OpenEMR: Open-source medical record software

I always think of it as the most complicated CRUD app of all time.

I work with a lot of smaller healthcare offices, and there are plenty of field-specific solutions like MedicFusion, ChiroTouch, et al.. Despite the relative small sizes and simpler needs for these offices, you'll still find unique complexities, business logic, and bespoke integrations.

The process of migrating from one solution to another is so involved and time-consuming that I wouldn't expect it to happen more than once in a decade, and only then if the current solution is somehow critically deficient, or their practice is changing in a way that demands expanded options.

The only potential advantage I can think of is the relatively higher frequency of new practices being opened, which creates a wider target audience of potential customers, and that's probably why there's more field-specific solutions, rather than general ePHI that supports multiple fields of practice.

Doctor here, I hate EMRs, they are oppressive, in many ways they make things worse for patients. I think the future of EMR is no EMR.

An LLM that takes multimodal input (audio, video, images, observations etc etc) and outputs whatever is required (a podcast summary of clinic patients, a checklist relevant to a patient’s condition in preop) is the future.

Forcing doctors, nurses and allied health to manually document everything they do in annoying web forms is stupid and soul destroying.

Multimodal LLMs will also replace much of medicine and nursing which is good.

The mish-mash of regulatory regimes and insurance industries that change state-by-state, as well as practice-specific workflows that are every bit as unique as any business logic developed for one-off companies who evolve without any unifying or centralized force to standardize procedures, apart from compliance requirement, but those are not prescriptive in regards to the content specifics. If nothing else, just the combinations of integrations necessary for radiological imagery, insurance and patient forms, billing, patient services, communications, office admin, marketing/outreach, etc., make a lot of small healthcare offices some of the most unique businesses I have encountered in my ~9-years of freelancing as an I.T. consultant.

One restaurant has much the same needs and day-to-day procedures as another, even if they serve different types of food at a different price point to a different target market in a different part of the country. Healthcare is not nearly so uniform, and to the extent there are common elements to their processes, they are elements that have long since become standard features in every ePHI management system. But even then, the task of adapting those features to an individual doctor's workflow is nowhere near as straightforward as setting up a POS or inventory management system.

Then there is the unique nature of the data itself. It doesn't just store SKUs of mutable entities with well defined attributes that support pattern-matching, data verification, and formatting rules. It stores patients, each with unique histories, conditions, diagnoses, prognoses with instructions, contraindications, supporting documents, scheduling, billing options, and the documentation of each discrete visit or encounter. Every doctor will have their own approach to all of these aspects that should comply with applicable laws and standards, but who are otherwise empowered to construct their own policies and procedures, especially if they are focused on a specialty or niche.

TLDR; I expect the idiosyncrasies and demands in ePHI management are more diverse and uniquely challenging than one might think.

I want to love this, as someone who has dealt with multiple EMRs as an engineer, and as a provider...

but no EMR is going to gain traction with documentation that has five bullet points for its backup discussion.

Even the linked "back up using our tools" is just "tar things up and run mysqldump".

There's no discussion of how to handle and maintain this on a system that may be available 24/7. It's possible to do these things, certainly, but no credence or weight is paid to the real world concerns of how often you should be backing up, state management, intelligent restoration. It's as much about the business continuity aspect as it is the technical.