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Open EMR
- thinkmassive 6y ago"OpenEMR is a Free and Open Source electronic health records and medical practice management application"
- simonebrunozzi 6y agoThanks. It took me several seconds to realize what this was about. My AWS-bias made me initially think of an open version of EMR (Elastic Map Reduce).
- n_f 6y agoSame lol, especially cuz it's on hacker news
- tprynn 6y agoEMR is just an automated way of deploying open source components (Hadoop and co.) - there's some glue code there but the equivalent "open" version is probably the Hortonworks stuff (now owned by Cloudera): https://github.com/hortonworks https://github.com/hortonworks
- thinkmassive 6y agoAs someone who worked at Hortonworks back in the day, this is why I clicked through to find out what is OpenEMR, haha
- oogetyboogety 6y agoThis was pretty cool from Cloudera https://dzone.com/articles/large-scale-health-data-analytics-with-ohdsi https://dzone.com/articles/large-scale-health-data-analytics...
- Bqhatevwr 6y agoDitto. I'm relatively new to HN and I am consistently frustrated by the "completely uninformative title" fetish link submitters seem to have. I also wish that when people submit what is clearly a "new version of software/thing X" they would submit a title like: "Salami 2.0 released, this popular meat product now has substantially more zest." Instead people just submit: "Salami 2.0" That's no better than Freshmeat.
- cambalache 6y agoBecause it is fear of losing face/status. You are just a worm if you dont recognize immediately that for example, SoC means "system on a chip"
- Defenestresque 6y agoIt's not really up to the submitters. One of the core guidelines of HN is to use the articles title and not to editorialize [0] >[otherwise] please use the original title, unless it is misleading or linkbait; don't editorialize. [0] https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html Obviously there are upsides and downsides to this, but IMO it significantly cuts down on clickbaity titles at the expense of some readability when the site being linked to chooses a less-than-descriptive title.
- ptx 6y agoI clicked on "features", trying to find out what EMR means, and was greeted by a banner that really clarified things: "ONC Certified HIT! 2014 Complete Edition EHR!"
- csense 6y agoWritten in PHP and using CVS for version control - Any plans for modernization?
- SftwreEngnr 6y agoIf it ain't broke, don't fix it.
- Kocrachon 6y agoNot sure how I feel about my medical information being handled by PHP...
- gen220 6y agoThis won't make you feel any better... Many healthcare systems are a COBOL-dialect all the way at the bottom. Some of these had PHP layers shimmed in, when the web became a thing. I've seen php scripts that shell out to .bat's, that interface with the COBOL engine. It's a mad world. For context, a large amount of healthtech software was written in the 80s (kind of like fintech, the difference is that there's no competitive advantage to having better technology in health). It's a minor miracle that anything works at all.
- ch4s3 6y agoI showed someone from the Allscripts innovation group what I could do in an Elixir repl once, and his jaw hit the floor. Then I showed him how we wrote parsers. He said we'd never make it because we turned around new features too fast for anyone to trust us.
- ch4s3 6y agoHaha, among the most popular EMR you'll find a snarl of Perl, PHP, VB, Mumps/M, C#, old Java, cobol, and several proprietary languages. There is a small number of people who die in the US every year do to medical mistakes attributable to software bugs.
- 6y ago
- BadInformatics 6y agoSee also https://gnuhealth.org https://gnuhealth.org, https://oscar-emr.com/ https://oscar-emr.com/ and https://hospitalrun.io/ https://hospitalrun.io/. As with anything in the b2b healthcare space, most of these systems suffer from quite a bit of legacy and at-best-average code quality. Despite that, many doctors, clinics and even small hospitals use them because the private solutions (think Epic [1], but smaller) aren't necessarily better code-wise (don't ask me how I know). I wish more FAANG-calibre devs would look into contributing to and evangelizing these platforms rather than writing yet another note-taking/"productivity management" app. It has a direct impact on the quality of care delivery in certain parts of the world and a positive impact on tool-related clinician burnout [2]. [1] https://news.ycombinator.com/item?id=18735023 https://news.ycombinator.com/item?id=18735023 [2] https://news.ycombinator.com/item?id=24336039 https://news.ycombinator.com/item?id=24336039
- sidlls 6y agoI hope like hell “FAANG caliber devs” never take an interest in this space. Or at least not until the culture changes substantially. There are just some things that “throw devs (of any quality) at it” just doesn’t work. The health care industry is one of them.
- boston_sre87 6y agoBelieve it or not, there are some engineers that have worked at faang companies that are not sloppy and I work with a few of them.
- sidlls 6y agoIt’s not about being sloppy. It’s about ego and hubris. Just want to add: I work with (ex-)FAANG folks on a daily basis, too. Not all of them have egos bigger than their britches. But the ones who think “this industry just needs better software, and I can write it” sure as hell do.
