OpenEMR: Electronic Medical Records and Medical Practice Management Software • Hacker News Board

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#161

Post by fny » Fri, Mar 17, 2017, 1:02 PM UTC

iheartmemcache wrote: post #154

ryanSrich wrote: post #135

Earlier quoted context omitted.

The reason why so many EHRs are poorly designed is in part because they are so flexible. Don't under estimate the ego of a physician to think their way is superior to the way the doctor down the road does something. The EHR model will eventually lose because its one sided. Consumers and patients are completely left out of the picture and EHRs have no incentives right now to change. Beyond that companies like Epic are…

SQL has 'interoperability' re: an ANSI standard. Theoretically you should be able to get off all those old Oracle contracts right? Eventually there are little nuanced things that users end up building their workflow completely around. Even if you change no functionality and just slightly alter the GUI, you're going to have complaints that something is broken. Inertia is your #1 vendor lock in feature. EPIC is as gold…

While I strongly agree with points 2 and 3, SQL standards are useless when hospitals invent their own schemas and data governance. Looking for serum creatinine? Good luck without local knowledge. There are probably 30 tables (not exaggerating) for that lab, and the closest you can get without chasing 7 people for info is grepping all the table names for "/CREA/".*

*Based on a true story.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#162

Post by nradov » Fri, Mar 17, 2017, 1:15 PM UTC

fny wrote: post #69

JusticeJuice wrote: post #38

I'm currently working on my thesis, I'm trying to design a radically different take on EMR/EHR systems - http://barnett.surge.sh/ I've come to realize healthcare software is a significantly trickier problem than most realize. Not in terms of technical possiblity, but other factors. Building healthcare software is really hard - which seems like such a paradox, because surely ensuring highly trained individuals have ha…

As far as I can tell, there's no economic incentive for health care systems to undergo these transformations willingly. Remember, the digital transformation didn't occur until the HITECH act in 2009, which mandated the use of electronic health records. Why digitize your operations and worry about maintaining tech infrastructure when you can do everything on paper with a handful of secretaries? You could argue providi…

It's no longer necessarily true that providers make money every time you get sick. Insurers have shifted risk to providers in some areas in the form of accountable care organizations (ACOs) which receive a flat fee per patient. So in theory the ACOs have a financial incentive to prevent you from getting sick.

Kaiser Permanente uses the same Epic EMR software as many other large provider organizations.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#163

Post by [deleted] » Fri, Mar 17, 2017, 1:15 PM UTC

fny wrote: post #69

JusticeJuice wrote: post #38

I'm currently working on my thesis, I'm trying to design a radically different take on EMR/EHR systems - http://barnett.surge.sh/ I've come to realize healthcare software is a significantly trickier problem than most realize. Not in terms of technical possiblity, but other factors. Building healthcare software is really hard - which seems like such a paradox, because surely ensuring highly trained individuals have ha…

As far as I can tell, there's no economic incentive for health care systems to undergo these transformations willingly. Remember, the digital transformation didn't occur until the HITECH act in 2009, which mandated the use of electronic health records. Why digitize your operations and worry about maintaining tech infrastructure when you can do everything on paper with a handful of secretaries? You could argue providi…

[deleted]

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#164

Post by nickpsecurity » Fri, Mar 17, 2017, 1:20 PM UTC

gm-conspiracy wrote: post #158

nickpsecurity wrote: post #113

Earlier quoted context omitted.

I saw one system that seemed like a must have: apps that ensure you got the prescription right. Paper-loving doctors screwing up prescriptions harms a lot of patients. Especially when they insist on writing in cursive. Much of your post seems to be about bad tech, though. It could mostly be mitigated with a supplier that gave a shit.

Also sounds like a shitty pharmacist and pharmacy tech.

I'm not going that far. What I read implied it was either a mental slip or illegible writing. Some of the drug names look similar when they're written in chicken scratch.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#165

Post by cmiles74 » Fri, Mar 17, 2017, 1:26 PM UTC

nradov wrote: post #70

cmiles74 wrote: post #35

Earlier quoted context omitted.

I don't think we will ever see HL7 messages exchanged between organizations. Each product has it's own list of message types that they support, and even then they will vary in terms of which segments have data and in some cases, even what that data will be. Patient identifiers also vary between organizations, making it hard to know which patient goes with which piece of data. Alternative methods for passing data betw…

You haven't been paying attention. I've been working on products which exchange HL7 messages between organizations for 20 years. It's very common now. Some configuration work is usually needed on each interface but that's mostly a solved problem.

My experience has been closer to that of mcphilip, every time we bring in a new system we end up with consultants from both sides (the new product and the hospital information system) and the cost is quite high. Where I work, exchanging HL7 messages directly with another organization has never been on the table and we have done a couple interop projects with other area hospitals.

That said, in my opinion the two organizations looking to exchange messages would need to have a pretty good relationship and a real business need in order to pursue this strategy. They may also have to compromise on dictionary values, etc., in order to have comprehensible data on both sides. For organizations with even a modest amount of rivalry, I can't see them spending this kind of time, effort and money.

