16 ms·

OpenEMR: Electronic Medical Records and Medical Practice Management Software

360 points by mabynogy 10y ago

SteveNuts 10y ago
Having HTTPS enabled on their site would go a long ways for software like this.
- exception_e 10y ago
  It's an issue with Source forge. We're working on this.
  - oomkiller 10y ago
    After sourceforge bundled malware with downloads, it's hard to trust a project that stuck with them, especially with health data, especially when there are numerous alternatives that are better.
    - exception_e 10y ago
      It's just for our website and wiki. We've moved to Github for the most part. There is talk between myself and a couple of other contributors to move the site and wiki to AWS :). Feel free to volunteer to speed this up, of course. EDIT: Misread your comment. We are hosting downloads on the SF site. Really need to move to AWS...
      - SteveNuts 10y ago
        How much traffic do you get? and is it all static?
hitgeek 10y ago
this project has been around for a long time. I always take a look at it when I need a reference system for thinking about data models or ux related issues for health record type projects. looks like it got a major facelift since the last time I checked it out. that must of been a lot of work. congrats to the contributors for making that happen, looks more modern.
- brady_m 10y ago
  Yep there was a lot of work both above and under the hood to modernize OpenEMR on the most recent release. Also was a several year effort to get complete meaningful use certification. Can see here for some more details on both efforts: http://www.openhealthnews.com/content/openemr-achieves-complete-meaningful-use-certification-breakthrough-release-50 http://www.openhealthnews.com/content/openemr-achieves-compl...
kevinmannix 10y ago
This is huge. I previously worked for a healthcare startup, and it seems like for every other healthcare startup we worked alongside or networked with, all roads lead to EMRs. It was (felt like) an impossibly large task without a clear path to execution due to the tangled web of healthcare IT & regulations. Something like this is huge, especially to potential competitors that now have a target to aim for.
- keltor 10y ago
  Unfortunately most of the time you end up having to individualize so much data structure for each deal it's a gigantic pain.
deleted 10y ago
[deleted]
qrbLPHiKpiux 10y ago
I use open dental. Tell me how open it is. An open EMR in healthcare does not mean much. Take a look at the necessary support needed to have the proper compliance.
- exception_e 10y ago
  Not sure what you mean... can you please be more specific? OpenEMR is 100% open source. It's GPL'ed :). As far as compliance, we are happy to inform you that OpenEMR is now 2014 ONC Ambulatory EHR Certification complete. EDIT: If you're asking about support, there are over 30 professional vendors. Community support is also available. If you have further questions, feel free to reach out to my email (in my profile).
jasondc 10y ago
There is even open source dental software, open source is seriously eating the enterprise (and healthcare) software world! I run OpenDental for my wife's practice in North Beach, SF. It's licensed as AGPL, but I'll still take it :)
- forgotmysn 10y ago
  kind of off-topic, but I moved to the City a couple years ago and need a new dentist. is your wife accepting new clients?
  - jasondc 10y ago
    Definitely, wsparkdental.com :)
    - reagan83 10y ago
      I just started going to this office last month and can vouch for how great of a place it is. Dr Choi is a really amazing dentist. HN becomes smaller each day :)
      - jasondc 10y ago
        Woah, great to hear! I'll pass it along to her! It is a small place :)
    - evancordell 10y ago
      Hey, nice to see LocalMed being used in the wild :) I worked there for a couple of years.
    - forgotmysn 10y ago
      damn, that office makes Apple's new donut look retro
- cmdrfred 10y ago
  I supported this for a few years as a sysadmin. The most flexible EMR application I have ever seen.
jdhe 10y ago
As other comments mention, this project has been going for a while, the central reason it (or something like it) has not been robustly built out and deployed universally is because of the way congress chose to structure the funding for development of EMRs/EHRs. Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop systems, then subsidize the purchase cost to providers to encourage adoption. Then, only once everyone has invested in their own proprietary system will they begin trying to universalize the system by developing cross compatibility. This methodology is perfectly in line with the free-market approach that the US has championed for decades. It is also the opposite of how almost every other country has developed and adopted universal EMRs. Sad. Especially because we know that a good, affordable universal EMR would significantly enhance the ability to deliver care for almost all sizes of healthcare providers.
- criley2 10y ago
  As a programmer for an American EHR firm -- all of the market share already belongs to one of those companies you malign. You could not have had the government sponsor some new software which would eliminate a billion dollar software market. It's a non-starter. All the hospitals already are signed on multi-year contracts with those large providers. Some of the EHR providers began writing medical software for hospitals in the 1960s and 1970s. These companies have multi-decade relationships with the hospitals they service, and decades of patient data stored. What Obama and the Democrats did was to break the "paper cycle". Many hospitals used paper-only system with very little software even into the 2000's and 2010's. The point of investing in each company was to jumpstart their products into meeting the huge new regulations, and the point of giving clients money to buy this new software was to break the paper cycle. There is no "one size fits all" option in the American market. I find it funny that you malign our practice as "(idiotic)" when it is your plan, quite frankly, which