Slashdot Log In
Senate Bill Calls For Open Source Electronic Health Records
Posted by
ScuttleMonkey
on Fri Apr 24, 2009 02:41 PM
from the wider-adoption-can-only-help dept.
from the wider-adoption-can-only-help dept.
An anonymous reader optimistically writes that new legislation has been introduced in the Senate that would call for a nationwide adoption of electronic health records built on open source. The bill does not seek to supplant proprietary alternatives, but instead to either augment or offer a cost effective alternative. "'We need advancements in health information technology across the board to improve the quality of care Americans receive,' said Senator Rockefeller, Chairman of the Senate Finance Subcommittee on Health Care. 'To make this happen, we need universal access to affordable and interoperable health information technology — from small, rural health clinics to large, urban hospitals.'"
Related Stories
Submission: Senate bill calls for open source EHRs by Anonymous Coward
This discussion has been archived.
No new comments can be posted.
The Fine Print: The following comments are owned by whoever posted them. We are not responsible for them in any way.
Full
Abbreviated
Hidden
Loading... please wait.
Hurray for Google Health! (Score:2, Insightful)
I remember not long ago reviewing the medical bills from my Dad's bout in the hospitals. There were charges for everything from phones to cable to aspirin to blood. Most people look and probably just shake their head then sign on the bottom line. I was overly curious and started to ask questions. The answers were all over the map. My favorite was the 700 dollars for blood. The billing person said that I wouldn't be charged for it if I agreed to donate blood that weekend. It took three tries on her part befo
Test it with the military first (Score:5, Insightful)
Re:Test it with the military first (Score:5, Interesting)
Dude, I hear where you're coming from but I just for the life of me can't believe anyone wants to trust their health history to the tender mercies of computers and the internet--the same entities that routinely reveal hundreds, sometimes thousands of people's IDs, credit card and bank info for days or weeks at a time to passing thieves.
And can you imagine what it will be like to correct inaccuracies??? We've all been to that movie with banks, utilities, etc. and it's a total nightmare. Imagine if your medical treatment rested upon timely resolution of computer errors. Good luck with that.
I am a survivor of serious medical malpractice. I can assure you doctors lie--and lie very convincingly--to protect one another's butts, not just on the witness stand but on medical records that follow you for the rest of your life.
I am deadset against computerized medical records. My information has been computerized against my will and without my permission and is shared, again against my will and without my permission, with every doctor and their office staff in the vast network owned by our local hospital. In this day of HIPPA I, ironically, have no privacy anymore about what I choose to share with my doctor--it's shared for me, the wheat and chaff alike. I start out any relationship with medical personnel behind the eight ball--all without my permission or control.
I no longer tell my doctor anything except the bare necessity of what he needs to know to treat my current ailment. My doctor is nothing but a conduit for information to my insurer, whose only desire is to deny me care, and the hospital network which nearly killed me and then smeared me with lies. My doc is a very nice person but I can no longer trust him, thanks to computerized records over which I have no control. I avoid medical care whenever possible because I value my privacy. At any rate, my medical care is now hopelessly compromised by the inaccuracies on my records.
=Smidge=
Parent
Re: (Score:2)
Would it help if you could choose what is shared and what is not?
I like the idea of making sure my doctor knows everything about me he can when making a diagnosis. I believe most of them are competent and not acting out of greed. If I get screwed by one, as you have, censoring out the idiot would be nice.
But looking at how many blood tests I have had over the years in physicals, and how many other things have built up in 3x years, I think there's a body of evidence a doctor could use. I also want them to kn
Re: (Score:3, Insightful)
"Would it help if you could choose what is shared and what is not?"
As someone who has not experienced malpractice but spent a lot of time with doctors-HELL NO.
I wan't my medical records HARD to get. I can't think of a situation where rapid access to your records would be needed. Not to say that there might not be certain situations.
But do you really think the ER is going to look up your name (if they have it), find your record and spend the time looking at it before they treat you? And heaven forbid if t
Re: (Score:3, Insightful)
But do you really think the ER is going to look up your name (if they have it), find your record and spend the time looking at it before they treat you? And heaven forbid if the file is the wrong one or their is some important inaccurate information (and there always is).
I do. I always look up a patient's medical record when I admit a patient. Why? Because, almost invariably, when I ask the patient a question about their medical history, they will either forget to mention something or will just tell me to "look in the damn chart." It also helps me to formulate a battery of questions to ask when I end up seeing the patient.
Does that mean that the medical record is accurate? No, of course not. And that's why I always ask the questions to confirm. Usually I'll say something
Re: (Score:3, Insightful)
Maybe some people have seen that providers using EHR rather than hardcopy records have been shown to reduce the instances of fatal medical errors, and prefer the (AFAICT, pur
Re: (Score:3, Informative)
Actually, Smidge is a medical doctor.
Doctors can't treat themselves, you know.
Re:Test it with the military first (Score:5, Informative)
The VA was and other federal agencies already were the "test". From TFA: The Health Information Technology Public Utility Act of 2009 will build upon the successful use of "open source" electronic health records by the Department of Veterans Affairs as well as the "open source exchange model," which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.
