Are there any decent parsers in Python/Java/Ruby that someone can recommend?
Simulated Hospital
61–70 of 108 posts
Re: Simulated Hospital
#62I am frequently asked about why systems in institutional healthcare are so hard to modernize, this has come up a lot related to pricing transparency. While HL7 is in theory a standard, in practice it is a semi-parseable "email" between two parties that know each other. Widely used systems like EPIC have bugs and quirks that have existed so long that the bugs themselves have become their own standard. Because HL7 rela…
Bizarro-world that doctors actually defend EPIC! They all complain about the ASP.NET 1.0 UI. It's just the convenience of viewing all patients from all hospitals in one virtual "chart" ;)
Re: Simulated Hospital
#63This would be super useful once you can set up your own pathways. It will also need FHIR and the ability to generate CCDs (which FHIR is capable of) to more fully represent current health care integration technologies.
The large EHR vendors have fairly open sandbox environments for “partner” (loosely defined, can be anyone) development purposes. The advantage of these is that they use real implementations instead of the standard as hypothetical implementation.
Re: Simulated Hospital
#64Every time I dip a little into healthcare tech I want to throw up. It's so bizarre, and even offensive, how convoluted and outdated these systems are. It's patches on top of patches on top of patches for decades. To the brave engineers working on maintaining these systems, I salute you. Hospitals, banks, government... just think of the tech these heavily regulated industries could have had, and how it could have impr…
> In the long term, regulation often kills competition, which inevitably kills innovation.
So does non-regulation, often. A lot of this carp is "emergent" bureaucracy between insurers, other insurers, hospitals, etc. Regulation and monopolies often support eachother, merging into a nasty complex such as this... it's impossible to tell where one begins and the other ends.
I see financialization as a bigger factor currently than regulation. It's not a coincidence that "medical billing" is the epicentre.
I just don't buy the idea that less regulation means less mindless complexity.
The best if the early neoliberal/austrian economists was IMO Schumpater. Creative destruction. Complexes evolve into cludges over time.
Creative destruction is often presented as a feature of free markets... But that's theoretical. Irl, we see firms and complexes become effectively immortal... Immune to market forces and moated from competition. These tend to be the massively inefficient ones.
Regulated or not, insurance consortiums are much more like a government department than they are like a local restaurant. There are a lot more "private" regulators in the mix than public ones.
Re: Simulated Hospital
#65Every time I dip a little into healthcare tech I want to throw up. It's so bizarre, and even offensive, how convoluted and outdated these systems are. It's patches on top of patches on top of patches for decades. To the brave engineers working on maintaining these systems, I salute you. Hospitals, banks, government... just think of the tech these heavily regulated industries could have had, and how it could have impr…
As someone working in this arena, I offer an alternative perspective for your consideration: healthcare was an early adopter of information technology and as a result many of its most core technologies come from a nearly unrecognizable time in computing. These systems are “outdated” as a result of success. The current prevalence of these venerable technologies may be in part due to regulation, but more often has to d…
That's a thoughtful perspective.
It's also useful for expecting similar in future industries. Ultimately, I think it doesn't even matter if the reason is regulatory complexity, industry rigidity, or technical debt.
The question is how do we dig out of such holes.
If we were starting from scratch, it's almost certain we'd have better software, better firms, norms, standards and such within a short period of time.
How do we do that when not starting from scratch?
Re: Simulated Hospital
#66When they say "Most EHRs use a message format called HL7v2, which is ugly and tedious to type." they aren't kidding, here's an example of it: MSH|^~\&|FROM_APP|FROM_FACILITY|TO_APP|TO_FACILITY|20180101000000||ADT^A01|20180101000000|P|2.5| EVN|A01|20110613083617| PID|1|843125^^^^MRN|21004053^^^^MRN~2269030303^^^^ORGNMBR||SULLY^BRIAN||19611209|M|||123 MAIN ST^^CITY^STATE^12345| PV1||I|H73 RM1^1^^HIGHWAY 01 CLINIC||||51…
What does HL7v3 look like?
Re: Simulated Hospital
#67Earlier quoted context omitted.
The wire format is a bit messy and hard to read. But developers mostly work through libraries like HAPI which have a decent API. https://hapifhir.github.io/hapi-hl7v2/
Last Published: 2017-06-23...is it still active?
HL7 has different lifetime to JS-framework-of-the-week. It doesn't really change since the software itself is updated at most every year. (not including small patches)
Re: Simulated Hospital
#68When they say "Most EHRs use a message format called HL7v2, which is ugly and tedious to type." they aren't kidding, here's an example of it: MSH|^~\&|FROM_APP|FROM_FACILITY|TO_APP|TO_FACILITY|20180101000000||ADT^A01|20180101000000|P|2.5| EVN|A01|20110613083617| PID|1|843125^^^^MRN|21004053^^^^MRN~2269030303^^^^ORGNMBR||SULLY^BRIAN||19611209|M|||123 MAIN ST^^CITY^STATE^12345| PV1||I|H73 RM1^1^^HIGHWAY 01 CLINIC||||51…
What does HL7v3 look like?
Re: Simulated Hospital
#69Interesting. Having just been discharged from hospital after a 22 days stay, I would hope an awful lot of data is in my record. I had blood taken daily, I think standard obs (observations) at least 4 times a day, electronic scans (CT, Xray, EEG, ECG), lots of medicine via IV, oral and subcut. Multiple discussions daily with doctors and nurses (usually with the Drs, there was one asking questions, one listening, and a…
So I work with Oz GP practices. It's not very likely you'll get a reasonable export of your data. It's doable, but may require some convincing. Your practice will likely get a copy of at least some of the hospital documents - that's common. You could ask for the same export of your data that they'd send when moving you to another clinic if you want a complete view (you may get it on a CD though...). It's not that there's really any issue, it's just that the staff likely never handled this request for the patient and wouldn't be sure how to do it.
There shouldn't be any issue to view all the received documents on the screen during your visit though.
Re: Simulated Hospital
#70Earlier quoted context omitted.
I've worked a lot with DICOM which has plenty of warts (as expected with a 30 year old living standard), but HL7 is a bit much for me. At least FHIR and DICOMweb are considerably saner.
You haven't lived until you've tried to debug it. The array isn't zero based. The line breaks have different characters for breaking the lines, and you get to guess which ones are doing it. Certain characters are ok (ASKII) but when a Mac gets a nice ' into the field, all hell breaks loose. Things like "lesion at 9 o'clock" then break the system, as does Mr O'Leary. The hours spent chasing down how some failure happe…
Healthcare is the perfect storm of layered, ossified systems created across decades + input data that's normal just often enough... that everyone thinks bounds are actually handled.
And then Mr. O'Leary checks in.
Fuzz testing tools would be great, but I haven't seen many institutions that have functional 1:1 lower environments (i.e. including all system-system integrations working in test).