is so ignorant to the complicated history and reality of medical providers and their software, that seems idiotic to me. Your opinion sounds to me like "The US Gov should, instead of using MS Windows, pay a company to invent a new operating system, then ban all use of Windows, OSX and Linux to ensure all firms must use the single new solution". We already had so many options that have existed for decades, with so many clients, and so much built-out software infrastructure. There was no "one-size-fits-all" solution unless your solution includes "Destroy the entire industry, and use force of government to destroy a half dozen major software companies in favor of the government mandated and almost assuredly inferior option" The crux you may not realize is how customized every major hospital system expects their EHR software to be. I don't think you realize the sheer level of customization these networks require, due to the size and scope of their businesses. It takes entire teams of my company to service certain major clients. The idea of a one-size-fits-all would have been laughed out of our country.
exception_e 10y ago
Please read about our groundbreaking v5 release here: https://medium.com/openemr/complete-meaningful-use-certification-1627b989d9bb#.5c9it7a59 https://medium.com/openemr/complete-meaningful-use-certifica...
- tim333 10y ago
  Congrats.
kakoni 10y ago
We've been gathering various open source health projects here. https://github.com/kakoni/awesome-health https://github.com/kakoni/awesome-health
- exception_e 10y ago
  Just sent both an issue and a PR. Great idea!
davidlee1435 10y ago
Github repo: https://github.com/openemr/openemr https://github.com/openemr/openemr
rdudek 10y ago
How are they planning on pushing it to hospitals? All major players have adopted Epic EMR, at least here in Colorado. And once they have a system, they'll stick with it due to premium support and huge cost will prevent switching.
- keltor 10y ago
  Epic, Cerner and Meditech are the largest EHRs and they combined control just about 50% of the market. Epic and Cerner tend more towards the Academic hospitals and Meditech and McKesson (#4) tend towards the Commercial hospitals. There has also been a ton of incentive payments from CMS that have almost exceeded the EHR industry as a whole. There have also been quite a few big switches from the 90s to today, a bunch of them from Meditech/Epic/Cerner to others, so it can definitely happen.
- exception_e 10y ago
  Hospitals in America aren't the main consumers of OpenEMR. Think smaller facilities, and hospitals and facilities outside of the US.
JusticeJuice 10y ago
I'm currently working on my thesis, I'm trying to design a radically different take on EMR/EHR systems - http://barnett.surge.sh/ 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 half decent tools would be a huge goal for society - but almost all healthcare software is still frankly, terrible. After heaps of reading I've narrowed it down to 3 reasons why healthcare software is so hard to build. 1 - Modern healthcare is complex, and varied. Building any healthcare softawre is no easy task, even simple systems have many other systems to integrate with. But what makes this worse, is that no two places do healthcare quite the same. Between regions, and institutions, healthcare can vary a shit ton. 2 - Healthcare is risky. Sounds obvious, but if your software fails, people die - but this risk creates an attitude of "dont touch it". Changing systems has such a risk, that institutions will use the same software until it's so out of date its not funny. This impeeds improvement and innovation. 3 - Healthcare software is hard to sell. Not in the sense that its unprofitable, but that it takes ages to get users. Say if I made video editing software - I could get professionals trying it out tommorrow. However, if I make a PMS, I have to sell it to the entire practice - not just a few keen doctors. From making contact to actually getting a small practice using your software could literally be years - making it super hard to enter the market. I've been working on this topic fulltime for a year now - and I must admit, I don't have the golden answer. However, I'm designing a system as a response to these factors, an alternative to interoperability, and would love to talk anybody in the industry about it. http://barnett.surge.sh/ http://barnett.surge.sh/ eliot.slevin@gmail.com
- dharma1 10y ago
  looks good, how far are you with it? is it open source?
  - JusticeJuice 10y ago
    It's essentially a giant design proposal - yes it's all open source, but theres nothing you can download and start using - yet :)
amelius 10y ago
Does it allow anonymization of patient data, so that it can be used for research?
- robertdown 10y ago
  Yes, openEMR allows for de-identification of patient data!
hetfeld 10y ago
Actually this is huge. And sadly very underrated, hope this will get more spread across the world news agencies and developing countries will use this software for government clinics.
ipunchghosts 10y ago
As much as I would love this, I simply dont think it will work. Why? Epic is simply too big and has too much of the market and they are too far behind. I use picnichealth.com to deal with this EMR mess and I love it!
- entee 10y ago
  The pricing seems incredibly high, am I understanding correctly that they want ~$300 up front then $33/month thereafter? That said, working in this industry, I know exactly how hard it is to do this right. In many ways this is what it costs to do the job, if not more, but I'm not sure I'd pay it. There's the tragedy of the whole EMR/patient data story: bloody expensive, who pays?
  - ipunchghosts 10y ago
    That's weird, they changed their pricing plan. I only see the concierge service. Perhaps they have enough customers to be happy at the moment. I pay 10/month which is completely worth it in my mind. I can pull up pathology reports at my out of state docs office in real-time. Makes the best out of 3 hour trip to see the doc! EDIT: I have also used this in conjunction with healthtap. EXTREMELY USEFUL! Doctors love it!
