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The Affordable Care Act mandated use of EMR and heavily funded its adoption. Is there really not one fully implemented open source solution after all that mone

by Dowwie 9y ago

The Affordable Care Act mandated use of EMR and heavily funded its adoption. Is there really not one fully implemented open source solution after all that money was spent? Why does this project exist?

exception_e 9y ago
Most of our users are outside of the US where nonfree solutions are simply not in the cards financially. In the US, we are seeing adoption in practices that can't afford expensive EMRs and in those that want to truly customize their system. Also, Meaningful Use/HITECH is not ACA.
ethanwillis 9y ago
You mean it heavily funded the adoption of Epic. Sorry to break it to you, this was shuffling around of money to conglomerates.
- robto 9y ago
  Pretty sure Epic isn't a conglomerate, though you are correct that they benefited immensely from the Meaningful Use/HITECH legislation.
- ch4s3 9y ago
  and a few others
pg_bot 9y ago
As someone who has made an EMR and has used OpenEMR there are a few reasons why there hasn't been a fully implemented open source solution in this space. 1.) Hospitals are fairly risk averse organizations. Instead of spending resources on building out a technical team and building their own solutions they usually will outsource tech to a third party (EPIC, GE, Cerner, etc). A CTO of a hospital is usually just a checkbook personified and buying IBM never got anyone fired. 2.) An EMR is not a trivial software application. A good one has an extremely large feature set with multiple specialized applications depending on the type of physician who is using it. 3.) There are compliance and regulatory hurdles which scare away a lot of people from working in the field. 4.) The players in the field have no incentive to open source their work since they make all of their money on enterprise sales contracts.
- rch 9y ago
  IBM Watson (and, separately, Epic) certainly helped get the former President of M.D. Anderson "fired": https://www.statnews.com/2017/03/08/md-anderson-depinho-resigns/ https://www.statnews.com/2017/03/08/md-anderson-depinho-resi... The CIO (Lynn Vogel) "departed" recently as well: http://med.stanford.edu/content/dam/sm/cancer/documents/pdfs/TCL011714.pdf http://med.stanford.edu/content/dam/sm/cancer/documents/pdfs...
- spraak 9y ago
  Not affiliated, but you may find Redox Engine [1] helpful if you work on any EMR integrations. [1] https://www.redoxengine.com/ https://www.redoxengine.com/
- jesdynf 9y ago
  PG, if you've used it before, you might glance at it again. I'm on the development team, and I've put a lot of effort into smoothing out the installation process and building HIPAA-friendly deployments. We've got one product in the Amazon Marketplace right now, with another one coming soon. https://github.com/openemr/openemr-devops https://github.com/openemr/openemr-devops
tedjdziuba 9y ago
> Why does this project exist? OpenEMR exists because during the summer of 2000, with the dot-com boom in full swing on the left side of the United States, four high school students in Cheshire, Connecticut spent the humid part of our year in a basement writing PHP code to manage documents for an internal medicine practice that belonged to one of the students' mothers. It worked well enough. The four of us were all college-bound in different directions, so instead of trying to sell the software to medical practices, we released it under the GPL. Open source contributors took it from there.
brady_m 9y ago
This project exists to offer an open source EMR and give providers and patients the freedom that comes with that. OpenEMR has gone through the rigid US regulatory requirement for an outpatient EMR and is Meaningful Use certified. It can compete in functionality with any of the other proprietary outpatient EMRs out there. This then give providers and patients throughout the globe, especially low resource areas, access to a free and open source fully functional product. And we are always looking for volunteers, contributors, and donations to maintain the progress of OpenEMR.
fencepost 9y ago
The ACA mandated and funded the adoption of EMR in large part by providing funding to physicians' offices which they could use largely as they wanted as long as they ended up with a certified EMR. Unfortunately the certification process is "not free" to tune of at least tens of thousands of dollars in testing costs to outside certification authorities, plus whatever work needs to be done as prep or to remediate issues. OpenEMR also used to have a very unpolished interface in a "frame-driven late 90s web form" kind of way, and that probably hurt its adoption some when practices were looking at it and comparing it to more polished offerings from the commercial vendors. There have been multiple open source EMR packages over time, many of them derived from failed commercial attempts that were then open-sourced. I believe that OpenEMR is one of those, but I think that most of the rest have fallen by the wayside or are used in situations where certifications and Meaningful Use attestation are not so relevant. Others on the thread (e.g. brady) are core members of the OpenEMR team so they're probably better able to answer questions.
aaavl2821 9y ago
the HITECH act essentially created a duopoly in the EMR market: Epic and Cerner. Cerner is a public company so you can look at their financials and see the massive tailwind that was the HITECh act. they sell basically compliance and billing products to hospitals for 9-figure installation checks and huge, multiyear service contracts. once you get locked in, its incredibly painful to get out (see above 9-figure, multi-year installs) EMRs are massive cash cows for the big players (who are now largely just 2, epic and cerner). these products are largely built to comply with regulations and make billing easier. they are build for hospital admins. physicians hate them, and many blame them for the massive increase in physician burnout over the last few years building one of these would be a pain in the ass as you need to digitize hundreds of clinical forms and comply with a dizzying set of regulations. the architecture for a lot of these things is from the 1970s, but the sheer amount of features needed makes building one from scratch painful. and the market power of the incumbents makes it really tough to even carve out niche features if there is any group in healthcare that should be disrupted, its the EMR companies
- orb_yt 9y ago
  > physicians hate them, and many blame them for the massive increase in physician burnout over the last few years It's funny, I assumed the same. I then asked a few who used the product, and was surprised to hear praise for Epic. I wonder if the product has actually improved, or if users have simply conceded.
  - aaavl2821 9y ago
    that's interesting, ive heard that epic is better than cerner and others, but most of my physician friends still dont like it out of curiousity, what kind of physicians were these, in terms of specialty as well as employment status (hospital employed, hospital affiliated, part of med group, independent)? most of the physician surveys ive seen express negative views about EMRs, but a sizable portion of physicians say that EMRs help make some things easier and more efficient. cant locate the surveys offhand
    - 9y ago

