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

151–160 of 214 posts

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

#151

Post by shaftoe »

JusticeJuice wrote: post #79
zupreme wrote: post #75

Earlier quoted context omitted.

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.

I work in healthcare. A lot of the complexity is FROM government attempts to help.

Look at HIPAA. Originally about medical record portability, now it largely deals with security, privacy, and availability. These sound good, but it is frustratingly vague, subject to massive reactive fines, and assumes a lot of practices that always feel out of date. It's way more of a pain than private compliance frameworks like PCI.

The problems in US healthcare are complex, entrenched, and Brook no simple fix. The government is incredibly buearacratic, designed by lawyers who value an openness to interpretation by courts that creates ambiguity, and creates solutions in their own mold.

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

#153

Post by Spooky23 »

nickpsecurity wrote: post #113
Spooky23 wrote: post #97

Earlier quoted context omitted.

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…

I saw one system that seemed like a must have: apps that ensure you got the prescription right. Paper-loving doctors screwing up prescriptions harms a lot of patients. Especially when they insist on writing in cursive. Much of your post seems to be about bad tech, though. It could mostly be mitigated with a supplier that gave a shit.

Prescriptions ordered electronically seems to be the only thing that is an improvement.

Everything else is not only bad IT, but ruins your interactions because the medicinal person is bent over a laptop.

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

#154

Post by iheartmemcache »

ryanSrich wrote: post #135
fny wrote: post #130

Earlier quoted context omitted.

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…

SQL has 'interoperability' re: an ANSI standard. Theoretically you should be able to get off all those old Oracle contracts right? Eventually there are little nuanced things that users end up building their workflow completely around. Even if you change no functionality and just slightly alter the GUI, you're going to have complaints that something is broken. Inertia is your #1 vendor lock in feature. EPIC is as golden as Oracle just due to resident incumbency.

#2 is the whole risk aversion thing. Any platform migration is going to have political risk attached to it. Nike won't move away from Oracle even if Postgres can do everything it can line for line because paying the $200k maintenance fee each quarter is a cheap recurring cost compared to the political risk of a failed project.

That's not even factoring in #3, the little features here and there which are value-adds to the platform and not part of the standard. I've inherited projects where my firm offers to support O&M for some poorly written ASP 1.1 Classic software. We'll go in, patch some business-logic bug, and get a phone-call later that afternoon asking to rollback our fix. Turns out their users had integrated bugs into their workflow such that when the software operates "properly" (i.e. 'to spec') it actually breaks things (i.e. stops operating in an expected fashion).

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

#155

Post by ThomPete »

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 agree with everything you say besides the claim there is no economic incentive.

Just a few

1) Getting patients to pay their bills.

2) Spending less time on each patient.

3) Reducing errors.

All these have economic incentives. But yes it's still a hard sell.

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

#156

Post by ThomPete »

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…

The primary reason why healthcare is hard is legal and politics more than anything else.

I think a lot could be solved if someone decided to build the healthcare version of Zapier.

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

#157

Post by mabynogy »

fredsmith42 wrote: post #141
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…

The EMR market is consolidating on two big vendors: Epic and Cerner. Depending on how you measure it (Hospitals on a system or Medical Records under management), either Cerner or Epic is #1 and the other is #2. At this point, in the U.S., it is almost impossible for a newcomer to break into the market. There are many companies out there slowly losing market share to Epic or Cerner. Allscripts, Nextgen, McKesson/HBOC,…

> Finally, you have to realize that you are dealing with a very powerful and conservative management culture.

Has anybody tried to address the patient needs before?

Patients should be easier to convince. It could be a good strategy to influence the doctors and mangement to change their habits.

I'm thinking of a tool to allow the patient to enter data that they could give to their doctor.

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

#158

Post by gm-conspiracy »

nickpsecurity wrote: post #113
Spooky23 wrote: post #97

Earlier quoted context omitted.

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…

I saw one system that seemed like a must have: apps that ensure you got the prescription right. Paper-loving doctors screwing up prescriptions harms a lot of patients. Especially when they insist on writing in cursive. Much of your post seems to be about bad tech, though. It could mostly be mitigated with a supplier that gave a shit.

Also sounds like a shitty pharmacist and pharmacy tech.

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

#159

Post by FLUX-YOU »

entee wrote: post #116
FLUX-YOU wrote: post #82

Earlier quoted context omitted.

That sounds more like a patient portal used by patients. Building something for physicians, nurses, revenue personnel, lab personnel, and practice managers is a completely different game.

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 b…

>But the front line workers are kind of disconnected from the design and functionality of the EMR.

We have front line personnel complaining to us all the time that the EMR is slow and unwieldy and suggest features to bypass the features that the EMR has built. These are applications that block the UI thread for nearly every database or long-running call, a veritable sin these days.

Most apps would come from people who have worked directly with the EMRs before, so it's rare to have one thing that talks to all of them but not impossible. If there is a perfect example of institutional knowledge, EMRs would be it. As a developer, you'd be focusing your marketing on people who already have that solution and position it as an addon. Independent products are difficult to do because interop barely exists and that interop standards that do (like HL7) have very little constraints or an escape hatch to add whatever you like.

The reason you have to take this parasitic marketing stance is due to the massive effect that EMRs have on every day workflow. Many decisions for buying software are made in light of how it works with the EMR if it's relevant to patient care. EMR choice is akin to operating system choice for the hospital or practice.

And there could well be a tight connection between the front line workers and the EMR developers, but it wouldn't matter because long-term contracts prevent any threat of either side losing their jobs soon.

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

#160

Post by nradov »

neandrake wrote: post #115
FLUX-YOU wrote: post #82

Earlier quoted context omitted.

That sounds more like a patient portal used by patients. Building something for physicians, nurses, revenue personnel, lab personnel, and practice managers is a completely different game.

I think the idea they were going for is that Google Health would be an EMR intended to be used by institutions except that the patient is in control of their record - enabling them to take their health record to any provider. The problem is that institutions have close to no reasons for investing into something like that. I think Microsoft HealthVault was more of what you describe, where it's a portal intended to be…

No, @FLUX-YOU has it right. Google Health was only ever intended as a patient portal (PHR) and was a direct competitor to Microsoft HealthVault. Google never added any EMR features. In fact after the initial release they never added any features at all; they just lost interest in it and shut it down.
Post reply on HN