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OpenEMR: Electronic Medical Records and Medical Practice Management Software

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

#181

Post by acveilleux »

nradov wrote: post #70
cmiles74 wrote: post #35

Earlier quoted context omitted.

I don't think we will ever see HL7 messages exchanged between organizations. Each product has it's own list of message types that they support, and even then they will vary in terms of which segments have data and in some cases, even what that data will be. Patient identifiers also vary between organizations, making it hard to know which patient goes with which piece of data. Alternative methods for passing data betw…

You haven't been paying attention. I've been working on products which exchange HL7 messages between organizations for 20 years. It's very common now. Some configuration work is usually needed on each interface but that's mostly a solved problem.

My experience is that "some configuration" translates to 6 months and 50k$. Especially when the really big vendors are involved and when those vendors have competing products.

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

#182

Post by ensignavenger »

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 I think your comments about poor communication (btw Epic systems) are outdated.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…

How do they prevent abuse? How does a patient know who is accessing their records?

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

#183

Post by ipunchghosts »

nradov wrote: post #126
ipunchghosts wrote: post #92

Earlier quoted context omitted.

> 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 i…

> 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,

I work with the Geisinger health system at a major US University doing analytics work for them. They are far ahead of most other systems and they are woefully behind.

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

#184

Post by officelineback »

iheartmemcache wrote: post #154
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…

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 gold…

Do we do relevant XKCD here at HN? Cos https://xkcd.com/1172/

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

#185

Post by entee »

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…

Good to hear it's gotten better!

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

#186

Post by Herodotus38 »

ensignavenger wrote: post #182
Herodotus38 wrote: post #118

Earlier quoted context omitted.

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…

How do they prevent abuse? How does a patient know who is accessing their records?

It is primarily through deterrence. Anyone allowed to use an EMR must go through training about HIPAA rules. A waiver is sometimes required that Epic asks you to print out and sign and put in the patient's chart (although they obviously can't prove you did this, it would be an issue if there was a problem later and it turns out you didn't do this, i.e. You would be liable for whatever penalties/prosecution). Furthermore, all usage is recorded and occasionally audited in my system. I'm not 100% sure the auditing is a requirement and true everywhere (definitely with any hospital or large clinic it will be).

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

#187

Post by Herodotus38 »

entee wrote: post #185
Herodotus38 wrote: post #118

Earlier quoted context omitted.

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…

Good to hear it's gotten better!

What I see happening is that eventually there will be so much merging of our healthcare systems in the next 10 years that there will eventually be a point where there are only several "players" in any area meaning that the problem of intercommunication becomes much simpler (i.e. Epic, Cerner, and Medtronic).

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

#188

Post by Herodotus38 »

ensignavenger wrote: post #182
Herodotus38 wrote: post #118

Earlier quoted context omitted.

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…

How do they prevent abuse? How does a patient know who is accessing their records?

Also, in reply to who is accessing your records you don't know. I suppose you could ask for records of who had accessed it by a certain date, but once your records are in there they will likely be accessed by your insurance company for billing purposes.

You can add an additional layer of warning in Epic. I see this most often with psych records or pts who want an extra layer, such as if they work in the same hospital. All this entails though is an extra prompt warning requiring you to put in a reason why you are accessing the records, and put in your usr/pwd again and warns you it is being recorded, etc...

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

#189

Post by brady_m »

peterwwillis wrote: post #148

I came here to ask the question "Has anyone (hopefully) done a 3rd party security audit of this open source medical records software?" But then I saw this: http://www.open-emr.org/wiki/index.php/FAQ#What_is_ImageMagi... And then this: http://www.open-emr.org/wiki/index.php/FAQ#What_are_the_corr... ..... http://www.open-emr.org/wiki/index.php/FAQ#What_do_I_do_if_I... http://www.open-emr.org/wiki/index.php/FAQ#What_is_…

Agree that security is an important topic.

Note there has not been a default password for about 5 years, and will update the FAQ.

Regarding the other FAQ links you posted, what specific security issues are there with those?

To get an idea of OpenEMR's security, recommend checking out the following section on the wiki(1 of those links has several 3rd party security audits): http://www.open-emr.org/wiki/index.php/OpenEMR_Wiki_Home_Pag...

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

#190

Post by gmarx »

fny wrote: post #161
iheartmemcache wrote: post #154

Earlier quoted context omitted.

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 gold…

While I strongly agree with points 2 and 3, SQL standards are useless when hospitals invent their own schemas and data governance. Looking for serum creatinine? Good luck without local knowledge. There are probably 30 tables (not exaggerating) for that lab, and the closest you can get without chasing 7 people for info is grepping all the table names for "/CREA/".* *Based on a true story.

Key point
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