by Dowwie 9y ago

exception_e 9y ago

Most of our users are outside of the US where nonfree solutions are simply not in the cards financially. In the US, we are seeing adoption in practices that can't afford expensive EMRs and in those that want to truly customize their system. Also, Meaningful Use/HITECH is not ACA.

ethanwillis 9y ago

You mean it heavily funded the adoption of Epic. Sorry to break it to you, this was shuffling around of money to conglomerates.

robto 9y ago
Pretty sure Epic isn't a conglomerate, though you are correct that they benefited immensely from the Meaningful Use/HITECH legislation.
ch4s3 9y ago
and a few others

pg_bot 9y ago

As someone who has made an EMR and has used OpenEMR there are a few reasons why there hasn't been a fully implemented open source solution in this space. 1.) Hospitals are fairly risk averse organizations. Instead of spending resources on building out a technical team and building their own solutions they usually will outsource tech to a third party (EPIC, GE, Cerner, etc). A CTO of a hospital is usually just a checkbook personified and buying IBM never got anyone fired. 2.) An EMR is not a trivial software application. A good one has an extremely large feature set with multiple specialized applications depending on the type of physician who is using it. 3.) There are compliance and regulatory hurdles which scare away a lot of people from working in the field. 4.) The players in the field have no incentive to open source their work since they make all of their money on enterprise sales contracts.