  - nogaleviner 10y ago
    PicnicHealth CEO here. We did raise prices to keep quality super high as we scale, but here's a nice discount for our HN friends. Enjoy! https://picnichealth.com/friends-of-picnic https://picnichealth.com/friends-of-picnic
ipunchghosts 10y ago
EMR is simply too messy for openEMR to put a dent in the issue. I truely wish it were different. If insurance carriers are permitted to operate across state lines in the future, i think there is a chance of a Google or Microsoft getting into the space which I think is the right way to go. Right now, the large companies managing EMR and huge monoliths that simply don't care about innovation. They are like defense contractors to the military. If the market ever opens up and consumers have more choice, its clear that someone like google or MS would win and I honestly believe really give healthcare a boost in this country.
- nradov 10y ago
  That's not how the EMR market works. Insurance sales across state lines won't make much difference to EMRs either way. Google and Microsoft are horizontal vendors. They aren't likely to put a major effort into a vertical market, and even if they did there's no reason that they would do it any better than the existing vendors. It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market.
  - ipunchghosts 10y ago
    > It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market. They have analytics, "moneyball" so to speak. There is a plethora of untapped data in these systems. I've worked with Gesinger in PA and you would not believe how far behind the curve they are and they are often touted to be on the forefront. What needs to happen is getting google or MS into health insurance. They could utilize all the data collected to benefit the patients and make a big profit. Additionally, they have the know how to set up a pharm lab for drug development. Insurance companies really should drive drug development. It makes sense for them to develop drugs for conditions costing them the most amount of money per patient. Instead, they are middle men who have to work with whatever big pharma give them.
    - nradov 10y ago
brianmartinek 10y ago
Does anyone know of a EMR system that could house my household/personal health data? One of the struggles I have is organizing my own health data in a singular place with structured data formats, document uploads, etc. The closest thing I have found is http://mymedicalapp.com/ http://mymedicalapp.com/ but it appears to have been abandoned by the developer.
- lukas 10y ago
  picnichealth.com
  - ipunchghosts 10y ago
    came here to say this. i use them. love it.
  - brianmartinek 10y ago
    Thanks for the recommendation. It is what I am looking for except that it doesn't seem to offer any upload options if there are holes in the data they retrieve. Still, a step in the right direction and I'll give it a try.
    - ipunchghosts 10y ago
      You can put data on a google drive and share a link with them. I did this for all my existing radiological data. They had no issue downloading it.
    - nogaleviner 10y ago
      PicnicHealth CEO here. You won't have this problem because we don't miss any data :) But really, if you have old stuff we can't get anymore we can find a way for you to send it over.
- deleted 10y ago
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- deleted 10y ago
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lacampbell 10y ago
My first permanent IT job was actually working with practice management software. It worked across multiple jurisdictions with fairly minimal changes - an appointment is an appointment in any country. I actually suspect it violated several laws - I remember I had full access to a database stored offshore where patient notes were there in plain text, along with their names and addresses. I emailed the privacy commission about it but they wanted to me to name names and I was scared of losing my job. So yeah, I hope you encrypt notes.
edimaudo 10y ago
Is it easy to use? Does it reduce the amount of paperwork to be done? How safe is it?
- robertdown 10y ago
  I think it is easy to use, and yes it has the potential to nearly (if not completely) eliminate all paperwork in your clinic. As far as safety, openEMR is fully HIPPA compliant as well as 2014 ONC Complete Ambulatory EHR certified (a/k/a Meaningful Use 2).
dualboot 10y ago
We've had an incredibly well adopted open-source EMR solution here in Canada for quite a while. OSCAR https://oscar-emr.com/oscar/ https://oscar-emr.com/oscar/
tfaruq 10y ago
What is the different with OpenMRS http://openmrs.org http://openmrs.org ?
walrus01 10y ago
If people had any idea how much antiquated medical software is out there in production running on Windows 98, 2000 or XP and coded in Visual Basic they would run away screaming. It's seriously that bad.
- gnaritas 10y ago
  Yup, but that sector is so heavily regulated that it scares off startups, and who can blame them.
  - clock_tower 10y ago
    You might be interested in athenahealth, a Web-oriented healthcare company which actually runs a sort of startup incubator ("More Disruption, Please"), and has led a lot of initiatives to improve interoperability. They realize these things create trouble for them as well as the rest of the field, but I think they're betting that their rivals are significantly less flexible than they are. (This is a safe bet, of course. The giants of the field, Epic and Cerner, are infamous for overwork, low pay, and high turnover. Their technology's also obsolete: Epic has a VB6 front end and MUMPS back end; Cerner uses C++, but it's probably C++ thinly translated from C thinly translated from Pascal, so they're not a whole lot better. At least MUMPS isn't vulnerable to C-style buffer overflow attacks!)
    - IgorPartola 10y ago
      Slightly OT: I read somewhere that whenever you see "to disrupt" you should replace it with "to fuck up" as that is the true meaning of what is being said. Not that it's always a bad thing, but it is almost always destructive.
- clock_tower 10y ago
  I see you know about Epic Systems Corporation. :)
