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OpenEMR: Electronic Medical Records and Medical Practice Management Software

open-emr.org

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

#191

Post by gmarx »

nradov wrote: post #162
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…

It's no longer necessarily true that providers make money every time you get sick. Insurers have shifted risk to providers in some areas in the form of accountable care organizations (ACOs) which receive a flat fee per patient. So in theory the ACOs have a financial incentive to prevent you from getting sick. Kaiser Permanente uses the same Epic EMR software as many other large provider organizations.

In fact they were essentially the first and the reason it has become a near monolopoly

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

#192

Post by ensignavenger »

Herodotus38 wrote: post #188
ensignavenger wrote: post #182

Earlier quoted context omitted.

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…

Thanks- ideally the auditing would be done regularly, and require a reason to be entered for any access the first time a new provider accesses your information. Even better each patient would have a USB stick with a One Time Token generator that would 1) hold basic emergency information on the USB drive) 2) Generate One Time Keys to grant access to new providers. Of course, in an emergency situation where a provider has an ID but can't find your USB key, they could enter an over-ride with a reason- which would be strictly audited. Also, patients should have a list of who has accessed their information and why- and even be able to sign up for alerts anytime someone new accesses it.

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

#193

Post by gmarx »

mabynogy wrote: post #157
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,…

> 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.

lots of people are working on the patient-centric record. No one has cracked the cultural problem and the integration problems. You would be requiring docs to re-enter most of the information in their own system.

Remember, the things we call EMR aren't primarily medical records, they are systems for sending the right codes to the billing systems

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

#194

Post by mdoneill »

entee wrote: post #68
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?

Double bonus for this, we've been working with FHIR at Lumiata and it's quite good for certain things. Difficulty is that most EMRs as is work with tabular databases, and FHIR isn't quite organized that way. It does require some work to translate the tables people usually have into that format. Still a native FHIR EMR would be really cool! [EDIT]: https://www.hl7.org/fhir/ for the interested

At MedicaSoft, we are building a native FHIR EMR and PHR. See medicasoft.us.

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

#195

Post by mabynogy »

gmarx wrote: post #193
mabynogy wrote: post #157

Earlier quoted context omitted.

> 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.

lots of people are working on the patient-centric record. No one has cracked the cultural problem and the integration problems. You would be requiring docs to re-enter most of the information in their own system. Remember, the things we call EMR aren't primarily medical records, they are systems for sending the right codes to the billing systems

> You would be requiring docs to re-enter most of the information in their own system.

Why not gave-up at the beginning with data exchange. Make something that could help both the patients and the physicians.

For example, a mobile app could gather some data concerning the patient habits (with the gps, accelerometer...).

The idea is to create a need and make it mandatory (because very useful).

> Remember, the things we call EMR aren't primarily medical records, they are systems for sending the right codes to the billing systems

Yes. I'm looking for a way to change that. For example, with something more health-centric than money-centric.

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

#196

Post by mabynogy »

sachinag wrote: post #73
mcphilip wrote: post #44

Earlier quoted context omitted.

I work at a top 10 EMR on the interface engine team. Messages between products require a lot of custom work to align message types and IDs, establishing a compendium of identifiers for external labs and identifiers, but it's not uncommon.

Yeah, but I can't take my data from Epic and move it all into Cerner via HL7, no matter what. What we need are government standards for data at rest, similar to DICOM, for other data - and tied to Medicare reimbursement. Literally some functionary at CMS could write that rule and patients would be better off.

Or machine learning to mechanized the matching.

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

#197

Post by Herodotus38 »

ensignavenger wrote: post #192
Herodotus38 wrote: post #188

Earlier quoted context omitted.

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…

Thanks- ideally the auditing would be done regularly, and require a reason to be entered for any access the first time a new provider accesses your information. Even better each patient would have a USB stick with a One Time Token generator that would 1) hold basic emergency information on the USB drive) 2) Generate One Time Keys to grant access to new providers. Of course, in an emergency situation where a provider…

So I think your ideas are good, but you have to realize the multiple competing priorities in healthcare. When you say ideally, you mean from a privacy standpoint. In my opinion "best health outcome of the patient" should be the highest ideal.

Say I am working a night where I may be paged on 100 patients who I am meeting for the first time. Just opening their records on The EMR eats a significant amount of time. Time which I need to take care of people. Adding an additional click would mean even less time and poorer outcomes.

You also have to realize that nobody is going to carry a USB. I have worked in diabetes clinics where most pts don't remember to bring in their glucometer, which is the entire point of the clinic. You have to realize that the patient population also includes the average American (and half by definition are below average intelligence.)

I mean, I could go on for hours and make my own personal list of the issues with American Healthcare and I wouldn't list pt privacy in the first 100....

Not trying to be dismissive but I'm just trying to give you computer technical folk an idea of why EMR is such a hard field and how many factors you have to consider which is really difficult if you aren't 'in' the system. Even I who knows more about programming than 99% of docs feel completely ignorant when I talk to healthcare IT folks about HL7, etc...

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

#198

Post by mabynogy »

Skeletor wrote: post #121

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…

Very clear and interesting concept:

https://app.drchrono.com/ehr-emr/medical-form-templates/5561...

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

#199

Post by gmarx »

fnovd wrote: post #17
jdhe wrote: post #13

As other comments mention, this project has been going for a while, the central reason it (or something like it) has not been robustly built out and deployed universally is because of the way congress chose to structure the funding for development of EMRs/EHRs. Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop s…

>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…

Now you've hit my area of expertise. This might help enable large retrospective cohort studies but would not be sufficient. In order to do that the universal system would need to do several things which are unlikely: 1)Universal clinically meaningful data model 2) Extensive use of standard terminology codes 3) good model of timeline 4) user interface which encourages the entry of discrete data over free text

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

#200

Post by gmarx »

ipunchghosts wrote: post #53

EMR is simply too messy for openEMR to put a dent in the issue. I truely wish it were different. If insurance carriers are permitted to operate across state lines in the future, i think there is a chance of a Google or Microsoft getting into the space which I think is the right way to go. Right now, the large companies managing EMR and huge monoliths that simply don't care about innovation. They are like defense cont…

your faith in Microsoft and Google is heartwarming and hilarious. I've been hearing this for over 20 years, as soon as the real smart tech people get involved we'll have this problem solved lickity split. Well, both those companies have tried to lick healthcare and both ran away with their tails between their legs after they took a crap on the bed.

Healthcare information tech sucks because it's innately more difficult than most other problem spaces

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