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Re: EMR philosopy w/ financials was Re: [Gnu-arch-users] EMR EBM EBMgmt
From: |
Mitch Amiano |
Subject: |
Re: EMR philosopy w/ financials was Re: [Gnu-arch-users] EMR EBM EBMgmt |
Date: |
Tue, 14 Aug 2007 18:51:11 -0400 |
User-agent: |
Thunderbird 2.0.0.6 (Windows/20070728) |
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.