- wallace_f 10y ago
  I did some work for a company that had 100+ banks running accounting software developed in Visual Basic in the early 90s. Unfortunately, this experience, supporting obsolete, spaghetti-code-nightmare, opened my eyes to the world that business is done in a much dirtier way than how I imagined growing up.
Skeletor 10y ago
I think it's great that there are projects like http://www.open-emr.org/ http://www.open-emr.org/ , https://oscar-emr.com/oscar/ https://oscar-emr.com/oscar/ , http://openmrs.org/ http://openmrs.org/ , and https://www.hl7.org/fhir/http.html https://www.hl7.org/fhir/http.html ; I think these tools would be even better if they released their code under LGPL (instead of GPL) so that lazy commercial EHR developers would reuse and help maintain some core modules to promote more interoperability. I don't think it's going to ever be possible (or that it is even desirable) to ever have a "Universal EHR" that everyone is forced to use through either government intervention or through market/economic forces. We can all exchange emails with each other, but we aren't all forced to use the same email client The reason that the entire healthcare system seems broken to most consumers is legacy EHR systems in large hospitals. These legacy enterprise vendors are essentially what Oracle was 20 years ago in the rest of the enterprise software market before companies like Salesforce.com came along. Another part of this "broken" feeling is the difficulty of exchanging data between different EHR systems; but this doesn't have to be the case. "If you've seen one HL7 standard implementation, you have seen exactly one HL7 standard implementation." Which means most systems don't interoperates with anyone else's systems unless there is an existing commercial relationship that forced everyone to interoperate on a local scale. For anyone looking to work on an idea to improve healthcare check out: https://www.drchrono.com/api/ https://www.drchrono.com/api/ and/or https://www.drchrono.com/careers/ https://www.drchrono.com/careers/
- mabynogy 10y ago
  Very clear and interesting concept: https://app.drchrono.com/ehr-emr/medical-form-templates/556163/initial-assessment https://app.drchrono.com/ehr-emr/medical-form-templates/5561...
sidcool 10y ago
There's a pretty nifty open source OpenMRS app called Bahmni that is widely used in poor countries. A lot of my friends contribute to it. Worth checking.
peterwwillis 10y ago
I came here to ask the question "Has anyone (hopefully) done a 3rd party security audit of this open source medical records software?" But then I saw this: http://www.open-emr.org/wiki/index.php/FAQ#What_is_ImageMagick.3F http://www.open-emr.org/wiki/index.php/FAQ#What_is_ImageMagi... And then this: http://www.open-emr.org/wiki/index.php/FAQ#What_are_the_correct_PHP_settings_.28can_be_found_in_the_php.ini_file.29.3F http://www.open-emr.org/wiki/index.php/FAQ#What_are_the_corr... ..... http://www.open-emr.org/wiki/index.php/FAQ#What_do_I_do_if_I_am_locked_out_of_OpenEMR.3F http://www.open-emr.org/wiki/index.php/FAQ#What_do_I_do_if_I... http://www.open-emr.org/wiki/index.php/FAQ#What_is_OpenEMR.27s_default_Username.2C_Password_and_other_related_issues.3F http://www.open-emr.org/wiki/index.php/FAQ#What_is_OpenEMR.2... God help us all.
- brady_m 10y ago
  Agree that security is an important topic. Note there has not been a default password for about 5 years, and will update the FAQ. Regarding the other FAQ links you posted, what specific security issues are there with those? To get an idea of OpenEMR's security, recommend checking out the following section on the wiki(1 of those links has several 3rd party security audits): http://www.open-emr.org/wiki/index.php/OpenEMR_Wiki_Home_Page#Security http://www.open-emr.org/wiki/index.php/OpenEMR_Wiki_Home_Pag...
  - peterwwillis 10y ago
    It shows the use of ImageMagick, a legendarily buggy and insecure application and library. It shows the use of system crypt() for password hashes, which isn't really very secure since (afaik) it doesn't support pbkdf2 on most systems or bcrypt (not the blowfish one) or script. It shows hardcoding database credentials in a flat file. And it shows it uses PHP, which has its own security problems as well as being well known as a language used by people not aware of secure coding practices.
mbrookes 10y ago
If you're interested in or working on medical software, you might be interested in Clinical Meteor: http://clinical.meteorapp.com/ http://clinical.meteorapp.com/ "clinical:meteor is an open-source project creating a next-gen framework for building healthcare apps".
messo 10y ago
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?
- ams6110 10y ago
  Not crazy about the state-run angle, but I want no part of any EMR system that doesn't allow me to log in and view my own records.
- ensignavenger 10y ago
  How do patients authorize a new care provider to access their data? How do patients prevent the government from accessing their private health data? (Obviously the latter is a problem even for distributed systems, but a lot easier if the government already has the data on servers they control!)
vpn1951 10y ago
vpn1951@yahoo.com; ask me your questions and I will give answers to what I can.
pdimitar 10y ago
I don't mean to come across as an asshole; I applaud the effort! But seeing hierarchical menus just made me close the tab immediately. There are others, much more human-approachable, UI paradigmas. If we want to push meaningful software to the non-tech-savvy people to make their lives better, we have to start letting go of ancient UX methodologies.
- tim333 10y ago
  What would you use instead?
  - pdimitar 10y ago
    I would analyze the most used click paths and extract the real-life scenarios people are serving with them, and just make buttons for them. Clicking them will provide you with a wizard-like interface that aims at a specific need. Obviously this cannot replace all menus but hey, it's a start. Please note: I am not an UX expert. It's just what I subjectively find as a common-sensical approach.

