Senate Bill Calls For Open Source Electronic Health Records

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.'"

Comments

Hurray for Google Health!

[Smidge207]

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 before I realized that by "agreeing to donate" blood, this charge would be removed.

Really what this Google records situation has done is brought to light a world that many of us don't know existed and that many of the medical billing world feared we'd discover.

This isn't just an issue with codes being assigned incorrectly but rather codes being assigned which pay more than other codes. And at first blush you think wow - that's underhanded. Actually no - it's just a creative way to fixing a problem that no one else in Congress or anywhere else in this country seems to have fixed. How do we pay for expensive medical treatment quickly so that the full service life cycle is completed in a manner that allows everyone to remain financial solvent. There are few industries where the payment for a procedure takes a whole year to arrive. Where in the world would you submit a bill and not expect it to be paid for an entire year.

As for this being outsourced - well maybe that plays a part in it but I doubt it. For any of you who have medical bills in front of you after longer bouts in a hospital, review the bills and ask some questions. You'll become enlightened quickly.

Good Job Google on doing what you are doing. Let's crack open the medical records world and find out what's really going on.

=Smidge=

Re:Hurray for Google Health!

[Anonymous Coward]

How is this a troll post? Seems pretty informative to me.

Re:Hurray for Google Health!

[Ironica]

It's not a troll... it's just totally off-topic. Google Health has nothing to do with TFA or Electronic Health Records. It's a *personal* health record, and a totally different animal in that respect.

Test it with the military first

[HasselhoffThePaladin]

They should implement this in the military first as a test. It's always the biggest pain in the ass to hand-carry your medical and dental records when you undergo a permanent change of station. Of course, paper backups would be a great idea in the initial stages.

Re:Test it with the military first

[Smidge207]

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=

Re:Test it with the military first

[DragonWriter]

They should implement this in the military first as a test.

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.

Re:Test it with the military first

[csartanis]

What is the benefit of this system? When healthcare providers have easy access to anyone and everyone's records they'll jack up the prices to everyone but the 'ideal' patients.

Re:Test it with the military first

[ivaldes3]

We already have Veterans Affairs VistA which is already a superset of open source in the public domain. The military has Ahlta which is a close cousin branch of the original VistA which is said to be not as good as VistA.

-- IV

Re:Test it with the military first

[Austerity Empowers]

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 know things about me even when I'm unconscious or otherwise unreliable.

There are some privacy issues that worry me, there is the equivalent of medical trolls that worry me. There's unauthorized and unapproved use of my data. I'd like some controls and legal assurances, but I do think it's worth the risk and trouble.

Re:Test it with the military first

[DragonWriter]

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.

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, purely speculative -- while bulk identity theft is easier with electronic records, they also reduce the number of people that are likely to have incidental access to the records in the first place, and reduce the opportunity for one-off identity theft) increased risk of identity theft with EHR to the (demonstrated) increased risk of avoidable, premature death with non-electronic records.

Re:Test it with the military first

[DragonWriter]

What is the benefit of this system? When healthcare providers have easy access to anyone and everyone's records they'll jack up the prices to everyone but the 'ideal' patients.

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.

When healthcare providers have easy access to anyone and everyone's records they'll jack up the prices to everyone but the 'ideal' patients.

Insurers, rather than providers, tend to be the ones that do that.

Re:Test it with the military first

[Anonymous Coward]

I no longer tell my doctor anything except the bare necessity of what he needs to know to treat my current ailment.

And how would you know exactly what pertains to your ailment and what doesn't in more-than-simple cases? You are no doctor.

Re:Test it with the military first

[Lord Ender]

There is no black market for your medical history. Nobody gives a crap.

I am confident my healthcare will be better if, no matter which hospital or ER I go to, my doctor can have immediate access to test results, X-rays, and other useful information. I don't carry that information with me when I travel, and I sometimes get sick when I travel... this will save lives.

Your little rant about the fact that doctors make mistakes is entirely unrelated to this. With paper or digital records, they will still make mistakes. But with digital, there will be fewer mistakes due to lack of information.

Re:Test it with the military first

[Anonymous Coward]

I can't mod, and if I could, I couldn't mod this up _enough_. What a great idea!

Re:Test it with the military first

[Anonymous Coward]

For starters, if you change jobs and/or medical insurers, your records will follow you from one to the next. That means that you won't have to repeat a whole bunch of tests because they are only in the records of your old insurer.

If you have an accident while on vacation, the doctor treating you at a random hospital would be able to see your medical history, prescription history, and would be able to avoid unnecessary tests and possibly deadly drug interactions. If it's an emergency, that could be the difference between life and death or crippling complications.