Parent
Re:Test it with the military first (Score:5, Interesting)
Nothing in the summary provided in TFA of this bill suggests it does anything to increase healthcare providesr access to "anyone and everyone's" records. What it does to is provide funding to cover provider costs of converting to use electronic (as opposed to paper) records systems, and seeks to make those systems interoperable with eachother and with billing systems, so that in the circumstances where information sharing is allowed (and, often, necessary) it now can be acheived at lower long-term costs and with greater accuracy. And, perhaps as importantly, even when sharing between providers isn't the issue, the accuracy and completeness of the records readily at hand to physicians during the course of treatment within, say, a single hospital will be improved, preventing avoidable errors.
Insurers, rather than providers, tend to be the ones that do that.
Parent
I don't see this happening any time soon (Score:2, Insightful)
If you force open source, you'll quickly bring to the forefront every security issue in the code, which will be a HIPAA nightmare.
Moreover, I don't think the industry is ready to give up all its little proprietary secrets. A lot of places are reluctant even to give out the documentation on their database schemas, let alone any serious amount of source code.
Open interchange of information, on the other hand, is a big necessity and has been happening for a long time now.
Re:I don't see this happening any time soon (Score:5, Informative)
Parent
Re: (Score:2)
Re: (Score:3, Informative)
It's really not a long article... you could have spent a couple minutes reading it and finding out that this is only providing for Open Source *alternatives* to conventional proprietary EHR systems. Most importantly, it's providing funding to safety-net clinics who want to implement open source EHRs; most of the existing funding for EHR implementation available to safety-net clinics practically requires them to choose a solution that is CCHIT certified, and you *know* that costs $$$. Not even VistA (the p
Good place to start (Score:5, Informative)
Re: (Score:3, Informative)
And for what it's worth, there are already plenty of open source medical imagi
A person should own their health record (Score:5, Insightful)
The information should legally belong to the patient, and health care providers and government should be required to create a system whereby the health records follow the person for life, regardless of jurisdiction or health care provider.
So the records would live in an independent information infrastructure, not owned by any particular health care provider.
And of course open standards would be needed to ensure interoperability of info systems that dealt with the records.
Re:A person should own their health record (Score:5, Interesting)
If it really belongs to the patient, the patient should be able to tell others to purge his records, so it will not follow him for life if he so chooses.
Parent
Re: (Score:2)
Why open Source not open Standard? (Score:5, Insightful)
I don't see why it matters who implements someone's electronic health records (open source, Joe's Software Shack, Bill's Multi-National Software Emporium, etc.)
But what the Government should work on (and it's their job to do so) is making sure there is a single open standard format for the records, so that they can be used and transfered between providers with different systems. Otherwise electronic documents can easily end up worse than paper.
Re:Why open Source not open Standard? (Score:4, Funny)
But what the Government should work on (and it's their job to do so) is making sure there is a single open standard format for the records, so that they can be used and transfered between providers with different systems. Otherwise electronic documents can easily end up worse than paper.
Agreed. Definitely a job for ISO!
Parent
Re: (Score:2)
In Ontario, the government has done this. All EMR software that is certified (and clinics therefore are eligible for government subsidies when they buy it) must import/export patient data using a very detailed XML schema.
In theory, at least, a doctor could export from one software package and import that XML file into a new package. EMR packages can store additional data, which can be exported in generic sections of the XML, but all standard data should be simple to transfer.
Oh yes, and doctors/clinics get
Re: (Score:3, Informative)
The standards for the data already exist. HITSP [hitsp.org] However adoption of the standard is optional, and healthcare IT is very very slow to update technologies. Most system to system healthcare messaging is currently done in HL7 V2.x which is a pipe-delimited text format and while new XML based standards exist, adoption of them has been slow and spotty, at best.
Doomed to fail... (Score:2, Funny)
Re:Doomed to fail... (Score:5, Funny)
as Microsoft just announced Doctor's Office 2009.
Yeah, but it won't be released until the second half of 2010.
Parent
Re: (Score:2)
Yeah, but it won't be released until the second half of 2010.
And it won't actually be usable until SP1.
(Duck and run.)
Health IT Federal Advisory Boards (Score:2)
Dodging the bullet (Score:3, Interesting)
Your medical records should be PRIVATE.
Even if they now store your data in 'free software' it still means you are now less free.
Why I don't want this (Score:3, Insightful)
If we end up with an "open source" medical record, and a central, unified medical history becomes available to every doctor that treats me, then they are going to know things I do not want them to know.
For instance, I have a history of amphetamine abuse. I'm past it, I beat it, I'm feeling much better now, thank you.
I do not want a doctor refusing to give me a drug to help me focus because he's afraid I'll relapse. Or not giving a weight loss drug for the same reason.
Re: (Score:2)
Re: (Score:2)
This is not about a "central, unified me
Re: (Score:2)
We're moving towards government provided health care. You won't get to decide what treatments you are eligible for anymore... At least not unless you're paying cash.
Re:Why I don't want this (Score:5, Interesting)
"You won't get to decide what treatments you are eligible for"
And this differs from the current private insurance system in what way?