360 points by mabynogy 10y ago

SteveNuts 10y ago

Having HTTPS enabled on their site would go a long ways for software like this.

exception_e 10y ago
It's an issue with Source forge. We're working on this.
- oomkiller 10y ago
  After sourceforge bundled malware with downloads, it's hard to trust a project that stuck with them, especially with health data, especially when there are numerous alternatives that are better.
  - exception_e 10y ago
    It's just for our website and wiki. We've moved to Github for the most part. There is talk between myself and a couple of other contributors to move the site and wiki to AWS :). Feel free to volunteer to speed this up, of course. EDIT: Misread your comment. We are hosting downloads on the SF site. Really need to move to AWS...
    - SteveNuts 10y ago
      How much traffic do you get? and is it all static?

hitgeek 10y ago

this project has been around for a long time. I always take a look at it when I need a reference system for thinking about data models or ux related issues for health record type projects. looks like it got a major facelift since the last time I checked it out. that must of been a lot of work. congrats to the contributors for making that happen, looks more modern.

brady_m 10y ago
Yep there was a lot of work both above and under the hood to modernize OpenEMR on the most recent release. Also was a several year effort to get complete meaningful use certification. Can see here for some more details on both efforts: http://www.openhealthnews.com/content/openemr-achieves-complete-meaningful-use-certification-breakthrough-release-50 http://www.openhealthnews.com/content/openemr-achieves-compl...

kevinmannix 10y ago

This is huge. I previously worked for a healthcare startup, and it seems like for every other healthcare startup we worked alongside or networked with, all roads lead to EMRs. It was (felt like) an impossibly large task without a clear path to execution due to the tangled web of healthcare IT & regulations. Something like this is huge, especially to potential competitors that now have a target to aim for.

keltor 10y ago
Unfortunately most of the time you end up having to individualize so much data structure for each deal it's a gigantic pain.

deleted 10y ago

[deleted]

qrbLPHiKpiux 10y ago

I use open dental. Tell me how open it is. An open EMR in healthcare does not mean much. Take a look at the necessary support needed to have the proper compliance.

exception_e 10y ago
Not sure what you mean... can you please be more specific? OpenEMR is 100% open source. It's GPL'ed :). As far as compliance, we are happy to inform you that OpenEMR is now 2014 ONC Ambulatory EHR Certification complete. EDIT: If you're asking about support, there are over 30 professional vendors. Community support is also available. If you have further questions, feel free to reach out to my email (in my profile).

jasondc 10y ago

There is even open source dental software, open source is seriously eating the enterprise (and healthcare) software world! I run OpenDental for my wife's practice in North Beach, SF. It's licensed as AGPL, but I'll still take it :)

forgotmysn 10y ago
kind of off-topic, but I moved to the City a couple years ago and need a new dentist. is your wife accepting new clients?
- jasondc 10y ago
  Definitely, wsparkdental.com :)
  - reagan83 10y ago
    I just started going to this office last month and can vouch for how great of a place it is. Dr Choi is a really amazing dentist. HN becomes smaller each day :)
    - jasondc 10y ago
      Woah, great to hear! I'll pass it along to her! It is a small place :)
  - evancordell 10y ago
    Hey, nice to see LocalMed being used in the wild :) I worked there for a couple of years.
  - forgotmysn 10y ago
    damn, that office makes Apple's new donut look retro
cmdrfred 10y ago
I supported this for a few years as a sysadmin. The most flexible EMR application I have ever seen.

jdhe 10y ago

As other comments mention, this project has been going for a while, the central reason it (or something like it) has not been robustly built out and deployed universally is because of the way congress chose to structure the funding for development of EMRs/EHRs. Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop systems, then subsidize the purchase cost to providers to encourage adoption. Then, only once everyone has invested in their own proprietary system will they begin trying to universalize the system by developing cross compatibility. This methodology is perfectly in line with the free-market approach that the US has championed for decades. It is also the opposite of how almost every other country has developed and adopted universal EMRs. Sad. Especially because we know that a good, affordable universal EMR would significantly enhance the ability to deliver care for almost all sizes of healthcare providers.

criley2 10y ago
As a programmer for an American EHR firm -- all of the market share already belongs to one of those companies you malign. You could not have had the government sponsor some new software which would eliminate a billion dollar software market. It's a non-starter. All the hospitals already are signed on multi-year contracts with those large providers. Some of the EHR providers began writing medical software for hospitals in the 1960s and 1970s. These companies have multi-decade relationships with the hospitals they service, and decades of patient data stored. What Obama and the Democrats did was to break the "paper cycle". Many hospitals used paper-only system with very little software even into the 2000's and 2010's. The point of investing in each company was to jumpstart their products into meeting the huge new regulations, and the point of giving clients money to buy this new software was to break the paper cycle. There is no "one size fits all" option in the American market. I find it funny that you malign our practice as "(idiotic)" when it is your plan, quite frankly, which is so ignorant to the complicated history and reality of medical providers and their software, that seems idiotic to me. Your opinion sounds to me like "The US Gov should, instead of using MS Windows, pay a company to invent a new operating system, then ban all use of Windows, OSX and Linux to ensure all firms must use the single new solution". We already had so many options that have existed for decades, with so many clients, and so much built-out software infrastructure. There was no "one-size-fits-all" solution unless your solution includes "Destroy the entire industry, and use force of government to destroy a half dozen major software companies in favor of the government mandated and almost assuredly inferior option" The crux you may not realize is how customized every major hospital system expects their EHR software to be. I don't think you realize the sheer level of customization these networks require, due to the size and scope of their businesses. It takes entire teams of my company to service certain major clients. The idea of a one-size-fits-all would have been laughed out of our country.

