Hope For FOSS In Electronic Health Records

Fred Trotter writes "CCHIT is the dominant Electronic Health Record certification body in the US. It is also decidedly anti-FOSS and has been for years. Certification of one kind or another will be required for EHR systems to qualify for funding under the Stimulus Act. If CCHIT is chosen as the certification body, and the current certification strategies continue, it will not be possible to have a funded EHR that is both certified and truly FOSS. Now, however, CCHIT has agreed to meet the FOSS Health IT community at HIMSS 09 to address this issue." We discussed the shortcomings in the stimulus bill as it relates to FOSS a few days back.

Comments

Anti-FOSS?

[FooGoo]

So let me get this strait...CCHIT is considered anti-FOSS because they charge fees that for certification that the FOSS folks cannot afford?

Sounds like we need a welfare program for FOSS apps to be able to play in the big leagues. How do you think CCHIT gets their operating budget? Through fees I would expect.

Re:Anti-FOSS?

[sumdumass]

Outside of the entire Fees for OSS idea, I think it is preposterous to think that once you certify a program or application to do a certain thing, you have to continue paying them based on annual sale of your program or application to keep that certification.

We don't need welfare for OSS, we need something different in place. A certification process shouldn't be dependent on future fees paid nor should it base any of the fees on the sales of the software. If you want to know why health care is so expensive, it's shit like this.

Think about it, 25K can go into 25 copies sold $1000 at a time. That isn't so much when considering what the software brings to the table. But an annual $5000 on top of that based on sales means the same program that was certified at $1000 a pop is now not certified if more money isn't paid. The question is, is that 5k a version sold?, up to 25 licenses sold? or is it 5 licenses sold? Now licenses could be a misnomer too, Take MS servers for instance, you need a license for the server, a license for the workstation's MS operating system, a license for the network connections to the server, and a license for all the MS applications running on those systems. Lets say MS Office is a given and for shits and giggles, lets say MS dynamics CRM is installed. Now, that means 1 server license, 1 workstation, 1 connection, 1 office and 1 CRM, that's 5 licenses just to be up and running. OF course more workstations will need less licenses but in the certification ordeal with CCHIT, how many of those licenses count as sales? I mean the ERM software could have modular features and easily require 5 licenses, so with the 5k based on sales, if that is for every 5 licenses, then you might need to recover 5k per workstation on top of your profit and expenses for creating the damn thing.

It's a racket that shouldn't be allowed. If we are going to require certification, then there should be some rules and guidelines and limits on costs instead of creating a get rich quick scheme that drives the cost of health care up so some damn politicians can fool the people when they claim to be fixing the problem. The opposite of that would be to open up the ability for other companies or organizations to become certifies and forbid lock ins to certain companies or organizations so competition can drive costs down to something more reasonable.

one of FOSS's problems.

[MonoSynth]

If the law states that there should be a 'view but not save/copy/print' right (like here in the Netherlands), how could you enforce that *and* be truly open source? You have to certificate each and every release of the full software on a source code level (and provide authorization based on the (i.e.) md5 sum of the executable) to enforce such rights. One simple edit & recompile and you can save/print those x-ray pics, which is against the law.

At the very least, forking, maintaining your own version and fixing bugs for your (employer's) own use is either impossible or very expensive.

Getting a second opinion

[Anonymous Coward]

There is a HUGE problem with this issue of electronic records and it relates to the philosophy of who should be responsible for what. IMHO each person should be responsible for his own records. When you use medical services, you always receive the records produced during those services, and the provider will keep a record as they always have. But these records should not be shared with anyone nor go into any kind of national database. These records can be in a standardized electronic format if that makes life easier, but paper records are just fine. When you use medical services in the future, it is up to you whether you wish to provide the records you have or not, and to select which records to provide. This is your body. It's nobody's business to read all the gory details unless you wish to provide them.

Why?

Many reasons, but I'll provide just one for brevity: It's called GETTING A SECOND OPINION

Suppose you have some condition. You go to a doctor and he says the only solution is to chop off your arms, legs, and while he's at it, your head, too. Shit, that sounds like a serious problem. You want to know what another doctor thinks. If that second doctor is required to punch up your ID in the national health system and read all prior records, he will see what the prior doctor said and that will influence his thinking. You want to get a second opinion without revealing to the second doctor anything you already know about the condition.

The excuse that a medication might conflict with another medication you're already taking is NO REASON to go produce a national health care record system wherein is located everything from the exact force applied when the delivery doctor slapped you on your ass, in a manner that reveals more than you might want to reveal.

CCHIT is SH*T

[Omega1045]

I spent a few years working as a software engineer for two electronic medical records companies. The second company certified some of its software with CCHIT. From that experience I can tell you that the CCHIT requirements are idiotic, and don't lead to better patient care, or better software for that matter. They are a hoop businesses jump through (both software companies and clinics). There are states that offer tax incentives for physicians that use CCHIT certified software. I know we spent a lot of time and effort implementing stupid features that were supposed to enhance security around patient data, help the physician provide better patient care, etc. In many cases these "CCHIT features" did just the opposite.

Its really disheartening when you write software all year to provide useful tools for doctors that improve the standard of care, and then have a bunch of useless and counterproductive features slapped on because of an upcoming CCHIT certification.

Re:Get out of your mother's basement

[nacturation]

if you can't afford these costs, don't waste our time because odds are good you won't be in business in a year from now"

And that's what you're going to tell all the solo pediatricians and family practitioners who currently use paper charts and who are going to have to suck up that cost when they buy a certified EMR?

If you have five people in your minuscule company with salaries, benefits, office space, equipment, legal and accounting fees, insurance, and other overhead of $100,000 per year for each employee (and really, that's low for anybody decently skilled) then $30,000 represents 6% of the total cost. Over the course of ten years, the cost of acquiring and maintaining certification, assuming your expenses don't go up at all, represents an average of 1.5% of your total expenses.

So in answer to your question: no, if I were running such a software business I don't think I'd tell practitioners that certification costs represent an average of 1.5% of the business's operating costs because nobody's going to give a shit. Do you scream bloody murder when your movie ticket price goes from $10.00 to $10.15?