Parent
Re: (Score:3, Insightful)
Which is, really, exactly the case now with "insurance company provided healthcare" -- you and your doctor don't decide what treatments you are eligible for unless you are paying cash now.
Current State of Medical Records (Score:5, Interesting)
Jay Rockefeller sucks. (Score:2)
He's all good with advocating that everyone else can live with his crap while he can sit back and cash in on his great grandfather's robber baron stock. Yeap, stand up guy. I can't wait till he's out of office.
Free data format is far more important (Score:2, Insightful)
Having a standardized, non-proprietary, free data format is much more important than "open source."
However, there's more to medical records program than a data format. You also need your code to be audited and easily auditable. Open source gets this free. "Free to see but not to use in a production environment" licenses also achieve this goal.
massive under taking for an open source project (Score:2)
Contact Your Senator! (Score:3, Interesting)
This is one of the key things me and my local linux user group recommended.
http://www.healthreform.gov/communityreports/new_jersey/new_jersey_08002.html [healthreform.gov]
Contact Your Senator and show your support!
http://www.senate.gov/general/contact_information/senators_cfm.cfm [senate.gov]
Our summary was:
* create/maintain/update a fully free and open source electronic health record system
* mandate their electronic health record system to be taught in medical and nursing schools
* mandate an open and freely implementable patient record communication standard
* mandate a national medical identification number and prohibit the use of and storage of Social Security Numbers in any health care system
Call for Standards, not Open Source (Score:3, Insightful)
Poor understanding of IT jargon by a politician's office...what a shock...
Interoperability First, Open Source Afterward... (Score:2)
Speaking as a CS postdoc working on a National Library Training fellowship, I have to stay the best bet is to start small and start fresh. There is a ton of praise about VistA, the VA system, but it is built on old storage technology and may not support the kind of analytics needed for quality improvement. Also, there is a lot of information captured in notes, which is free text and not really helpful in terms of decision support and continuity of care.
I think a good place to start would be a couple of thin
Why electronic? (Score:3, Insightful)
I don't understand all these buzz about electronic health records. The roots of health care crisis are that doctors charge you $500 for seeing you for 2 minute w/o doing anything else and hospital charges thousands for lying on their bed for one night of "observation." Those are probably caused by lack of doctors and hospitals as well as, over zealots about quality and ridiculous malpractice insurance costs due to ridiculous high malpractice claims.
It does not seem to be caused by the need to pull out your chart by a $20/hour assistant.
It just seems like marketing gimmick trying to treat a non-existent cause. Can the patients just take their charts around like patients in many places of world are doing?
Re: (Score:3, Informative)
Yes. If this were the nineteenth century, a patient could just take their charts around to different doctors by hand in a manila folder.
Firstly, I think we are running out of "manila" :-)
More importantly, there is currently an inherent excuse for lousy misinformed care by the "team" of doctors that maintains a person. I didn't get the memo. It was in a manila folder somewhere and it didn't get to me.
In the future, an obvious mistake made by a physician that could have been easily avoided by a quick scan or
Finally, funding for non-proprietary solutions (Score:3, Informative)
I'm irrationally excited about this proposed legislation. I work for a safety-net clinic, and we basically have a mandate to get onto an electronic system by 2012 or our reimbursement levels go down. Unfortunately, the funding currently available all but requires CCHIT-certified solutions... which are all expensive proprietary works, built to run on Windows servers, yadda yadda. Color me unreassured by their promises of safety.
I just hope they make the funding available in time for us to be able to choose an open source solution. This is so very needed.
Re: (Score:2, Funny)
This whole thing reminds me of this absolutely classic Dilbert...
http://tijil.org/gallery/v/dilbert-eunuch-c.jpg.html [tijil.org]
Re: (Score:3, Informative)
Yes, it could be. This bill provides funds for certain providers that would cover the cost of implementing and maintain EHR systems using open source software for up to five years, with a potential for another 5 year renewal.
The idea is to (1) assure that the providers can afford the cost of implementing EHR by putting up federal funds, and (2) simultaneous
Re: (Score:2)
Re: (Score:3, Insightful)
Isn't an EHR just a file format? That goes for both the files and the interfaces.
No, it's not. An EHR (a good one) is an intricate interface to a complex database containing text, statistics, images, and receiving data from a variety of systems including labs, pharmacies, and imaging systems. EHRs contain a lot of built-in structures for the data they contain, for auto-coding, decision support, drug-drug interaction, etc.
Then there's the whole user access/permissions/security component, too... you need to make as sure as possible that only the people with a need to see the information
RTFA (Score:5, Informative)
Why not RTFA?
FTFA: The Health Information Technology Public Utility Act of 2009 will build upon the successful use of "open source" electronic health records by the Department of Veterans Affairs as well as the "open source exchange model," which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.
Parent
Re: (Score:3, Informative)
This bill doesn't, from the summary, mandate anyone to have anything "open" to anyone else. It only provides funding to purchase open source EHR systems, but you'd think on Slashdot, of all places, people would readily distinguish between an "open source" electronic health records system and "open" health records.