OpenEMR: Open-source medical record software • Hacker News Board

Re: OpenEMR: Open-source medical record software

#31

Post by SkyPuncher » Sun, Jun 23, 2024, 4:00 AM UTC

jauntywundrkind wrote: post #13

TZubiri wrote: post #6

Ok. However. If I'm running a hospital, I want my record software to be developed and maintained by a company that can pay its developers. The place for openness, vendor neutrality and transparency are protocols and file formats, which define how different software communicate.

I haven't seen a single friend who works in a medical profession recommend or feel well supported or feel like their system was well rolled out. I would 100% rather go to a place using open source software, with enthusiasts hope & open improvement iterating forward & leaving the door open to others to improve & build community around. It's a shame that we leave the work of important things locked to a couple far off…

Being famous the medical space, it’s almost universally because an EMR rollout becomes a political game.

Every single implementation I’ve seen involved a bunch of executive stake holders requesting features with absolutely no input from front line staff. Everyone’s goal is to get a resume item in without any care about how the hospital is actually run.

Re: OpenEMR: Open-source medical record software

#32

Post by standapart » Sun, Jun 23, 2024, 4:05 AM UTC

bruce511 wrote: post #24

Taikonerd wrote: post #2

OpenEMR seems like it could have a market opportunity, in principle. The EMR market in the US is dominated by two big, unpopular systems (Cerner and Epic). A smaller, nimbler competitor could make inroads among health systems that don't like that duopoly. Does anyone have any stories about setting up / using OpenEMR?

I don't have experience with health systems. I do have experience with entering a market with settled incumbents, and I do have experience in large organisations. Firstly, Open Source is not a factor here. The number of customers who care about our code is zero. Not even rounding to zero, just zero. Paying someone to look at, understand, Make, test, change etc dwarfs what they pay us. They are in the "health" busines…

A master class in enterprise software sales fit into a single comment. Bravo!

Re: OpenEMR: Open-source medical record software

#33

Post by FireBeyond » Sun, Jun 23, 2024, 4:06 AM UTC

nativeit wrote: post #23

shigawire wrote: post #16

Earlier quoted context omitted.

I think that would be a good idea and the only way it would work. Unless this is way, way, way more polished you won't see a Mayo Clinic or Cedars-Sinai using something like this. They tried that 20 years ago and it was scrapped for Epic. If it targeted smaller rural access hospitals or smaller practices and sold consulting and hosting services it might work if it way undercut the current bigger players... But this m…

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…

One of the more interesting ones is ESO's ESOsuite, for pre-hospital providers.

It has to deal with rough and spotty connectivity even during record creation, it has to handle sync between different providers (FD arrives first, starts gathering information, EMS arrives after to transport. How do you reconcile field values? It's one thing to coalesce provider interventions, but what about demographic discrepancies? "Just give the provider a choice between options" you think - not the biggest priority when approaching the hospital and stabilizing your patient, and not when you need to contact the hospital and give them said demographics and CC/HX/VS before you arrive).

Re: OpenEMR: Open-source medical record software

#34

Post by whartung » Sun, Jun 23, 2024, 4:10 AM UTC

curious_cat_163 wrote: post #5

shigawire wrote: post #4

Earlier quoted context omitted.

As someone (biased) who works with one of those two, I have a hard time believing the complexity of installing an EMR can be handled by this type of project. The challenges are not the challenges of tech. They aren't sexy. It is just really boring and complex business logic and the strength of both those companies is the vast amount of support they provide during install and future maintenance. The problem is less ab…

Thanks for sharing your insights. One wonders if the business model for supporting efforts like this could be to provide the support/services, while keeping the code base open source?

In the old days that would be classic VAR opportunity. Independents solving local problems. And, while license fees always affect the value proposition of a solution, there’s typically a lot of consulting and implementation labor dominates those contracts.

Today, though, the electronic medical record is a much more regulated with all the government standards. Part of the whole consolidation of smaller practices is just keeping up with the EMR requirements and other systemic parts of the modern health care system.

But where there are great opportunities for things like OpenEMR is internationally in developing countries. There’s a great need for fundamental EMR services and information exchange that open source solutions can be a really good fit.

