Re: EMR philosopy w/ financials was Re: [Gnu-arch-users] EMR EBM EBMgmt

[Mitch Amiano]

patrick blanchard wrote:
> On 8/14/07, *Mitch Amiano* <address@hidden 
> <mailto:address@hidden>> 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.

I must have missed something in the discussion. Can you tell me more 
about MedSystemsGNU?

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.)

>      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.