exception_e 10y ago

Please read about our groundbreaking v5 release here: https://medium.com/openemr/complete-meaningful-use-certification-1627b989d9bb#.5c9it7a59 https://medium.com/openemr/complete-meaningful-use-certifica...

tim333 10y ago
Congrats.

kakoni 10y ago

We've been gathering various open source health projects here. https://github.com/kakoni/awesome-health https://github.com/kakoni/awesome-health

exception_e 10y ago
Just sent both an issue and a PR. Great idea!

davidlee1435 10y ago

Github repo: https://github.com/openemr/openemr https://github.com/openemr/openemr

rdudek 10y ago

How are they planning on pushing it to hospitals? All major players have adopted Epic EMR, at least here in Colorado. And once they have a system, they'll stick with it due to premium support and huge cost will prevent switching.

keltor 10y ago
Epic, Cerner and Meditech are the largest EHRs and they combined control just about 50% of the market. Epic and Cerner tend more towards the Academic hospitals and Meditech and McKesson (#4) tend towards the Commercial hospitals. There has also been a ton of incentive payments from CMS that have almost exceeded the EHR industry as a whole. There have also been quite a few big switches from the 90s to today, a bunch of them from Meditech/Epic/Cerner to others, so it can definitely happen.
exception_e 10y ago
Hospitals in America aren't the main consumers of OpenEMR. Think smaller facilities, and hospitals and facilities outside of the US.

JusticeJuice 10y ago

I'm currently working on my thesis, I'm trying to design a radically different take on EMR/EHR systems - http://barnett.surge.sh/ 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 half decent tools would be a huge goal for society - but almost all healthcare software is still frankly, terrible. After heaps of reading I've narrowed it down to 3 reasons why healthcare software is so hard to build. 1 - Modern healthcare is complex, and varied. Building any healthcare softawre is no easy task, even simple systems have many other systems to integrate with. But what makes this worse, is that no two places do healthcare quite the same. Between regions, and institutions, healthcare can vary a shit ton. 2 - Healthcare is risky. Sounds obvious, but if your software fails, people die - but this risk creates an attitude of "dont touch it". Changing systems has such a risk, that institutions will use the same software until it's so out of date its not funny. This impeeds improvement and innovation. 3 - Healthcare software is hard to sell. Not in the sense that its unprofitable, but that it takes ages to get users. Say if I made video editing software - I could get professionals trying it out tommorrow. However, if I make a PMS, I have to sell it to the entire practice - not just a few keen doctors. From making contact to actually getting a small practice using your software could literally be years - making it super hard to enter the market. I've been working on this topic fulltime for a year now - and I must admit, I don't have the golden answer. However, I'm designing a system as a response to these factors, an alternative to interoperability, and would love to talk anybody in the industry about it. http://barnett.surge.sh/ http://barnett.surge.sh/ eliot.slevin@gmail.com

dharma1 10y ago
looks good, how far are you with it? is it open source?
- JusticeJuice 10y ago
  It's essentially a giant design proposal - yes it's all open source, but theres nothing you can download and start using - yet :)

amelius 10y ago

Does it allow anonymization of patient data, so that it can be used for research?

robertdown 10y ago
Yes, openEMR allows for de-identification of patient data!

hetfeld 10y ago

Actually this is huge. And sadly very underrated, hope this will get more spread across the world news agencies and developing countries will use this software for government clinics.

ipunchghosts 10y ago

As much as I would love this, I simply dont think it will work. Why? Epic is simply too big and has too much of the market and they are too far behind. I use picnichealth.com to deal with this EMR mess and I love it!

entee 10y ago
The pricing seems incredibly high, am I understanding correctly that they want ~$300 up front then $33/month thereafter? That said, working in this industry, I know exactly how hard it is to do this right. In many ways this is what it costs to do the job, if not more, but I'm not sure I'd pay it. There's the tragedy of the whole EMR/patient data story: bloody expensive, who pays?
- ipunchghosts 10y ago
  That's weird, they changed their pricing plan. I only see the concierge service. Perhaps they have enough customers to be happy at the moment. I pay 10/month which is completely worth it in my mind. I can pull up pathology reports at my out of state docs office in real-time. Makes the best out of 3 hour trip to see the doc! EDIT: I have also used this in conjunction with healthtap. EXTREMELY USEFUL! Doctors love it!
- nogaleviner 10y ago
  PicnicHealth CEO here. We did raise prices to keep quality super high as we scale, but here's a nice discount for our HN friends. Enjoy! https://picnichealth.com/friends-of-picnic https://picnichealth.com/friends-of-picnic

ipunchghosts 10y ago

EMR is simply too messy for openEMR to put a dent in the issue. I truely wish it were different. If insurance carriers are permitted to operate across state lines in the future, i think there is a chance of a Google or Microsoft getting into the space which I think is the right way to go. Right now, the large companies managing EMR and huge monoliths that simply don't care about innovation. They are like defense contractors to the military. If the market ever opens up and consumers have more choice, its clear that someone like google or MS would win and I honestly believe really give healthcare a boost in this country.

