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OpenEMR: Open-source medical record software

open-emr.org

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Re: OpenEMR: Open-source medical record software

#81

Post by ethbr1 »

nradov wrote: post #68
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…

In the USA at least there is a single mandated technical standard for providers to send claims to payers (insurance companies). Changes to the technical format are infrequent, although some payers do change their coverage rules all the time. https://www.cms.gov/priorities/key-initiatives/burden-reduct...

HHS/CMS is making forward progress, usually when mandated to do so by Congress.

Granted, whenever a new requirement comes into play, cue frantic scrambling by underfunded provider/insurer IT departments to support, followed by a few years of waivers from HHS to allow everyone to implement, followed by support a decade later.

But it is moving the system forward.

Re: OpenEMR: Open-source medical record software

#82

Post by shigawire »

eisa01 wrote: post #65
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…

Why do the Epic deployments in e.g., Norway and Denmark fail? The most recent "Helseplatformen" in Norway has not been successful according to the practitioners, citing lack of support and training

I'd say whether it failed is debatable. My understanding is the best counter bid was building a new system from the ground up... I feel that outcome would have been much worse.

Re: OpenEMR: Open-source medical record software

#83

Post by dopylitty »

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…

Sometimes it feels like the pursuit of digitization has actually made them less efficient and lower quality overall.

Instead of just having a doctor providing medical care and a government giving them a check suddenly you have a thousand programmers, data center management, managers of programmers, information security teams trying in vain to secure the whole mess, etc.

And that's before you get into the fact that the doctor suddenly can't practice at all when some teenager decides to ransomware the whole business.

Re: OpenEMR: Open-source medical record software

#84

Post by gagagaga7 »

FloatArtifact wrote: post #63
gagagaga7 wrote: post #49

Earlier quoted context omitted.

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. Multimoda…

Sounds like you don't have a very good understanding of what nurses actually do nor do you appreciate them.

Ok, I’ve spent the last 18 years working in hospitals, and the stats in my post are accepted in nursing research. Very open to hear where I’m wrong.

Re: OpenEMR: Open-source medical record software

#85

Post by gagagaga7 »

aprilthird2021 wrote: post #77
lostlogin wrote: post #61

Earlier quoted context omitted.

> 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). It’s not quite the same as what you are saying, but things are changing quickly. Software is diagnosing pathology in radiology now. Software made up at least 3/4 of the pixels in the MRI scans I acquire.…

Why would things be changing quickly now when old-school AI have been out-diagnosing doctors for years? Again, like I said, doctors are ultimately responsible for the final call made. So no amount of AI will replace any doctors. It may remove some toil, but they cannot be replaced.

Was the previous test Done with massive amounts of structured input which would be incredibly time-consuming for the doctor involved? I think the difference now is that we’re talking About making diagnosis with minimal extra work or time from the clinicians

Re: OpenEMR: Open-source medical record software

#86

Post by nradov »

ethbr1 wrote: post #80
lostlogin wrote: post #58

Earlier quoted context omitted.

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.

Lack of data interface standards is the biggest thing holding healthcare technical efficiency back, from what I've seen. And I understand why it's hard! But it should be possible to make progress around the edges, on more defined use cases and subsets... like pricing. That said, the major system vendors have zero incentive to originate interoperability, so it'll have to come from HHS if anywhere.

There are existing interoperability standards covering just about every healthcare use case (including price transparency) from organizations like HL7, DirectTrust, ASC X12, NCPDP, CMS, etc. The trouble is that many payer and provider organizations have chosen not to fully implement those standards. Instead they just do the bare minimum to achieve regulatory compliance because it's a cost center, not a revenue driver.

The major EHR vendors are all active participants in open industry standards development. You can literally read the meeting minutes from standards development organizations to see that. But just because they ship a new interoperability feature doesn't mean their customers actually turn it on.

Re: OpenEMR: Open-source medical record software

#87

Post by nradov »

duffpkg wrote: post #78
oezi wrote: post #57

Earlier quoted context omitted.

ClearHealth/HealthCloud is abandoned, right? What would you recommend today as an OpenSource EMR?

ClearHealth and it's affiliated companies were acquired in 2017. ClearHealth the EMR stopped open source releases in 2017/2018. You can kind of hair split what is and isn't an "EMR" but if you want a system most providers would call an EMR it is extremely difficult to have it be any sort of open source anymore. Basic fundamentals like procedure codes, diagnosis codes, eprescribing, billing, drug databases, interopera…

Good points, but diagnosis codes don't generally require any licensing fees. Depending on the use case those are usually either ICD-10-CM or SNOMED CT, both of which code systems are free to use.

Re: OpenEMR: Open-source medical record software

#88

Post by ijustlovemath »

shigawire wrote: post #21
nativeit wrote: post #19

Earlier quoted context omitted.

I would agree with this. The actual tech isn't all that difficult, you just need a very large and flexible database with a functional front-end, detailed process automation and business rules, hardened security, and high reliability. All very well-worn and established elements that can be found pretty readily even in the open source software space. It's the aforementioned integrations, as well as the overall implemen…

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

A CRUD app that breaks every rule of normalization and software design at far too many points!

Re: OpenEMR: Open-source medical record software

#89

Post by nradov »

Taikonerd wrote: post #71
shigawire wrote: post #17

Earlier quoted context omitted.

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…

> Try to ask those same friends to agree on the "correct" workflow for some aspect of their clinical work. Does that argue for a two-part design like: 1. APIs for scheduling, billing, lab tests, etc. These are standardized across all health systems. 2. "Workflow" code for a particular health system. This is custom.

There are already standard APIs defined for all of your item 1 from HL7 and ASC X12. Some of them are messaging APIs rather than HTTP/REST/JSON APIs so they can be a bit daunting to new developers. Most modern EHRs support those APIs but it can still be a huge amount of work to build interfaces to other organizations.

Re: OpenEMR: Open-source medical record software

#90

Post by lostlogin »

aprilthird2021 wrote: post #77
lostlogin wrote: post #61

Earlier quoted context omitted.

> 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). It’s not quite the same as what you are saying, but things are changing quickly. Software is diagnosing pathology in radiology now. Software made up at least 3/4 of the pixels in the MRI scans I acquire.…

Why would things be changing quickly now when old-school AI have been out-diagnosing doctors for years? Again, like I said, doctors are ultimately responsible for the final call made. So no amount of AI will replace any doctors. It may remove some toil, but they cannot be replaced.

> Why would things be changing quickly now when old-school AI have been out-diagnosing doctors for years?

The tools actually save time and effort now, and don’t have a steep learning curve.

At least that’s my view from radiology as a tech.

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