OpenEMR is Accepting Donations on OpenCollective • Hacker News Board

Re: OpenEMR is Accepting Donations on OpenCollective

#21

Post by aaavl2821 » Mon, Dec 18, 2017, 7:33 PM UTC

Dowwie wrote: post #2

The Affordable Care Act mandated use of EMR and heavily funded its adoption. Is there really not one fully implemented open source solution after all that money was spent? Why does this project exist?

the HITECH act essentially created a duopoly in the EMR market: Epic and Cerner. Cerner is a public company so you can look at their financials and see the massive tailwind that was the HITECh act. they sell basically compliance and billing products to hospitals for 9-figure installation checks and huge, multiyear service contracts. once you get locked in, its incredibly painful to get out (see above 9-figure, multi-year installs)

EMRs are massive cash cows for the big players (who are now largely just 2, epic and cerner). these products are largely built to comply with regulations and make billing easier. they are build for hospital admins. physicians hate them, and many blame them for the massive increase in physician burnout over the last few years

building one of these would be a pain in the ass as you need to digitize hundreds of clinical forms and comply with a dizzying set of regulations. the architecture for a lot of these things is from the 1970s, but the sheer amount of features needed makes building one from scratch painful. and the market power of the incumbents makes it really tough to even carve out niche features

if there is any group in healthcare that should be disrupted, its the EMR companies

Re: OpenEMR is Accepting Donations on OpenCollective

#22

Post by orb_yt » Mon, Dec 18, 2017, 7:39 PM UTC

aaavl2821 wrote: post #21

Dowwie wrote: post #2

The Affordable Care Act mandated use of EMR and heavily funded its adoption. Is there really not one fully implemented open source solution after all that money was spent? Why does this project exist?

the HITECH act essentially created a duopoly in the EMR market: Epic and Cerner. Cerner is a public company so you can look at their financials and see the massive tailwind that was the HITECh act. they sell basically compliance and billing products to hospitals for 9-figure installation checks and huge, multiyear service contracts. once you get locked in, its incredibly painful to get out (see above 9-figure, multi-…

> physicians hate them, and many blame them for the massive increase in physician burnout over the last few years

It's funny, I assumed the same. I then asked a few who used the product, and was surprised to hear praise for Epic. I wonder if the product has actually improved, or if users have simply conceded.

Re: OpenEMR is Accepting Donations on OpenCollective

#23

Post by exception_e » Mon, Dec 18, 2017, 7:55 PM UTC

Hi everyone. Happy to see my posting caught some attention (nice start to my lunch break!).

Obviously, our team is asking for badly needed donations to support our work (primarily for poor locale users), but we're always looking for volunteers, as Brady pointed out. I am a serial HN reader and have learned that folks love React (and Vue) here. If there are any React (or Vue) gurus interested in volunteering, we'd love to get our UI at parity with modern web standards. I can definitely say that volunteering on this project is great for technical reasons as well as getting to meet grateful users from all over the world.

I noticed there's some healthy discussion here around US healthcare/open source usage and I ask you to consider that very modern and developed countries such as the US, UK, etc, etc have the money for EMRs and a more-or-less reasonable gov't that offers up regulations and incentives to get rid of paper. This is simply _not_ the case in many parts of the world. Therefore, I ask you to consider that without medical open source solutions (not just limited to OpenEMR), most are stuck on paper!

NOTE/UPDATE: John, our data scientist on the project, posted on here about his AWS efforts (seen below). He's never used HN and is having a hard time editing his post. `:%s/Trial/Tier` is what he's getting at... we have put together a very low cost (AWS free tier) solution for folks in low resource areas as well universities looking to teach with a modern EMR without the big price tag!

-Matthew

Re: OpenEMR is Accepting Donations on OpenCollective

#24

Post by aaavl2821 » Mon, Dec 18, 2017, 8:04 PM UTC

orb_yt wrote: post #22

aaavl2821 wrote: post #21

Earlier quoted context omitted.

the HITECH act essentially created a duopoly in the EMR market: Epic and Cerner. Cerner is a public company so you can look at their financials and see the massive tailwind that was the HITECh act. they sell basically compliance and billing products to hospitals for 9-figure installation checks and huge, multiyear service contracts. once you get locked in, its incredibly painful to get out (see above 9-figure, multi-…

> physicians hate them, and many blame them for the massive increase in physician burnout over the last few years It's funny, I assumed the same. I then asked a few who used the product, and was surprised to hear praise for Epic. I wonder if the product has actually improved, or if users have simply conceded.

that's interesting, ive heard that epic is better than cerner and others, but most of my physician friends still dont like it

out of curiousity, what kind of physicians were these, in terms of specialty as well as employment status (hospital employed, hospital affiliated, part of med group, independent)?