- boston_sre87 6y ago
- recursive 6y agoIn this space, a significant issue, maybe the main one, is configuration and deployment. Lacking a single, blessed, vendor that can do this seems like it might be an obstacle for adoption.
- adzm 6y agoOne of the hurdles of EMR systems is that there is a pretty significant minimum viable product due to various standards that can't be ignored. Thankfully, this space is far more open now than it used to be; HL7 for example used to require payment just to see the standards. Pretty much everything you would need access to (HL7, CCDA, SNOMED, LOINC, ICD-10, etc) is freely available now! Generally just having an EMR system is not enough; you also need practice management, scheduling, billing, insurance claims, etc. Interoperability between separate software for these things is... tenuous at best, though some practices do manage to handle it, it can be very fragile. Hence integrated solutions are pretty much the best way to go, and also prevent disruption from competitors which may be better in one space but not another, since it's so hard to get them to talk to each other well.
- dragonwriter 6y ago> Pretty much everything you would need access to (HL7, CCDA, SNOMED, LOINC, ICD-10, etc) is freely available now! The AMA’s CPT-4, incorporated as a component of HCPCS, is not free, and is the mandated code set for most professional procedure coding. And while otherwise that may be true for most of what you need for core EMR functionality, everyone wants EMR and billing/insurance transaction handling to be modules of the same core system (because you are going to need both, and they need to interface smoothly to avoid a whole lot of operational friction), and most of the mandatory billing/insurance standards are decidedly not gratis; older versions of at least the X-12 standards in this space were subsidized by CMS and available for free, but that hasn't been the case for the versions required since 2010. And that's just basic transaction standards, a lot of the code set standards are also proprietary. (In addition to not being free, the standards in this space are exceptionally poorly written, ambiguous, self-contradictory, and incorporate vast quantities of external material, often also not free, by reference—and often not hyperlinks, but “here is the name of the document and the postal address from which you can contact the entity from which you can order it.”)
- breck 6y agoThere will be an Uber of this space, someone who says "I understand the problems these laws are trying to solve, unfortunately they are a kludge and we can solve them much better with better technology". So complying with all these standards will be a second priority done for backwards compat for the person who comes in and disrupts this space.
- WesBrownSQL 6y ago1. Certification, in the USA if you want to get paid from the government you must be certified. This isn't a small undertaking at all and requires quite a bit of development and then the cost of actually doing the third party testing. It has driven companies out of business and forced consolidation even among the larger players. 2. Configurability. EMR's are crazy configurable to meet any hospitals requirements. This means lots of consultant hours to get things setup and running. Take a look at how much money Epic and Cerner make just from "consulting". 3. Interoperability. Again, there are standards like HL7 and FHIR are widely used but the data isn't always great. We are seeing more and more API endpoints all of this requires a level of customization. All of this adds up to a ton of cost for a small-ish market with a large pool of no or low profit buyers and pretty much a replacement market. Oh, and you are building software that could cause harm or death. I can't imagine why people don't want to come into this industry and really push the state of the art.
- duffpkg 6y agoI was "ringleader" (many diverse groups have been involved over the years) of the OpenEMR project in 2003-2005 and went on to create the open source ClearHealth and HealthCloud EMR (electronic medical record) systems. OpenEMR has a lot of dedicated folks in it and has been a project of some sort of another for ~25 years at this point. You can read quite a bit about open source in healthcare in my book, Hacking Healthcare. A bit dated but still in print. Unfortunately there are massive headwinds against open source in US healthcare settings. Regulation requires certifications that cost upwards of $100K first time, $10K with each release, just in fees. Licensed data sets also make for real difficulties in licensing. Required 3rd parties like SureScripts are openly hostile to open source. Most largest buyers of systems are institutional and most current interpretations of law make it so that open source systems cannot be sold as "sole source" which makes life very hard to close and keep those deals. Finally, until a business model emerges that favors open source and patient health, everyone makes more money with lock-in and so that perpetuates. Ask me anything. Can confirm, a little concerningly, that code I wrote 17 years ago is still widely present in the OpenEMR codebase including my old office number for test patients, lol.
- russnewcomer 6y agoI recently worked on a very small, very custom open source 'EMR' system for a friend involved in prenatal care in a developing country, and so what I wonder is are there attempts to get OpenEMR/Clear Health etc into countries and settings where there is not the same huge regulatory barriers? To me it seems like the U.S. is largely lost for a generation for open source/patient-centric EMR, but maybe there is hope for other countries?
- duffpkg 6y agoExcluding mexico where a ClearHealth derivative still, as far as I know, powers one of the large hospital chains there, no. In my personal experience the venn diagram of countries where there is not much regulation but yet it is advanced enough medically that EMR is a primary problem is pretty much zero. To put it another way most countries where regulation is low have much more pressing medical needs than software.