Re: OpenEMR: Open-source medical record software

#35

Post by goda90 » Sun, Jun 23, 2024, 4:21 AM UTC

gagagaga7 wrote: post #25

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…

LLMs aren't intelligent. They won't replace an EMR. They'll hallucinate information, associate the wrong details and just generally be not deterministic in the way you want an EMR to be. But they can be a powerful interface that does reduce documentation and time spent hunting down information in an EMR.

The future of EMRs is more machine learning models of various kinds(not just LLMs) all built into the EMR to turn it into a medical scribe with great memory and a keen eye for what's important.

Nurses and doctors aren't going anywhere until we achieve true artificial intelligence, but until then the goal is to keep their eyes off the computer and on the patient as much as possible.

Re: OpenEMR: Open-source medical record software

#36

Post by jijji » Sun, Jun 23, 2024, 4:33 AM UTC

tormeh wrote: post #3

I know basking projects based on their choice of language is controversial, but PHP really is pushing it for me. And for medical data, too. PHP isn't boring technology - Java is boring technology - PHP is downright dangerous.

PHP is used by at least 76% of web sites on the internet today [0], down from 79-80% as of a few years ago... If anything PHP is quick to develop in and very fast. It takes me about 5 times longer to develop a web app in Java versus PHP, mainly because of lines of code, and pre-compilation wait-time to execute.

[0] https://w3techs.com/technologies/details/pl-php

Re: OpenEMR: Open-source medical record software

#37

Post by beachy » Sun, Jun 23, 2024, 4:45 AM UTC

wrs wrote: post #22

bobmcnamara wrote: post #7

Earlier quoted context omitted.

In the dental space, the market opportunity has been demonstrated by OpenDental, a GPL competitor in the dental space. Others include Epic and Dentrix.

I wonder if there’s a similar opportunity in the veterinarian space? Still a lot of independent vets out there, and it’s presumably simpler problem as there’s less coding and insurance to worry about.

My son worked in this space for a successful NZ company. It sounded like it was indeed a bit simpler (but still with plenty of complexity) but since nature abhors a vacuum, they added complexity by shoveling in features. I remember one being a surprisingly complex system for tracking the creatures' nickname(s).

Re: OpenEMR: Open-source medical record software

#38

Post by aprilthird2021 » Sun, Jun 23, 2024, 4:53 AM UTC

gagagaga7 wrote: post #25

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…

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

You should read up on the history of AI in medicine. 30-40 years ago they had rudimentary (by our current era understanding) systems that basically equalled and beat physicians in diagnosing and prescribing medicine to patients when given a list of symptoms (sources at the end).

None of these ever had any uptake because physicians didn't want to use them, even when shown they performed more accurately.

Ultimately credentialed professionals like medicine and law will never be replaced by LLMs because LLMs cannot be held responsible for the medical regimes they place patients under (or the legal advice they give).

Sources:

https://en.m.wikipedia.org/wiki/DXplain

https://www.dhinsights.org/news/does-ai-matter-if-human-clin...

Re: OpenEMR: Open-source medical record software

#39

Post by aprilthird2021 » Sun, Jun 23, 2024, 4:55 AM UTC

39896880 wrote: post #26

gagagaga7 wrote: post #25

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…

Agreed, and honestly this is one of the easiest and best behaving use case for LLMs. We’re not talking replacing any diagnoses, but freeing the humans to do what they do best, using their intuition.

AIs performed better at replacing human diagnoses long ago. Physicians don't like to use them because, well 8-10 years of specialized study tends to make you feel like you know what you're talking about vs some computer

Re: OpenEMR: Open-source medical record software

#40

Post by duffpkg » Sun, Jun 23, 2024, 5:05 AM UTC

I was the main contributor and maintainer to OpenEMR about ~20 years ago and then decided it was irredeemable and started over with ClearHealth/HealthCloud. Shockingly some of my code code lives on (from PHP 3). I am reluctant to say don't use it but if you do please don't expose it to anything public, which sadly happens most of the time. There are some real problems that exist in that code base from a security and HIPAA perspective.