On 8/14/07, Mitch Amiano <[EMAIL PROTECTED]> wrote: > > patrick blanchard wrote: > > > > > > On 8/14/07, *Mitch Amiano* <[EMAIL PROTECTED] > > <mailto:[EMAIL PROTECTED]>> wrote: > > > > Thomas Lord wrote: > > > Mitch Amiano wrote: > > >> There exists a general market <snip/> > > > <snip/> > > > > They are my records, and while I shouldn't be allowed to falsify > > someone > > else's entries, or muck with some other's version of the same > > records, > > by the same token I should have complete access to the content as it > > pertains to me. From that aspect, I think Arch philosophically is > > appealing. > > > > > > Yes, they are your records. HIPPA, and the guarded release of medical > > information itself is possibly a wolf in sheep's clothing; designed to > > mitigate legal risk to the business of medicine. Unfortunately your > > personal experience of financial loss, and exposing yourself to the > > health risk of repeat immunizations (you did read the potential > > complications of the immunizations didn't you?) is a common occurance; > > the identification of it by the patient is not so common however. Can > > it be traced to the state of medical charting? Not all of it, but it > > certainly adds mud to the murky water. > Yeah. I was due for a booster on one of them anyway, but I felt the > other one was unavoidable. > > > One last comment - where's the money for it going to come from? > > > > > > Are you asking me or Patrick? > > > > > Definitely posing that question to Patrick. I recognize from > listening > > in on the Arch list that you've been through the wringer financially > > while working on Arch. > > > > I'm playing Devil's advocate rather than looking at it as the techie > I > > am at heart. Regardless of how many neat open source projects that > > could be leveraged to address one aspect or another of medical > > records > > management, it still costs people time, effort, and resources to > > attempt > > such an endeavor. People have to eat; better still if they can pay > > their > > own medical expenses too, and have something left over. I'm not a > big > > mover and shaker, but I would think it would be best to identify one > > aspect or two of the problem that is REALLY PAINFUL to someone with > > money, so that you can get them to start transferring capital to > > you in > > exchange for addressing their perception of the pain. > > > > Another way to put it: Patrick, are you viewing this as an > > "internal" IT > > problem, or have you considered the problem/solution in terms of a > > business model? > > > > > > internal IT problem (I don't like paper, and I don't like current > > EMRs) -- the 'itch'. As to the business model, it's up for grabs, but > > I would tend to follow Thomas' thread on the matter. MedSystemsGnu is > > GPL3. > So, with an Oracle dump, the first path I would consider is setting up a > Linux box with the Oracle 11g database, and upload your dump. See > http://oss.oracle.com/. Then at least you've got SQL and some basic > tools access to the data for a while while you migrate.
Is it possible to import the .dmp to MySQL? I must have missed something in the discussion. Can you tell me more > about MedSystemsGNU? I understand there is a GNU / medical initiative already. However, it seems to be missing something important - maybe a 'view from the trenches' perspective. Anyway, it's just a hunch, but I am not convinced it's the proper direction. There appears to be a lot of 'me-too' approach, not real innovation. If I am going to spend my time and effort on something like this, I don't want to reinvent. This project is going to be costly for me in many ways, but it's a labor of love. I also have been thinking about using a free medical clinic that I established 3 years ago as a testbed. for medsystemsgnu (msg). BTW, I took a look at the shell script. AFAICT, it looks like pretty > good work, and I've done a lot of scripting. (You misspelled category as > catagory.) thank you. > > > Doubtless there is a market for medical records > > management for doctor's practices, clinics and hospitals. What > > about for > > the client or families? It would have been worth about a hundred > bucks > > to me in the case I outlined above, to get a valid immunization > record > > and avoid the hassle of being poked with a needle. (Perhaps it's > > about > > time someone created a medical records "credit union" as it were, > and > > separate the ownership of the records from the institutions.) > > > > > > Where is the barrier? Not w/ you, but w/ the current state of EMRs and > > paper, and the pervasive philosopy of medicine and sharing information > > w/ the patient. 'Let's not make it too easy' might be a silent mantra > > heard amidst hallways of hospitals and clinics. At least the silent > > mantra sheds some light on a fact of medicine; sometimes the client > > knows more than the professional and the man behind the curtain > > is....well...falliable. > Not to mention the rampant falsification of medical coding. I heard this > narrative recently: > Client, waiting for a blood draw: "What does code XYZ mean?" > Jr. Staffer: "Oh, that's a headache." > Client: "A headache? Why is it listed as a headache? I didn't come in > for a headache." > Jr. Staffer: "Um, I don't know... you'll have to talk to your doctor > about that..." > Sr. Staffer, later, to Jr. Staffer: "The insurance company won't pay for > the actual procedure. So they throw in codes that they know will be > allowed. Avoid talking to patients about the codes." > Wink, wink, nudge, nudge. > > I don't pretend to have any such experience in the medical field to be > able to prognosticate about it. But long periods of expansion and > technological growth are often punctuated by major upheavals. I would > wonder rhetorically, if a significant part of the effort being expended > now is really being made with the design to shore up barriers which are > constantly (perhaps increasingly) being eroded by the environment. But > I'm beginning to babble. No, you are just starting to vocalize something important. I hope you recognize your 'babble' is really thinking, and don't degrade yourself anymore. Unfortunately, my wife fell ill last year. Not from her cancer, but from a medical mistake. She beat the cancer, but not the mistake; and it's not a subtle one. She required 2 open chest surgeries, chest tubes, and almost died twice. As a physician, I expected openness and honesty from my collegues. Instead I recieved 'we have never seen this before'. It was degrading for me as a professional. It was worrisome for me as the husband of the patient. For example, she was in recovery for open chest surgery and despite seven urgent faxes and phone calls to the specialists, they didn't send her records. It seems unethical now not to try and do the best I can to improve the system. I've learned to trust a 'hunch', even when 'the expert' is degrading it. As to an upheaval, part of heaving upwards is empowering the masses. I don't know XML, but it sounds like something that could work as a front end. I can't get XML to work and have a hunch the XML initiative may have a hidden agenda somewhere. I can wrap my head around version control, and mesh it with the trench work I've already done w/ sane and Hylafax, and also have a clinic ready and willing for a testbed. Who knows where it will lead. But that somewhere is certainly better than were we are now. patrick
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