- ramimac 6y agoIf you're interested in the security posture here, I saw a good talk on bug-hunting in OpenEMR at BSidesCT last weekend: https://www.youtube.com/watch?v=wSvlhFQzUNg https://www.youtube.com/watch?v=wSvlhFQzUNg
- Forge36 6y agoPrevious discussion https://news.ycombinator.com/item?id=13888893 https://news.ycombinator.com/item?id=13888893
- hanklazard 6y agoI've been coming back to the project intermittently over the last few years and have been pleased to see the progress. The reason I came back this time was that our managing partner just told us we'll be paying next year in our small outpatient clinic--truly unreal. I dream of a day when we could just use our own system, maybe something that I could even manage myself (maybe not realistic?). Bravo to the contributors of this project!
- slater 6y agodid we hug the server too much?
- throwaway201103 6y agoI would not accept EMR unless my records are encrypted and can only be unlocked with a smartcard that remains in my posession. Or something close to that.
- JshWright 6y agoSo... You don't want your doctor to be able to view your records without your physical presence?
- kokon 6y agoAnd in some cases, you might not even be in a condition to give the smart-cards (eg. coma, stroke)
- throwaway201103 6y agoYou're often in that condition anyway. If you're taken to hospital in a coma or stroke condition, they won't necessarily know who you are nor will you be able to consent to any procedures. They proceed on good faith in that case.
- anaganisk 6y agoSo (hope it never happens) if you have met with a bad accident, the first responders must break in to your house, call lockpickinglawyer (youtube lock picking guy) break your safe open, retrieve your smart card, then bring it to hospital and start your treatment? And I thought time is very critical. Privacy is important, but its implementation must be reasonable, come on.
- punnerud 6y agoI was release coordinator 5-7 years ago for an EMR software (DIPS) in Norway, to one of the bigger hospitals (Kalnes). It was said that there was a unwritten policy that they never use open source software, the only exception was for the ERP database running on Linux. There was more than 2000 systems in that portfolio to various hospitals under the same policy. After checking with other employees if found the reason; they had to make sure the supplier did not have to many levels of sub contractors, and had to be close to the core development. So not open source in it self, but open source was seen as a big red flag.
- sreeni_ananth 6y agoOpen EMR was the first choice for our project, but it did fit our workflow needs and the UI/UX is also quite outdated. It's FHIR api also had minimal support. So we ended up building our own EMR on top of HAPI FHIR repository, (https://hapifhir.io https://hapifhir.io).
- vishnuyar 6y agothe latest version of openemr is supporting FHIR resources very well. The API is well documented too.https://github.com/openemr/openemr/blob/master/API_README.md https://github.com/openemr/openemr/blob/master/API_README.md
- sreeni_ananth 6y agoThere is definitely support, but it is nowhere near what is documented in FHIR website. You can look at the search capabilities for example : https://www.hl7.org/fhir/search.html https://www.hl7.org/fhir/search.html.
- subsaharancoder 6y agoIn this space it's worth mention OpenMRS https://openmrs.org/ https://openmrs.org/ which also aims to do the same thing. Most of its deployments are in developing countries (I was part of a team driving adoption of it in Kenya) but I'm yet to see a successful large scale deployment of the platform.
- desktopninja 6y agoExperimented with it and seemed to scale well. 3x load balancers (nginx or httpd or haproxy or iis) https only 3x apache tomcats to deploy openmrs war ... https only. azul jre with -Xmx=2g. Tomcats were also as close to default configuration as possible. 3x mysql clustered ... https only No issues on any of these OS's: Windows Server 2008r2 Windows Server 2016 CentOS 7 CentOS 7.5 Raspian Lite MACOS OSes ran on virtualized (hyper-v, virtualbox, xen) and baremetal. Commodity hardware (old laptops, desktops with at least 4G ram. and PIs) and real server hardware. Purposely used mixed computing resources to simulate what a team say in Ndola, Zambia might have at their disposal.
- subsaharancoder 6y agoBy "scale" I'm not referring to OpenMRS capabilities t run on commodity hardware. I'm referring to a large deployment at a national level or at a large public hospital in Kenya. Most deployments have been pilots and at smaller establishments.
- desktopninja 6y agoUltimately it would depend on quality of the software. The community behind it appear to be very engaged so if an organization were deploy it at scale (national level or large org) and offer them amiable incentives to support the application, it might become the standard.
- ElijahLynn 6y agoHomepage doesn't even say what EMR is nor what the project is about.
- ahupp 6y agoKaiser spent $4 billion on implementing an EMR with Epic, after abandoning their own project developed with IBM. Imagine if that kind of investment was directed towards a open source consortium. I realize these kinds of projects are incredibly complicated to do correctly even for a single customer, but the benefit of a shared medical record nationwide would be enormous.
- oogetyboogety 6y agohttps://www.researchgate.net/publication/333051226_Comparison_of_Open-Source_Electronic_Health_Record_Systems_Based_on_Functional_and_User_Performance_Criteria https://www.researchgate.net/publication/333051226_Compariso... This recently came out and I thought it was a good read on the topic.