Because in a number of scenarios (insurer change, moving, travelling) there's less unnecessary duplication of tests, costs would go down. That would hopefully eventually show up in your employer's premiums and your co-payments (as opposed to some HMO administrator's bonus).

Re:Test it with the military first

[Anonymous Coward]

You know Brazil already has been doing this fro quite some time and their system is open sourced - by them.

Re:Test it with the military first

[Anonymous Coward]

I work in a high tech health care information company. Have for over three years.

We already have information on millions and we do a vastly better job of keeping it safe, and accurate than your average insurance carrier. Those places are veritable fountains of incompetence and general ineptitude.

I'm sorry to hear that you were the victim of doctor malpractice, but you are dead set against something that is inevitable.

If your information was indeed "computerized and shared against your will" you can sue the companies or individuals responsible under the HIPAA act very easily and very successfully. That act has teeth and the companies are terrified of being in violation of it.

Re:Test it with the military first

[dgatwood]

I'll believe it when I see it. Until we actually see Medicare requiring that all patient records be stored in a standardized, patent-free, open interchange format, we're going to have the same mess we do now, only in a few years, some of those messes will be open source messes.

Re:Test it with the military first

[Anonymous Coward]

only in a few years, some of those messes will be open source messes.

I thought one of the advantages of open source was that it was easier for clients to correct (or pay someone else to correct) software related issues. So wouldn't your cynical prediction be at least a slight improvement to the status quo?

Re:Test it with the military first

[sexconker]

Actually, Smidge is a medical doctor.
Doctors can't treat themselves, you know.

Re:Test it with the military first

[winwar]

"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 the file is the wrong one or their is some important inaccurate information (and there always is).

"I believe most of them are competent and not acting out of greed."

In my experience, most doctors know less than me on the relevant diagnoses. It is unusual when a doctor suggests a novel treatment. The primary reason I go to a doctor is for a referral or prescription. Hell, most GP's send me to a specialist for something they SHOULD be able to treat. As for greed, well lots of them choose fields based on money....

"I also want them to know things about me even when I'm unconscious or otherwise unreliable."

No medical record is accurate. There are always ommissions or just plain errors. Couple that with the fact that E-records will be made to the lowest common denominator (otherwise it would be hard to share) and probably take more time to fill out, I would rather it not happen (as probably would most doctors).

I generally consider it a solution to a problem that doesn't exist. Now for certain organizations, it makes sense (like the military). But for most, no.

Re:Test it with the military first

[winwar]

"...it now can be acheived at lower long-term costs and with greater accuracy."

Are you kidding? The electronic records will suck as bad as the paper ones. Probably worse considering the input to create the record, the time to input the data, and the limitations of any format.

I believe it would increase errors because "everyone trusts data"...

Re:Test it with the military first

[sexconker]

Your records already do follow you.
You will still have to repeat tests, as no one wants to be liable for someone else's mistake ("they did the test wrong, and you should have caught it, now my dick fell off").

If you have serious issues that would necessitate specific treatment, or that would counterindicate standard treatment for trauma or other emergencies, then wear a MedicAlert bracelet.

It's a hell of a lot more accessible and reliable than any digital record ever will be. It works when the network's down, the power's out, and when you're trapped in your car and your IDs have been burnt to shit, along with 2/3s of you.

People are so eager to "go digital" when there is so often very little benefit to doing so, and very big risks and shortcomings.

Re:Test it with the military first

[sexconker]

Hence the benefit.
You thought it was to benefit the patients?

You realize this is a for-profit industry and government, right?

Re:Test it with the military first

[thePowerOfGrayskull]

I'm not sure I follow this. Do you not want your doctor to have access to full health information? What if the information you wanted withheld was critical, but you simply don't have the background or knowledge to know that it's critical?

From a privacy perspective, I can understand - but only to a point. It seems hubris to me when someone presumes to decide what information their doctors "need" access to in order to provide the best treatment for them.

In principle, you could say that it's your right - after all, if you want to die via stupidity, there's nothing anybody should do to stop you. But there's a fine line between dying of stupidity and dying of ignorance. I'm not so sure that the patient is the right person to make that decision.

Re:Test it with the military first

[dgatwood]

No, when you have an open source app used by some hospitals, it will be trivial for closed source companies to reverse engineer the open formats, but also trivial for them to write apps that import data from that format but don't support exporting data... just like proprietary app vendors have done with dozens of other open standards in the past. Without laws that require hospitals to use software that provides both import and export support for open standards, we aren't really any better off than we are now.

In fact, if anything, we'll be in a worse position if this law pushes open source without mandatory input and output support for open data interchange standards. RIght now, when a patient moves from one hospital to another, big and small hospitals are inconvenienced almost equally. With open source at the smaller hospitals, the bigger hospitals would be able to quickly import data when they take patients away from the smaller hospitals, but the reverse might not be true. This would leave the smaller hospitals at a rather significant competitive disadvantage, leading to further monopolization of the health care industry, which would lead to higher prices for consumers and poorer quality of service....