nradov 10y ago
That's not how the EMR market works. Insurance sales across state lines won't make much difference to EMRs either way. Google and Microsoft are horizontal vendors. They aren't likely to put a major effort into a vertical market, and even if they did there's no reason that they would do it any better than the existing vendors. It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market.
- ipunchghosts 10y ago
  > It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market. They have analytics, "moneyball" so to speak. There is a plethora of untapped data in these systems. I've worked with Gesinger in PA and you would not believe how far behind the curve they are and they are often touted to be on the forefront. What needs to happen is getting google or MS into health insurance. They could utilize all the data collected to benefit the patients and make a big profit. Additionally, they have the know how to set up a pharm lab for drug development. Insurance companies really should drive drug development. It makes sense for them to develop drugs for conditions costing them the most amount of money per patient. Instead, they are middle men who have to work with whatever big pharma give them.
  - nradov 10y ago

brianmartinek 10y ago

Does anyone know of a EMR system that could house my household/personal health data? One of the struggles I have is organizing my own health data in a singular place with structured data formats, document uploads, etc. The closest thing I have found is http://mymedicalapp.com/ http://mymedicalapp.com/ but it appears to have been abandoned by the developer.

lukas 10y ago
picnichealth.com
- ipunchghosts 10y ago
  came here to say this. i use them. love it.
- brianmartinek 10y ago
  Thanks for the recommendation. It is what I am looking for except that it doesn't seem to offer any upload options if there are holes in the data they retrieve. Still, a step in the right direction and I'll give it a try.
  - ipunchghosts 10y ago
    You can put data on a google drive and share a link with them. I did this for all my existing radiological data. They had no issue downloading it.
  - nogaleviner 10y ago
    PicnicHealth CEO here. You won't have this problem because we don't miss any data :) But really, if you have old stuff we can't get anymore we can find a way for you to send it over.
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lacampbell 10y ago

My first permanent IT job was actually working with practice management software. It worked across multiple jurisdictions with fairly minimal changes - an appointment is an appointment in any country. I actually suspect it violated several laws - I remember I had full access to a database stored offshore where patient notes were there in plain text, along with their names and addresses. I emailed the privacy commission about it but they wanted to me to name names and I was scared of losing my job. So yeah, I hope you encrypt notes.

edimaudo 10y ago

Is it easy to use? Does it reduce the amount of paperwork to be done? How safe is it?

robertdown 10y ago
I think it is easy to use, and yes it has the potential to nearly (if not completely) eliminate all paperwork in your clinic. As far as safety, openEMR is fully HIPPA compliant as well as 2014 ONC Complete Ambulatory EHR certified (a/k/a Meaningful Use 2).

dualboot 10y ago

We've had an incredibly well adopted open-source EMR solution here in Canada for quite a while. OSCAR https://oscar-emr.com/oscar/ https://oscar-emr.com/oscar/

tfaruq 10y ago

What is the different with OpenMRS http://openmrs.org http://openmrs.org ?

walrus01 10y ago

If people had any idea how much antiquated medical software is out there in production running on Windows 98, 2000 or XP and coded in Visual Basic they would run away screaming. It's seriously that bad.

gnaritas 10y ago
Yup, but that sector is so heavily regulated that it scares off startups, and who can blame them.
- clock_tower 10y ago
  You might be interested in athenahealth, a Web-oriented healthcare company which actually runs a sort of startup incubator ("More Disruption, Please"), and has led a lot of initiatives to improve interoperability. They realize these things create trouble for them as well as the rest of the field, but I think they're betting that their rivals are significantly less flexible than they are. (This is a safe bet, of course. The giants of the field, Epic and Cerner, are infamous for overwork, low pay, and high turnover. Their technology's also obsolete: Epic has a VB6 front end and MUMPS back end; Cerner uses C++, but it's probably C++ thinly translated from C thinly translated from Pascal, so they're not a whole lot better. At least MUMPS isn't vulnerable to C-style buffer overflow attacks!)
  - IgorPartola 10y ago
    Slightly OT: I read somewhere that whenever you see "to disrupt" you should replace it with "to fuck up" as that is the true meaning of what is being said. Not that it's always a bad thing, but it is almost always destructive.
clock_tower 10y ago
I see you know about Epic Systems Corporation. :)
wallace_f 10y ago
I did some work for a company that had 100+ banks running accounting software developed in Visual Basic in the early 90s. Unfortunately, this experience, supporting obsolete, spaghetti-code-nightmare, opened my eyes to the world that business is done in a much dirtier way than how I imagined growing up.

