5 ms·

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 mas

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
  - fencepost 9y ago
    I'm hoping to get feedback on Epic in the next few months, as we lose a long-term client that's being purchased by a LARGE medical group running Epic. Our client has been on eClinicalWorks for something like 10 years at this point, so I think there's going to be some whiplash of change in about 6 weeks. I'll probably be keeping at least somewhat in touch with them, so in a couple months perhaps I'll have some basis for comparison.
brady_m 9y ago
But OpenEMR is already built, is in working form, is certified for Meaningful Use in the US, and most importantly is open source. Epic and Cerner and other proprietary systems are too expensive for many practices in the US and have simply placed both a huge financial burden on the medical system and a productivity burden on the physicians. Physicians need to take back their EMRs and their productivity and OpenEMR is a great route to do this. For example, a practicing ophthalmologist, whom is also a software developer, developed an eye module in OpenEMR with the goal of the physician maintaining productivity (ie. not to spend time entering meaningless data in an awkward and distracting fashion), which he succeeded at. Can read about the project here: http://www.open-emr.org/wiki/index.php/Eye_Exam http://www.open-emr.org/wiki/index.php/Eye_Exam And right now OpenEMR needs more volunteers, physicians, developers, and donations to keep progressing. And what is so great about an open source project like this is that if OpenEMR keeps doing great things in the US, then these achievements are essentially multiplied by 1000 as low resource areas throughout the globe get free access to this same open source fully functional EMR.
- aaavl2821 9y ago
  i agree it sounds like a great tool, and epic and cerner leave huge unmet needs in terms of productivity and also cost. seems like marketing is the huge challenge id imagine this is really for independent physicians at least in the most-near term, as the sales cycle at big hospitals is brutal, and youd have epic / cerner folks scaring the hospital admins about real / imagined security concerns. but marketing to independent physicians is brutal. from what ive heard you need at least an inside, and sometimes field, sales force, and getting through all the marketing noise docs get is really hard. would love to hear your thoughts on how to market this more widely edit: my post mostly concerns US physicians, but id imagine marketing challegnes would be just as big or greater for developing nations
  - jesdynf 9y ago
    I wrote a reference implementation of OpenEMR, the "OpenEMR Full Stack", that's taking aim at facility-grade loads. It's deployed from Amazon CloudFormation, and the highlights include multi-AZ redundancy, an Elastic Beanstalk deployment fronted with a load balancer running parallel OpenEMR instances in multiple AZs, an internal Route53 domain protected with SSL between nodes, redundant document stores for patient records, and enterprise-grade backup and recovery structures all wrapped up CloudTrail and Amazon's Key Management System. https://github.com/openemr/openemr-devops/tree/master/packages/full_stack https://github.com/openemr/openemr-devops/tree/master/packag...

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
- fencepost 9y ago
  I'm hoping to get feedback on Epic in the next few months, as we lose a long-term client that's being purchased by a LARGE medical group running Epic. Our client has been on eClinicalWorks for something like 10 years at this point, so I think there's going to be some whiplash of change in about 6 weeks. I'll probably be keeping at least somewhat in touch with them, so in a couple months perhaps I'll have some basis for comparison.

brady_m 9y ago

But OpenEMR is already built, is in working form, is certified for Meaningful Use in the US, and most importantly is open source. Epic and Cerner and other proprietary systems are too expensive for many practices in the US and have simply placed both a huge financial burden on the medical system and a productivity burden on the physicians. Physicians need to take back their EMRs and their productivity and OpenEMR is a great route to do this. For example, a practicing ophthalmologist, whom is also a software developer, developed an eye module in OpenEMR with the goal of the physician maintaining productivity (ie. not to spend time entering meaningless data in an awkward and distracting fashion), which he succeeded at. Can read about the project here: http://www.open-emr.org/wiki/index.php/Eye_Exam http://www.open-emr.org/wiki/index.php/Eye_Exam And right now OpenEMR needs more volunteers, physicians, developers, and donations to keep progressing. And what is so great about an open source project like this is that if OpenEMR keeps doing great things in the US, then these achievements are essentially multiplied by 1000 as low resource areas throughout the globe get free access to this same open source fully functional EMR.

aaavl2821 9y ago
i agree it sounds like a great tool, and epic and cerner leave huge unmet needs in terms of productivity and also cost. seems like marketing is the huge challenge id imagine this is really for independent physicians at least in the most-near term, as the sales cycle at big hospitals is brutal, and youd have epic / cerner folks scaring the hospital admins about real / imagined security concerns. but marketing to independent physicians is brutal. from what ive heard you need at least an inside, and sometimes field, sales force, and getting through all the marketing noise docs get is really hard. would love to hear your thoughts on how to market this more widely edit: my post mostly concerns US physicians, but id imagine marketing challegnes would be just as big or greater for developing nations
- jesdynf 9y ago
  I wrote a reference implementation of OpenEMR, the "OpenEMR Full Stack", that's taking aim at facility-grade loads. It's deployed from Amazon CloudFormation, and the highlights include multi-AZ redundancy, an Elastic Beanstalk deployment fronted with a load balancer running parallel OpenEMR instances in multiple AZs, an internal Route53 domain protected with SSL between nodes, redundant document stores for patient records, and enterprise-grade backup and recovery structures all wrapped up CloudTrail and Amazon's Key Management System. https://github.com/openemr/openemr-devops/tree/master/packages/full_stack https://github.com/openemr/openemr-devops/tree/master/packag...