Healthcare IT

Hi,

I saw on one of your videos you asked for video submissions. Forgive my video, I'm just now getting into video and audio editing as a hobby. If you didn't want to use the video, I wrote the question down.

1. Given that many healthcare organizations fear open source and start-up solutions for a plethora of reasons (Legal, regulatory, privacy), how would you start trying change people perceptions?

2. What are some of your favorite healthcare open source applications?

A couple of sources for your perusal:

Open Source Healthcare Applications: http://opensource.com/health/14/12/year-review-open-source-health

Things to look for at CES this year: http://www.forbes.com/sites/ciocentral/2014/01/02/medical-technology-stories-to-watch-at-ces-2014/2/ 

Thanks for your two cents!

Jon

  

https://www.youtube.com/watch?v=g3zLKU_d3K8&feature=youtu.be

I'm kinda surprised to hear that opensource is feared the healthcare field, I'm not exactly knowledgeable in the HC area but its surprising. 

Supa, dont be surprised, it seems here in the UK, they insist on using Windows for their front and back ends, rather shocking, would have thought for the most part they would have some sort of Linux back end.

Although I cant speak for research departments, That I would presume use Red Hat or maybe Debian, but it again boils down to 2 things, Money and Comparability, and unfortunately companies wont port their systems to other platforms, and it would require people skilled in open source stuff, more so if it was the OS.

 

open source is feared in healthcare? Hmm.. you need to go to some healthcare symposium things as I believe OpenEMR and OpenMRS are sort of popular at medium-sized hospitals. I was working on a project a couple of years ago and these were basically supported by dell/dell consultants. I think that because dell was spending so much time with open patient health record systems is one of the reasons they bought cerner. (they may have only acquired a stake in cerner or something like that). 

Most of the hospital administration paranoia is around leaking patient records. So anything that takes that responsibility out of your hands is an easy sell. That's one reason dell's consulting wings are basically keeping the business afloat. No one wants their neck on the line for undertaking such things.

The truth is that it will take an adequately funded security team that is paid well and regularly audited to keep a lid on these kinds of things within an organization. Commercial Vendors don't deal with that, I think, and with Open Source the onus will be on the organization to work a tiny bit harder to make sure their facilities and audit their data. 

 

Thanks for the reply. You are correct in that stand alone hospitals do often utilize the lower cost, no cost systems. OpenEMR and VistA are two well documented, ONC approved, open source EHR's. (ONC is the Office of the National Coordinator for Health Information Technology, see link below) VistA being the government's open source EHR. This is a great solution that is quickly going the the way of the dodo (not the EHR's, the organizations that use them). Without getting into a lot of details (I can if anyone wants to know), most stand alone hospitals are being acquired by large systems that employ the commercial solutions. 

My comment on fear, is more eloquently stated by you that administration is mainly concerned about privacy breaches and passing the buck on responsibility. The fear being the exposure caused by the lack of buffer layer in responsibility for patient data and privacy. Additionally, the "fear" of the cost/manpower to manage and maintain the system. I find that most larger organizations would rather just write a check for the "piece of mind" than make the investment.

I really appreciate your conversation and thoughts. I actually wasn't expecting any reply. I come from small rural hospital that was recently acquired by a large system that uses a commercial product. I do know that some of my nearest competitors do use OpenEMR. The IT people in my hospital are good at what they do, however, lack my curiosity in envisioning "what could be".

... fear may have been to strong a word. Sometimes I am more hammer than finesse. A more appropriate word may have just been "concerned".

http://www.healthit.gov/policy-researchers-implementers/about-onc-hit-certification-program 

 

You can make an open source program super secure but on the flip side, it can be unsecured if no one is pumping updates or commits. The last major bug that was found in Android was patched within 24 hours and an update was rolled out IF you had a Nexus device that was being supported.

The issue with open EMR, that somewhat defeats the purpose of going the open source route, is that you cannot make changes to the software without having to have it validated each time you make a change. This is why places, like where I work at, pay millions of dollars a year for our EMR system. There are so many things that have to talk correctly (and calculate correctly for Meaningful Use) that a slight change can mean your practice making 3 million dollars, or paying the government a few million in penalties.

 

I looked into openEMR when I started my position and administratively, it just was not cost effective to move away from what we had already for a plethora of reasons.

 

Don't get me wrong, I'm not saying it's bad by any means, though.

Totally agreed! It's just a little frustrating to be able to envision a solution, but, then see so many roadblocks created by so much government oversight. (The amount of oversight and regulation is a complete other debate)

This has been a pretty good debate. I'm not a expert in IT, my training is in leadership and administration so the smarter I can get on IT will help me be able to have intelligent conversations. I'm glad there are some experts here that I can learn from.

Wendell - I wasn't expecting you to have such expertise in healthcare. You are a man of many talents. I look forward to continuing to learn from you, Logan and others. 

Depending on what state you're in, some states have given 'small business' grants to IT companies to learn/get certified in/etc these EMR systems (often, open ones) so -- just because it's open source doesn't mean you can't hire an IT company that knows the software, can support it and will take responsibility in case of an event.

Dell has been doing that type of consulting for ages -- but I think they really favor Cerner now because they stand to make the most consulting $ from that. It may be worth making a few calls around the state government, or doing some digging to find out what IT companies in the area have been certified for that stuff. You may be able to get the best of both worlds.