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OpenEMR: Open-source medical record software

open-emr.org

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Re: OpenEMR: Open-source medical record software

#41

Post by nradov »

aprilthird2021 wrote: post #38
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…

In most cases the diagnosis is the easy part. The hard part is gathering the signs and symptoms necessary to make the diagnosis. AI isn't particularly helpful for that.

Re: OpenEMR: Open-source medical record software

#42

Post by duffpkg »

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?

There are several others like eClinical in wide use. Depends on acute/outpatient etc. Open source is more a less a losing proposition for a mainstream EMR because of certification and integration requirements that amount to at least hundreds of thousands of dollars per year. ClearHealth was, as far as I know, the only open source EMR ever to have surescripts and full federal certification. It cost us about ~2 million a year to maintain all that.

Re: OpenEMR: Open-source medical record software

#43

Post by renewiltord »

A friend of mine running a subscription service to obesity drugs used OpenEMR and it was far too complex for them. They just hired two NYC engineers and they moved to SF and built them a sufficiently capable EMR system. I was asked to inspect the code. It's perfectly fine. My impression is that the software is very capable but is not a good tool to bootstrap from.

Re: OpenEMR: Open-source medical record software

#44

Post by mikeqq2024 »

standapart wrote: post #32
bruce511 wrote: post #24

Earlier quoted context omitted.

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!

Well said

Re: OpenEMR: Open-source medical record software

#45

Post by mikeqq2024 »

ranger_danger wrote: post #14
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?

There are already many smaller competitors such as Paradigm, eClinicalWorks, Intellicure, gGastro, Athena, Practice Fusion, PrimeSUITE, eMD Central, NextGen etc. Those are just the ones I've had to work with in the past but I'm sure there's many more.

Curious what you do with them,,

Re: OpenEMR: Open-source medical record software

#46

Post by mikeqq2024 »

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"

Mind elaborate how is this done?

Re: OpenEMR: Open-source medical record software

#47

Post by robinwassen »

standapart wrote: post #32
bruce511 wrote: post #24

Earlier quoted context omitted.

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!

I agree that this is spot on.

The last part missing is "build a flawed product and bake it into the contract so you charge high consultant costs to the customer to fix it" which is where the cash cow is for many enterprise / B2G products.

Re: OpenEMR: Open-source medical record software

#48

Post by rushabh »

There has been decent traction for Frappe Health (GPL) in Kenya. Not spending on expensive contracts and losing valuable forex is a big driver.

Here is a talk by Dr Mwogi on implementing at one of Kenya’s largest public hospitals https://youtu.be/yL6akPy2X5c?si=4UzUSJYm3PjxA3hL

Re: OpenEMR: Open-source medical record software

#49

Post by gagagaga7 »

mikeqq2024 wrote: post #46
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" Mind elaborate how is this done?

For starters, ward nurses spend 25-35% of their time doing documentation. This is doing patient notes, transcribing vitals, filling in forms and checklists, logging in and out of workstations, etc etc.

Much of this could be replaced by audio/video input.

Secondly, if the LLM can identify at risk patients or drug checks, you don’t need a nurse or 2 nurses to dispense medications or identify at risk patients. Multimodal input LLM plus a caring low skilled person can do the necessary things far more often.

These 2 factors alone can reduce nursing workload by half.

As for family doctors, I would personally be very happy to transfer my basic general care to a good LLM right now. Everything I need is straightforward, protocolised and the hassle of making appointments, delays, waiting rooms, form filling etc is more of a barrier to my healthcare than current LLM deficiencies.

Re: OpenEMR: Open-source medical record software

#50

Post by TeMPOraL »

standapart wrote: post #32
bruce511 wrote: post #24

Earlier quoted context omitted.

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!

Master class in why critical software that's relied on by millions wastes billions of people-hours each year, not to mention all the misery it causes.

The part where person making the purchase decision is neither the user nor beholden to the users? That's bad.

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