My understanding was that "meaningful use" would make interop much easier, perhaps on a higher level than HL7 messages. In my experience this has not been the case.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#166

Post by messo » Fri, Mar 17, 2017, 1:31 PM UTC

Norway has been building a universal and state-run system the last couple of years, which gathers all the patient information in one centralized system. Existing commercial companies that already deliver solutions to doctors and hospitals have integrated this new system into their existing products. It is practically interoperable by now. I believe this is the way to go. The system was beta-testet last year, and is being rolled out to doctors offices this year.

This will benefit both doctors and patients, as they no longer need to manually juggle between countless different systems (and plain old paperfiles). Overmedication (and dangerous drug interactions) has been a real problem for decades, because one doctor does not know what the other has been doing. When a patient has to visit different hospitals, they have to take new blood samples, tests etc.

Patients can now log in to one service (helsenorge.no), with the same security as other state-run services (taxes etc), they get access to their complete health journal, they can order an appointment at their local doctors office, order an online consultation, reorder prescriptions etc.

Maybe something for other countries to learn from?

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#167

Post by nradov » Fri, Mar 17, 2017, 1:34 PM UTC

ryanSrich wrote: post #135

fny wrote: post #130

Earlier quoted context omitted.

I have no idea what the market is like in New Zealand, so my insights there are limited, but a lot of EMR systems in the US have a similar notion of customizability built into the interface. Epic, the largest EHR vendor in the US, for example, doesn't sell a one size fits all solution. Hospitals develop their own GUIs and workflows within Epic, but again, hospital administrators make all the UX/UI decisions while opt…

The reason why so many EHRs are poorly designed is in part because they are so flexible. Don't under estimate the ego of a physician to think their way is superior to the way the doctor down the road does something. The EHR model will eventually lose because its one sided. Consumers and patients are completely left out of the picture and EHRs have no incentives right now to change. Beyond that companies like Epic are…

You don't seem to understand the market dynamics. Consumer preferences have little or no impact on provider EHR selection. In general the only consumers who really care about controlling their own data are those with complex, long-term chronic medical conditions who see providers from multiple different organizations. Otherwise most patients are satisfied using the captive PHRs tied into individual provider organization EHRs. Real world patients aren't going to switch providers over issues like this.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#168

Post by [deleted] » Fri, Mar 17, 2017, 1:42 PM UTC

fny wrote: post #161

iheartmemcache wrote: post #154

Earlier quoted context omitted.

SQL has 'interoperability' re: an ANSI standard. Theoretically you should be able to get off all those old Oracle contracts right? Eventually there are little nuanced things that users end up building their workflow completely around. Even if you change no functionality and just slightly alter the GUI, you're going to have complaints that something is broken. Inertia is your #1 vendor lock in feature. EPIC is as gold…

While I strongly agree with points 2 and 3, SQL standards are useless when hospitals invent their own schemas and data governance. Looking for serum creatinine? Good luck without local knowledge. There are probably 30 tables (not exaggerating) for that lab, and the closest you can get without chasing 7 people for info is grepping all the table names for "/CREA/".* *Based on a true story.

[deleted]

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#169

Post by nradov » Fri, Mar 17, 2017, 1:44 PM UTC

zupreme wrote: post #75

JusticeJuice wrote: post #38

I'm currently working on my thesis, I'm trying to design a radically different take on EMR/EHR systems - http://barnett.surge.sh/ I've come to realize healthcare software is a significantly trickier problem than most realize. Not in terms of technical possiblity, but other factors. Building healthcare software is really hard - which seems like such a paradox, because surely ensuring highly trained individuals have ha…

So my startup hosts and supports a decent number of EHR/EMR solutions and I even seriously entered talks at one point for us to partner up with a large medical conglomerate to write a new platform. That idea died for the same two reasons most similar initiatives in healthcare die: Government and Insurance (called "Payers" in the healthcare industry). You can write the absolute best EMR & PM (Practice Management) plat…

All of the major payers have standard interfaces for submitting electronic claims now. The payers aren't a barrier to launching a new EHR.

Re: OpenEMR: Electronic Medical Records and Medical Practice Management Software

#170

Post by nradov » Fri, Mar 17, 2017, 1:57 PM UTC

mabynogy wrote: post #157

fredsmith42 wrote: post #141

Earlier quoted context omitted.

The EMR market is consolidating on two big vendors: Epic and Cerner. Depending on how you measure it (Hospitals on a system or Medical Records under management), either Cerner or Epic is #1 and the other is #2. At this point, in the U.S., it is almost impossible for a newcomer to break into the market. There are many companies out there slowly losing market share to Epic or Cerner. Allscripts, Nextgen, McKesson/HBOC,…

> Finally, you have to realize that you are dealing with a very powerful and conservative management culture. Has anybody tried to address the patient needs before? Patients should be easier to convince. It could be a good strategy to influence the doctors and mangement to change their habits. I'm thinking of a tool to allow the patient to enter data that they could give to their doctor.

It wouldn't help. Very few patients actually care about this stuff. When patients go in to see their doctors they aren't going to waste time discussing software.