rch 9y ago
IBM Watson (and, separately, Epic) certainly helped get the former President of M.D. Anderson "fired": https://www.statnews.com/2017/03/08/md-anderson-depinho-resigns/ https://www.statnews.com/2017/03/08/md-anderson-depinho-resi... The CIO (Lynn Vogel) "departed" recently as well: http://med.stanford.edu/content/dam/sm/cancer/documents/pdfs/TCL011714.pdf http://med.stanford.edu/content/dam/sm/cancer/documents/pdfs...
spraak 9y ago
Not affiliated, but you may find Redox Engine [1] helpful if you work on any EMR integrations. [1] https://www.redoxengine.com/ https://www.redoxengine.com/
jesdynf 9y ago
PG, if you've used it before, you might glance at it again. I'm on the development team, and I've put a lot of effort into smoothing out the installation process and building HIPAA-friendly deployments. We've got one product in the Amazon Marketplace right now, with another one coming soon. https://github.com/openemr/openemr-devops https://github.com/openemr/openemr-devops

tedjdziuba 9y ago

> Why does this project exist? OpenEMR exists because during the summer of 2000, with the dot-com boom in full swing on the left side of the United States, four high school students in Cheshire, Connecticut spent the humid part of our year in a basement writing PHP code to manage documents for an internal medicine practice that belonged to one of the students' mothers. It worked well enough. The four of us were all college-bound in different directions, so instead of trying to sell the software to medical practices, we released it under the GPL. Open source contributors took it from there.

brady_m 9y ago

This project exists to offer an open source EMR and give providers and patients the freedom that comes with that. OpenEMR has gone through the rigid US regulatory requirement for an outpatient EMR and is Meaningful Use certified. It can compete in functionality with any of the other proprietary outpatient EMRs out there. This then give providers and patients throughout the globe, especially low resource areas, access to a free and open source fully functional product. And we are always looking for volunteers, contributors, and donations to maintain the progress of OpenEMR.

fencepost 9y ago

The ACA mandated and funded the adoption of EMR in large part by providing funding to physicians' offices which they could use largely as they wanted as long as they ended up with a certified EMR. Unfortunately the certification process is "not free" to tune of at least tens of thousands of dollars in testing costs to outside certification authorities, plus whatever work needs to be done as prep or to remediate issues. OpenEMR also used to have a very unpolished interface in a "frame-driven late 90s web form" kind of way, and that probably hurt its adoption some when practices were looking at it and comparing it to more polished offerings from the commercial vendors. There have been multiple open source EMR packages over time, many of them derived from failed commercial attempts that were then open-sourced. I believe that OpenEMR is one of those, but I think that most of the rest have fallen by the wayside or are used in situations where certifications and Meaningful Use attestation are not so relevant. Others on the thread (e.g. brady) are core members of the OpenEMR team so they're probably better able to answer questions.

aaavl2821 9y ago

the HITECH act essentially created a duopoly in the EMR market: Epic and Cerner. Cerner is a public company so you can look at their financials and see the massive tailwind that was the HITECh act. they sell basically compliance and billing products to hospitals for 9-figure installation checks and huge, multiyear service contracts. once you get locked in, its incredibly painful to get out (see above 9-figure, multi-year installs) EMRs are massive cash cows for the big players (who are now largely just 2, epic and cerner). these products are largely built to comply with regulations and make billing easier. they are build for hospital admins. physicians hate them, and many blame them for the massive increase in physician burnout over the last few years building one of these would be a pain in the ass as you need to digitize hundreds of clinical forms and comply with a dizzying set of regulations. the architecture for a lot of these things is from the 1970s, but the sheer amount of features needed makes building one from scratch painful. and the market power of the incumbents makes it really tough to even carve out niche features if there is any group in healthcare that should be disrupted, its the EMR companies

orb_yt 9y ago
> physicians hate them, and many blame them for the massive increase in physician burnout over the last few years It's funny, I assumed the same. I then asked a few who used the product, and was surprised to hear praise for Epic. I wonder if the product has actually improved, or if users have simply conceded.
- aaavl2821 9y ago
  that's interesting, ive heard that epic is better than cerner and others, but most of my physician friends still dont like it out of curiousity, what kind of physicians were these, in terms of specialty as well as employment status (hospital employed, hospital affiliated, part of med group, independent)? most of the physician surveys ive seen express negative views about EMRs, but a sizable portion of physicians say that EMRs help make some things easier and more efficient. cant locate the surveys offhand
  - 9y ago