On Fri, Feb 01, 2013 at 04:33:30PM -0800, Clinton . wrote: > According to a recent RAND Corp. study, the efficiency gains hoped for with > EMRs have been stifled due to the incompatibilities between different > systems.
That is EXACTLY why OpenEMR (and Diane's presentation) is so important to open source and our community. The people at the meeting Thursday night can change the world. Bring your doctor with you. I'm bringing two doctors! While compatability IS a problem, the specifics vary between regions and practices. Portland is dominated by Providence, Legacy, Kaiser, OHSU, and Adventist. All these organizations use EPIC (http://www.epic.com/) and spend tens of millions of dollars a year on configuration, training, and support. And, surprisingly, all these big EPIC systems do NOT interchange data. A Portland doctor can use the Providence EPIC web portal to look at any Providence patient's data from Alaska to northern California, but they cannot combine that data with data from Legacy, if the same patient went to Legacy for an emergency room visit, an X-Ray, or a lab test. Medium-sized primary care organizations ( i.e. Portland Clinic) also use EPIC. Small clinics (1 to 20 doctors) use many different EMRs, some "free on the web", some purchased at great expense, etc. And as you say, interchange of "live" data between these EMRs doesn't happen - at best, data is moved as unstructured text or images. Many small clinics do NOT use EMR, because they can be a P.I.T.A., enforcing "one size fits all" operating procedures, often incompatable with the unique way many doctors practice For good reasons - patients are unique, too. More importantly, many practices have been bankrupted when the proprietary vendors jacked up their prices, with patient data inaccessable in proprietary formats and not migratable to other EMRs. To many vendors, anti-interoperable design is a monopolistic feature, not a bug. That does not mean no interchange happens. Some of the EPIC systems allow doctors to "print to file", which they can save in their own EMR's. However, that is complicated, and it is not "structured data", meaning that only humans and not algorithms can search the interchanged data. However, if the images are digitized, then someday machine can parse them - as opposed to handwritten notes, phone slips, etc. in a fat manila envelope. And someday, that historical data from 10 or 30 years ago will be vital to new kinds of treatment. A chicken and egg problem: developing history-based treatments requires detailed history, and there's little justification for maintaining the detailed history without those treatments. The interchange is improving. Legacy has a "small practice IT outreach" staff working hard to make their structured data interchange with other EMRs. The manager is interested in working with us for OpenEMR interchange. It helps A LOT when the target EMR is open source. This may work out like the reverse engineering Andrew Tridgell did that resulted in Samba accessing SMB, and Git replacing Bitkeeper. So - all the reasons that we love free software, and that Portland is a great place to do it, are also the reasons we should extend free software into medical informatics here in our community, creating new businesses and keeping ourselves and our neighbors alive. This could be the NEXT BIG THING, and if local doctors and software people work together, we could make Portland the global hub for medical informatics. You choose - professional success and personal longevity, or paying monopolists for bad software and bad medicine? If your career and life matter to you, show up Thursday, and bring your doctor with you. Keith -- Keith Lofstrom [email protected] Voice (503)-520-1993 _______________________________________________ PLUG mailing list [email protected] http://lists.pdxlinux.org/mailman/listinfo/plug
