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

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

#171

Post by organsnyder » Fri, Mar 17, 2017, 1:57 PM 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…

There is absolutely an incentive for healthcare systems to do these transformations. But it requires leadership that is willing and able to see the long-term benefits. Of course, that can be challenging, and is probably only feasible in larger nonprofits (for-profits need to please shareholders, and smaller organizations simply can't afford it), but the future payoff is there.

I think we're in the turd-age (opposite of golden age) of EMRs right now. Everyone has adopted them—many unwillingly—but user interfaces are still terrible, and interoperability is spotty at best. There are signs of this changing (lots of vendors are touting/promising UX improvements, and FHIR is hot right now), but it will still take time.

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

#172

Post by ryanSrich » Fri, Mar 17, 2017, 2:00 PM UTC

nradov wrote: post #167

ryanSrich wrote: post #135

Earlier quoted context omitted.

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…

You don't seem to understand the market dynamics. Consumer preferences have little or no impact on provider EHR selection. In general the only consumers who really care about controlling their own data are those with complex, long-term chronic medical conditions who see providers from multiple different organizations. Otherwise most patients are satisfied using the captive PHRs tied into individual provider organizat…

Actually quite the contrary. I work in this space everyday.

My point was that the model you describe is dated and broken. When consumers have the choice to make decisions around technology, price and value, they'll do exactly that. Right now they have no say in the matter, as you've pointed out.

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

#173

Post by Spooky23 » Fri, Mar 17, 2017, 2:00 PM UTC

nradov wrote: post #128

Spooky23 wrote: post #101

Earlier quoted context omitted.

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.

Legacy isn't a dirty word.

But the fact is that these ancient systems are nightmarish to work with, and because they are so ancient, they predate many of the standards and capabilities that modern systems have.

I spent a decade working around a big legacy system originally built on a Sperry mainframe in the mid 70s. The system was awesome in some ways -- amazingly performant, efficient and well tuned. But the reason it was so awesome was it's downside as well... it is almost static, changes are difficult/impossible to make. In the EMR space, things have to change, but because it uses an ancient/domain specific set of artifacts, you're stuck with a small number of incumbent vendors with whatever functionality they are willing to do.

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

#174

Post by nradov » Fri, Mar 17, 2017, 2:18 PM UTC

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.

You're looking for a personal health record (PHR), not an EMR. One option is Microsoft HealthVault. https://www.healthvault.com/

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

#175

Post by numbsafari » Fri, Mar 17, 2017, 2:48 PM UTC

JusticeJuice wrote: post #94

numbsafari wrote: post #80

Earlier quoted context omitted.

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,…

So, if I want to run an daily analysis of every record in your system, does that processing happen on your system, or do you somehow replicate the data to me?

I guess my point is... it's likely that you may want a "single source of truth" for the data, but farm out copies for other applications. And once you do that, you probably want some kind of "replication protocol" that sends updates, rather than making a full copy of the data every day.

And once you've done that, aren't you right back where we are today?

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

#176

Post by ams6110 » Fri, Mar 17, 2017, 3:08 PM UTC

messo wrote: post #166

Norway has been building a universal and state-run system the last couple of years, which gathers all the patient information in one centralized system. Existing commercial companies that already deliver solutions to doctors and hospitals have integrated this new system into their existing products. It is practically interoperable by now. I believe this is the way to go. The system was beta-testet last year, and is b…

Not crazy about the state-run angle, but I want no part of any EMR system that doesn't allow me to log in and view my own records.

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

#177

Post by acveilleux » Fri, Mar 17, 2017, 3:27 PM UTC

iheartmemcache wrote: post #149

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…

Oh man, this is so insanely true, allow me to just contextualize this for you with a POV from the States. I'm not in medicine (oh thank Christ) but I come from a family where I couldn't ignore the the industry if I wanted to. (Literally every male for 3 generations on both sides have worked directly in either medicine in a university capacity after their PhD, actively practice(d) medicine, or more commonly done both.…

I work in healthcare integration. I have interfaced with EPIC and Cerner and pretty much all the other main EHR platforms and seen my clients struggle with their IT.

You sir are absolutely spot on.

As for single-payer, well yes it does make a huge difference on the billing side which is often the biggest IT/tech user of an hospital. My canadian clients still have to worry about billing but they only have 1 insurance carrier to deal with and they know precisely how much everything will earn them upfront. Everyone else (tourists, out of region people, folks who let their healthcare ID lapse) pays cash at basically the same rates, thank you.

Fun fact, the oldest healthcare products like Meditech started from Billing and grew from there, it shows throughout the software still (and not just because they're written in MUMPS / InterSystems Caché). In Meditech results don't actually need a patient ID to be accepted (via electronic messaging/HL7), they need an account number so they can be billed on the right invoice. Nope the software will not figure out from the Order ID which account it goes to... Downstream systems are expected to keep those account numbers around and up to date, a patient might have 2-4 of them at the same time.

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

#178

Post by acveilleux » Fri, Mar 17, 2017, 3:34 PM UTC

fredsmith42 wrote: post #138

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…

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.

He's probably limiting the definition to the kind of overarching EMR that fully replaces paper charts for all departments and provide a single view of the patients.

I've also done migrations (I'm in radiology systems, PACS and RIS) where clients had reports going back to the early 1980s. Not very common mind you, especially in private practices (which we get a lot of) and rural hospitals (the kind of places with CPSI/Evident or, god forbid, Healthland.)

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

#179

Post by acveilleux » Fri, Mar 17, 2017, 3:43 PM UTC

JusticeJuice wrote: post #150

fredsmith42 wrote: post #141

Earlier quoted context omitted.

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,…

> In New Zealand, the market is different at this point, but how long can they resist the network effects of the big vendors? Good point, here all hospitals use software from Orion Health, which is an NZ company - They have a really good hold on the market and I don't see that changing. > You have mentioned in another post that you are concentrating just on records, … With all due respect, I think you are being naïve…

It's kind of funny cause I'm in the imaging side and there's a buzz now about "deconstructed PACS" where centers will mix and match different vendors to provide radiologist workflow, image storage, DMWL worklist, Diagnostics Viewer, VR, distribution and analytics.

Right now, that's quite niche and arguably the DICOM space is the most open part of Health IT, but perhaps that will eventually percolate up to EMRs. Maybe once FHIR catches on or whatever will replace FHIR. I'm frankly still using HL7 2.x and mostly 2.2/2.3 level features.

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

#180

Post by ensignavenger » Fri, Mar 17, 2017, 3:54 PM UTC

messo wrote: post #166

Norway has been building a universal and state-run system the last couple of years, which gathers all the patient information in one centralized system. Existing commercial companies that already deliver solutions to doctors and hospitals have integrated this new system into their existing products. It is practically interoperable by now. I believe this is the way to go. The system was beta-testet last year, and is b…

How do patients authorize a new care provider to access their data? How do patients prevent the government from accessing their private health data? (Obviously the latter is a problem even for distributed systems, but a lot easier if the government already has the data on servers they control!)