Skeletor 10y ago

I think it's great that there are projects like http://www.open-emr.org/ http://www.open-emr.org/ , https://oscar-emr.com/oscar/ https://oscar-emr.com/oscar/ , http://openmrs.org/ http://openmrs.org/ , and https://www.hl7.org/fhir/http.html https://www.hl7.org/fhir/http.html ; I think these tools would be even better if they released their code under LGPL (instead of GPL) so that lazy commercial EHR developers would reuse and help maintain some core modules to promote more interoperability. I don't think it's going to ever be possible (or that it is even desirable) to ever have a "Universal EHR" that everyone is forced to use through either government intervention or through market/economic forces. We can all exchange emails with each other, but we aren't all forced to use the same email client The reason that the entire healthcare system seems broken to most consumers is legacy EHR systems in large hospitals. These legacy enterprise vendors are essentially what Oracle was 20 years ago in the rest of the enterprise software market before companies like Salesforce.com came along. Another part of this "broken" feeling is the difficulty of exchanging data between different EHR systems; but this doesn't have to be the case. "If you've seen one HL7 standard implementation, you have seen exactly one HL7 standard implementation." Which means most systems don't interoperates with anyone else's systems unless there is an existing commercial relationship that forced everyone to interoperate on a local scale. For anyone looking to work on an idea to improve healthcare check out: https://www.drchrono.com/api/ https://www.drchrono.com/api/ and/or https://www.drchrono.com/careers/ https://www.drchrono.com/careers/

mabynogy 10y ago
Very clear and interesting concept: https://app.drchrono.com/ehr-emr/medical-form-templates/556163/initial-assessment https://app.drchrono.com/ehr-emr/medical-form-templates/5561...

sidcool 10y ago

There's a pretty nifty open source OpenMRS app called Bahmni that is widely used in poor countries. A lot of my friends contribute to it. Worth checking.

peterwwillis 10y ago

I came here to ask the question "Has anyone (hopefully) done a 3rd party security audit of this open source medical records software?" But then I saw this: http://www.open-emr.org/wiki/index.php/FAQ#What_is_ImageMagick.3F http://www.open-emr.org/wiki/index.php/FAQ#What_is_ImageMagi... And then this: http://www.open-emr.org/wiki/index.php/FAQ#What_are_the_correct_PHP_settings_.28can_be_found_in_the_php.ini_file.29.3F http://www.open-emr.org/wiki/index.php/FAQ#What_are_the_corr... ..... http://www.open-emr.org/wiki/index.php/FAQ#What_do_I_do_if_I_am_locked_out_of_OpenEMR.3F http://www.open-emr.org/wiki/index.php/FAQ#What_do_I_do_if_I... http://www.open-emr.org/wiki/index.php/FAQ#What_is_OpenEMR.27s_default_Username.2C_Password_and_other_related_issues.3F http://www.open-emr.org/wiki/index.php/FAQ#What_is_OpenEMR.2... God help us all.

brady_m 10y ago
Agree that security is an important topic. Note there has not been a default password for about 5 years, and will update the FAQ. Regarding the other FAQ links you posted, what specific security issues are there with those? To get an idea of OpenEMR's security, recommend checking out the following section on the wiki(1 of those links has several 3rd party security audits): http://www.open-emr.org/wiki/index.php/OpenEMR_Wiki_Home_Page#Security http://www.open-emr.org/wiki/index.php/OpenEMR_Wiki_Home_Pag...
- peterwwillis 10y ago
  It shows the use of ImageMagick, a legendarily buggy and insecure application and library. It shows the use of system crypt() for password hashes, which isn't really very secure since (afaik) it doesn't support pbkdf2 on most systems or bcrypt (not the blowfish one) or script. It shows hardcoding database credentials in a flat file. And it shows it uses PHP, which has its own security problems as well as being well known as a language used by people not aware of secure coding practices.

mbrookes 10y ago

If you're interested in or working on medical software, you might be interested in Clinical Meteor: http://clinical.meteorapp.com/ http://clinical.meteorapp.com/ "clinical:meteor is an open-source project creating a next-gen framework for building healthcare apps".

messo 10y ago

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?

ams6110 10y ago
Not crazy about the state-run angle, but I want no part of any EMR system that doesn't allow me to log in and view my own records.
ensignavenger 10y ago
How do patients authorize a new care provider to access their data? How do patients prevent the government from accessing their private health data? (Obviously the latter is a problem even for distributed systems, but a lot easier if the government already has the data on servers they control!)

vpn1951 10y ago

vpn1951@yahoo.com; ask me your questions and I will give answers to what I can.

pdimitar 10y ago

I don't mean to come across as an asshole; I applaud the effort! But seeing hierarchical menus just made me close the tab immediately. There are others, much more human-approachable, UI paradigmas. If we want to push meaningful software to the non-tech-savvy people to make their lives better, we have to start letting go of ancient UX methodologies.

tim333 10y ago
What would you use instead?
- pdimitar 10y ago
  I would analyze the most used click paths and extract the real-life scenarios people are serving with them, and just make buttons for them. Clicking them will provide you with a wizard-like interface that aims at a specific need. Obviously this cannot replace all menus but hey, it's a start. Please note: I am not an UX expert. It's just what I subjectively find as a common-sensical approach.