most of the physician surveys ive seen express negative views about EMRs, but a sizable portion of physicians say that EMRs help make some things easier and more efficient. cant locate the surveys offhand

Re: OpenEMR is Accepting Donations on OpenCollective

#25

Post by brady_m » Mon, Dec 18, 2017, 8:09 PM UTC

aaavl2821 wrote: post #21

Dowwie wrote: post #2

The Affordable Care Act mandated use of EMR and heavily funded its adoption. Is there really not one fully implemented open source solution after all that money was spent? Why does this project exist?

the HITECH act essentially created a duopoly in the EMR market: Epic and Cerner. Cerner is a public company so you can look at their financials and see the massive tailwind that was the HITECh act. they sell basically compliance and billing products to hospitals for 9-figure installation checks and huge, multiyear service contracts. once you get locked in, its incredibly painful to get out (see above 9-figure, multi-…

But OpenEMR is already built, is in working form, is certified for Meaningful Use in the US, and most importantly is open source.

Epic and Cerner and other proprietary systems are too expensive for many practices in the US and have simply placed both a huge financial burden on the medical system and a productivity burden on the physicians.

Physicians need to take back their EMRs and their productivity and OpenEMR is a great route to do this. For example, a practicing ophthalmologist, whom is also a software developer, developed an eye module in OpenEMR with the goal of the physician maintaining productivity (ie. not to spend time entering meaningless data in an awkward and distracting fashion), which he succeeded at. Can read about the project here: http://www.open-emr.org/wiki/index.php/Eye_Exam

And right now OpenEMR needs more volunteers, physicians, developers, and donations to keep progressing. And what is so great about an open source project like this is that if OpenEMR keeps doing great things in the US, then these achievements are essentially multiplied by 1000 as low resource areas throughout the globe get free access to this same open source fully functional EMR.

Re: OpenEMR is Accepting Donations on OpenCollective

#26

Post by aaavl2821 » Mon, Dec 18, 2017, 8:26 PM UTC

brady_m wrote: post #25

aaavl2821 wrote: post #21

Earlier quoted context omitted.

the HITECH act essentially created a duopoly in the EMR market: Epic and Cerner. Cerner is a public company so you can look at their financials and see the massive tailwind that was the HITECh act. they sell basically compliance and billing products to hospitals for 9-figure installation checks and huge, multiyear service contracts. once you get locked in, its incredibly painful to get out (see above 9-figure, multi-…

But OpenEMR is already built, is in working form, is certified for Meaningful Use in the US, and most importantly is open source. Epic and Cerner and other proprietary systems are too expensive for many practices in the US and have simply placed both a huge financial burden on the medical system and a productivity burden on the physicians. Physicians need to take back their EMRs and their productivity and OpenEMR is…

i agree it sounds like a great tool, and epic and cerner leave huge unmet needs in terms of productivity and also cost. seems like marketing is the huge challenge

id imagine this is really for independent physicians at least in the most-near term, as the sales cycle at big hospitals is brutal, and youd have epic / cerner folks scaring the hospital admins about real / imagined security concerns.

but marketing to independent physicians is brutal. from what ive heard you need at least an inside, and sometimes field, sales force, and getting through all the marketing noise docs get is really hard. would love to hear your thoughts on how to market this more widely

edit: my post mostly concerns US physicians, but id imagine marketing challegnes would be just as big or greater for developing nations

Re: OpenEMR is Accepting Donations on OpenCollective

#27

Post by jesdynf » Mon, Dec 18, 2017, 8:37 PM UTC

aaavl2821 wrote: post #26

brady_m wrote: post #25

Earlier quoted context omitted.

But OpenEMR is already built, is in working form, is certified for Meaningful Use in the US, and most importantly is open source. Epic and Cerner and other proprietary systems are too expensive for many practices in the US and have simply placed both a huge financial burden on the medical system and a productivity burden on the physicians. Physicians need to take back their EMRs and their productivity and OpenEMR is…

i agree it sounds like a great tool, and epic and cerner leave huge unmet needs in terms of productivity and also cost. seems like marketing is the huge challenge id imagine this is really for independent physicians at least in the most-near term, as the sales cycle at big hospitals is brutal, and youd have epic / cerner folks scaring the hospital admins about real / imagined security concerns. but marketing to indep…

I wrote a reference implementation of OpenEMR, the "OpenEMR Full Stack", that's taking aim at facility-grade loads. It's deployed from Amazon CloudFormation, and the highlights include multi-AZ redundancy, an Elastic Beanstalk deployment fronted with a load balancer running parallel OpenEMR instances in multiple AZs, an internal Route53 domain protected with SSL between nodes, redundant document stores for patient records, and enterprise-grade backup and recovery structures all wrapped up CloudTrail and Amazon's Key Management System.

https://github.com/openemr/openemr-devops/tree/master/packag...

