spent to improve it.

Even the tech fantasy of magic money wand can't solve this problem. It isn't the fault of doctors ("you know who hates EHRs the most? Doctors"). No clever turn of the phrase or insight is going to provide the answer. Blah-blah-blahing about incentives isn't going to provide any solutions. It's a complex system.

The original poster was saying as much. But then all the other commenters go on and start talking about economics, incentives, anecdotes, and assorted conspiracy theories. The guy is studying this! I think he's coming to the right answers.

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

#134

Post by angersock » Fri, Mar 17, 2017, 4:19 AM UTC

nradov wrote: post #67

angersock wrote: post #49

Earlier quoted context omitted.

> 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.

> You really can't blame the vendors for that.

To quote the great Henry Ford: "Any customer can have a car painted any color that he wants so long as it is black."

They've empowered the clients to keep doing stupid things because it's good for business.

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

#135

Post by ryanSrich » Fri, Mar 17, 2017, 4:21 AM UTC

fny wrote: post #130

JusticeJuice wrote: post #74

Earlier quoted context omitted.

> 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 opt…

The reason why so many EHRs are poorly designed is in part because they are so flexible. Don't under estimate the ego of a physician to think their way is superior to the way the doctor down the road does something.

The EHR model will eventually lose because its one sided. Consumers and patients are completely left out of the picture and EHRs have no incentives right now to change. Beyond that companies like Epic are operating on outdated business models. The days of the black box of data that lives inside the four walls of the health system are numbered.

Consumers won't deal with a dumpster fire of technology once they have the choice. Digital health will win once the barriers of compliance and interoperability are broken down.

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

#136

Post by jldugger » Fri, Mar 17, 2017, 4:39 AM UTC

yellowapple wrote: post #125

jldugger wrote: post #112

Earlier quoted context omitted.

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.

Part of the challenge is that hospitals represent only one portion of the care chain. My mom's GP, for instance, has never used a hospital as their office. There are dozens of hospitals within 30 minutes driving distance, of which few are owned by the same company / non-profit.

KP is in the vein of what I'm suggesting though, just wish it was more widely available.

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

#137

Post by fredsmith42 » Fri, Mar 17, 2017, 4:41 AM UTC

Herodotus38 wrote: post #118

entee wrote: post #52

Earlier quoted context omitted.

The issue with small practices and even slightly larger physician's groups is that an EMR is often just a cost, with very little benefit. If you're a hospital with lab facilities, imaging facilities, surgical facilities etc. it's hugely useful to have medical records flow internally (quasi-)seamlessly. The EMR does that well, and the large cost of typing things into the EMR (it's slow, painful, annoying, never met a…

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…

That is great for other accesing records from other hospitals that use Epic, but what happens if you want to access the records of a patient who also visits a VA or Cerner hospital? You are still in the dark.

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

#138

Post by fredsmith42 » Fri, Mar 17, 2017, 4:48 AM UTC

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…

Um, what? I've spent 20 years implementing EHRs. You seem to be implying that hospitals were using paper until 2009. I've implemented lab systems with electronic charts in VMS. The systems weren't, and aren't, interoperable, but they were definitely recognizable as EMRs.

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

#139

Post by fredsmith42 » Fri, Mar 17, 2017, 4:54 AM UTC

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…

Most if not all health care systems are implementing FHIR as a layer over HL7. Most of those systems don't have people really conversant with web technologies. Interoperability is, I think, a mirage built on top of already overworked integration staffs.

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

#140

Post by [deleted] » Fri, Mar 17, 2017, 5:16 AM UTC

Herodotus38 wrote: post #118

entee wrote: post #52

Earlier quoted context omitted.

The issue with small practices and even slightly larger physician's groups is that an EMR is often just a cost, with very little benefit. If you're a hospital with lab facilities, imaging facilities, surgical facilities etc. it's hugely useful to have medical records flow internally (quasi-)seamlessly. The EMR does that well, and the large cost of typing things into the EMR (it's slow, painful, annoying, never met a…

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…

[deleted]