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OpenEMR: Open-source medical record software

open-emr.org

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Re: OpenEMR: Open-source medical record software

#51

Post by dvh »

I worked in EMR company and the amount of monthly legislative changes was insane. Insurance companies always changed their data formats every month. I think they did it because if hospital's monthly export contained some error they could hold their money for couple days more.

So anyway when our country switched to euro, the deadline came and the insurance company still didn't publish format for the new month. They were too busy with the euro switch that they didn't have time to mess with the export format. Few hours later they published new format. They just switched orders of 2 columns.

But back to churn. Month old EMR is useless. Forget about working 2 years on something, publishing it on GitHub and calling it a day. In a small 250k town we needed 7 full-time programmers and 5 servicemen to keep it going. Patient arrives at v7.13.148 and leaves two weeks later at v7.15.203 and you need to keep their data in some kind of consistent way.

Re: OpenEMR: Open-source medical record software

#52

Post by bfung »

nradov wrote: post #41
aprilthird2021 wrote: post #38

Earlier quoted context omitted.

> 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.

Yep - and the hardest part about getting the input signs and symptoms data is that patients often don’t know the words to describe what they’re feeling.

LLMs are not going to help if the input data is also garbage, let alone hallucinations.

“Are you dizzy?” - sometimes, I’m not sure… etc

Re: OpenEMR: Open-source medical record software

#53

Post by openrisk »

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…

This rings more than true, but it reflects market conditions that are not set in stone (otherwise we'd have lots of hundred-year old incumbents, but the evidence is that companies live shorter and shorter lives).

The cost dimension is (ultimately) what indicates whether a domain is ripe for disruption. No matter how cozy an arrangement it will eventually implode if it extracts unjustified rents while alternatives are readily available. Ofcourse cartels can remain untouched longer than you can remain solvent. There is a timing element and luck involved.

Open source can be an important lever in this direction because it is not just "free", it is also more transparent. Ceteris paribus the cost of assurance should be lower. When resistance to chance is primarily due to risk aversion this could be an other element to weigh in. But for this dynamic to kick in there has to be adoption and amortization of costs and that is a catch-22.

Re: OpenEMR: Open-source medical record software

#54

Post by achillean »

duffpkg wrote: post #40

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…

Looks like there are at least a few hundred instances of OpenEMR exposed to the Internet: https://www.shodan.io/search/report?query=http.favicon.hash%...

Re: OpenEMR: Open-source medical record software

#55

Post by TZubiri »

recursive wrote: post #12
TZubiri wrote: post #8

Earlier quoted context omitted.

Php is strictly for websites, according to any sources but PHP devs. Medical records is not a website.

What does this mean? I've been working in this space for years. All the hospitals want web apps. Some want to deploy them internally.

If they want a web app, PHP is ok.

Medical records are not a website, so its logic should not be in PHP.

A frontend for medical data? Yes, a HIS? NO

Re: OpenEMR: Open-source medical record software

#56

Post by oezi »

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…

Never is a very strong word. In particular considering what changed in just 100 years in medicine.

It is hard to imagine that any kind of textual computer input will persist more than 20 years in the future.

Re: OpenEMR: Open-source medical record software

#57

Post by oezi »

duffpkg wrote: post #40

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…

ClearHealth/HealthCloud is abandoned, right?

What would you recommend today as an OpenSource EMR?

Re: OpenEMR: Open-source medical record software

#58

Post by lostlogin »

dvh wrote: post #51

I worked in EMR company and the amount of monthly legislative changes was insane. Insurance companies always changed their data formats every month. I think they did it because if hospital's monthly export contained some error they could hold their money for couple days more. So anyway when our country switched to euro, the deadline came and the insurance company still didn't publish format for the new month. They we…

When you work in a a patient facing role, you battle the EMR (or Radiology Information System in my case) and hate it’s ancient, bug ridden mess of inefficiency. Why is it just as crap as it was 20 years ago?

But if you ever see the billing side you realise that billing is where the bulk of the action happens and that the horror is even worse over there.

Re: OpenEMR: Open-source medical record software

#59

Post by lostlogin »

beachy wrote: post #37
wrs wrote: post #22

Earlier quoted context omitted.

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).

> I remember one being a surprisingly complex system for tracking the creatures' nickname(s).

This is amazing.

That great thread on falsehoods programmers believe about names gets a new twist when you add in a variety of species.

https://news.ycombinator.com/item?id=29143353

Re: OpenEMR: Open-source medical record software

#60

Post by lostlogin »

shigawire wrote: post #17
jauntywundrkind wrote: post #13

Earlier quoted context omitted.

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…

I'm super biased admittedly as I have worked on the implementation side for these big systems but... Try to ask those same friends to agree on the "correct" workflow for some aspect of their clinical work. You won't find agreement in the same state, in the same hospital system, in the same hospital, or even in the same department. I can't claim what is out there is great, but it's like that quote about democracy. It…

> It's not technically complex, just organizationally complex to find agreement

Assuming you’re talking about the EMR and its records, I think that quite a lot is technically complex as well as being organisationally complex. Without a deep domain knowledge it can be hard to tell if something is needlessly convoluted or actually complicated and healthcare conflates the two all the time.

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