Re: OpenEMR is Accepting Donations on OpenCollective

#28

Post by robertdown » Mon, Dec 18, 2017, 8:53 PM UTC

aaavl2821 wrote: post #26

brady_m wrote: post #25

Earlier quoted context omitted.

But OpenEMR is already built, is in working form, is certified for Meaningful Use in the US, and most importantly is open source. Epic and Cerner and other proprietary systems are too expensive for many practices in the US and have simply placed both a huge financial burden on the medical system and a productivity burden on the physicians. Physicians need to take back their EMRs and their productivity and OpenEMR is…

i agree it sounds like a great tool, and epic and cerner leave huge unmet needs in terms of productivity and also cost. seems like marketing is the huge challenge id imagine this is really for independent physicians at least in the most-near term, as the sales cycle at big hospitals is brutal, and youd have epic / cerner folks scaring the hospital admins about real / imagined security concerns. but marketing to indep…

It's hard to argue marketing to giant health care systems is difficult when you go up against corporations like Epic, Cerner, or Athena Health. We simply lack the funding to do so (just thinking about Cerner's marketing budget is mind-spinning). But outside the U.S. I find that marketing is substantially easier. Many developing nations and low-resource clinics seek out ways to be financially stable with next to no funding (compared to U.S. providers). While hard to track, we estimate most of the installs are outside the U.S. helping build healthcare in areas that could never dream of a 9 figure IT install. Being a free and open-source platform is our greatest "sales pitch."

Re: OpenEMR is Accepting Donations on OpenCollective

#29

Post by brady_m » Mon, Dec 18, 2017, 9:03 PM UTC

aaavl2821 wrote: post #26

brady_m wrote: post #25

Earlier quoted context omitted.

But OpenEMR is already built, is in working form, is certified for Meaningful Use in the US, and most importantly is open source. Epic and Cerner and other proprietary systems are too expensive for many practices in the US and have simply placed both a huge financial burden on the medical system and a productivity burden on the physicians. Physicians need to take back their EMRs and their productivity and OpenEMR is…

i agree it sounds like a great tool, and epic and cerner leave huge unmet needs in terms of productivity and also cost. seems like marketing is the huge challenge id imagine this is really for independent physicians at least in the most-near term, as the sales cycle at big hospitals is brutal, and youd have epic / cerner folks scaring the hospital admins about real / imagined security concerns. but marketing to indep…

Yep, marketing is a real issue, since that can take up extensive resources (I am just guessing that the proprietary EMRs sink 20% or more of their resources into marketing).

Especially since US based physicians are trained that more money means better things. As you can imagine the skepticism that then results when discussing a free EMR.

Prior to a year or so ago, OpenEMR really relied on the professional support (this is basically an organic ecosystem of companies, vendors, and professionals that offer paid services to support OpenEMR) for marketing. However, the project is now taking on a more active role in marketing and is why it is listed as an item to fund in the OpenEMR Collective blog. The goal would be to get professional marketing advice and guidance.

The developing nations market is really another matter. The marketing is still important and requires resources, but is mainly focused on making OpenEMR known and accessible to these nations (for example, OpenEMR currently supports 33 languages).

And we are always looking for volunteers with (or without since we are all learning) expertise to help us in these endeavors, and anybody is free to participate in the community (hint hint).

Re: OpenEMR is Accepting Donations on OpenCollective

#30

Post by aaavl2821 » Mon, Dec 18, 2017, 9:54 PM UTC

brady_m wrote: post #29

aaavl2821 wrote: post #26

Earlier quoted context omitted.

i agree it sounds like a great tool, and epic and cerner leave huge unmet needs in terms of productivity and also cost. seems like marketing is the huge challenge id imagine this is really for independent physicians at least in the most-near term, as the sales cycle at big hospitals is brutal, and youd have epic / cerner folks scaring the hospital admins about real / imagined security concerns. but marketing to indep…

Yep, marketing is a real issue, since that can take up extensive resources (I am just guessing that the proprietary EMRs sink 20% or more of their resources into marketing). Especially since US based physicians are trained that more money means better things. As you can imagine the skepticism that then results when discussing a free EMR. Prior to a year or so ago, OpenEMR really relied on the professional support (th…

Thanks for the info, I'll look into the project. I really believe EMRs need to work better for docs and be more open. I know a few physician-programmers who've built their own web apps but EMR integration obviously sucks. If they can build on top of something open source and a small medical group can save money without losing functionality with an open source solution, that could garner enough donations / financial support to for ex hire an engineer

I am only a hobbyist programmer and am investing most of my spare time into learning new things, but if I ever get to the point where I felt I could add something to the open source community I'd definitely start with a project like this