Re:Test it with the military first

[zuperduperman]

> What if the information you wanted withheld was critical, but you simply don't have the background or knowledge to know that it's critical?

If there is missing information that is critical then any responsible doctor should be capable of recognizing that - they will be in the same position as any doctor with no information and should ask questions and order fresh tests. You're right that this may cause delay and perhaps result in some slight increase in risk. However it also gives patients the chance to get a genuine second opinion which is vital.

Re:Test it with the military first

[WhiteHorse-The Origi]

Healthcare providers != Insurance companies. You need electronic records to minimize labor and materials. We also need to get rid of for-profit insurance, doctors, pharmacies, and hospitals. I have no problem paying into an insurance pool, but when 30% is taken out for profit to some rich people, it really chaps my ass.

Re:Test it with the military first

[Anonymous Coward]

"There is no black market for your medical history. Nobody gives a crap."

You are not in the healthcare/medical/pharm fields.

Data mining is frakin huge. They already do it without your permission as standard practice; there is no black market, as you say, because what would be the black market is legalized for the public good. With computerized records, it just makes it easier.

Worse, it's been shown again and again that medical information is so unique, that they can take a couple of studies and identify the individual backwards. This came from an NIH scientist lecturing in DC to my MPH class.

"But with digital, there will be fewer mistakes due to lack of information."

Again, you do not understand.

The medical community is trained NOT to know information and still carry out health care. Doctors are trained to know that patients often lie, underestimate, describe things oddly, etc. The ER is used to having people come in and not have a clue what is wrong with them.

While there are certainly benefits to knowing medical history, and that will surely save lives and help reduce errors, it is not overwhelming compared to the system we have presently. Further, in the new system, and what I believe the previous poster was referring to, it makes the health care field more likely to pass blame upstream or downstream, since *that is what they already do now*.

I've mentioned this before on /. on medical topics with EHR--the only advantage to EHR is the cost and time savings, which are significant. Those advantages have not been sufficiently balanced with the loss of privacy and trust in the medical system. Anyone pointedly advoacting EHR as the next great thing has a paycheck coming to them, not because they truly believe, if cash wasn't involved, that EHR is a better system than what we have now *for the patient*.

Re:Test it with the military first

[Lord Ender]

Bah. I've had to be RE-Xrayed because the doc I was at didn't have access to the an X-ray done on me in the same spot only shortly before. That's expensive and unsafe.

Also, please please be more specific as to why you think my privacy will be lost. There's a black market for credit card numbers, not for your medicine--No motivation to hack your records and make them available.

Re:Test it with the military first

[amabbi]

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 like, "I looked in your record and I saw that you were in the hospital last year for .... and that you have a history of .... and ..... Is there anything else?" And if you've ever tried to take a history and physical on a cantankerous patient, you'll be glad that there's a record in the computer because more often than I care to admit, that's the only information I have to go on when patient's refuse to cooperate.

Re:Test it with the military first

[Anonymous Coward]

The Veterans Administration has been using computerized Medical records for many years now with a high degree of success. I am not implying that there have not been problems and will not be some in the future, but it is an excellent way of insuring quality care nation wide as this technology is further developed. The basic code is already in the public domain as it was developed for government use by government employees.

Training Videos

[SolarStorm]

What a great place for the wanna be crook to go find the "How NOT to" book of everything.

Re:Training Videos

[badkarmadayaccount]

Uhhh, bub, I think you have the wrong article open...

I don't see this happening any time soon

[tg2k]

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

[profplump]

From what I've seen they're reluctant to give out the schema because they don't have decent documentation and they're embarrassed by the DB. I support several companies that do claims processing using a system that uses fixed-record-length ASCII tables as the DB. The schema is defined only by an ordered list of column types -- you have to calculate the offset for each bit of data. And the column types aren't enforced -- you can put any type of data you want in any field -- the types just specify a field width. And don't even get me started on the lack of foreign key checking.

Re:I don't see this happening any time soon

[MrMarket]

I have not RTFA, but does the bill force open source, or does it fund and support the community infrastructure for updating code base, change control, etc...?

Re:I don't see this happening any time soon

[Ironica]

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 particular OSS solution mentioned in the article) is CCHIT certified, and it's a totally built-out EHR developed by the US Government.

Re:I don't see this happening any time soon

[RingDev]

If you force open source, you'll quickly bring to the forefront every security issue in the code, which will be a HIPAA nightmare.

PSSSST. The "P" in HIPAA stands for "Portability", not "Protection" or "Private"

-Rick

Re:I don't see this happening any time soon

[rdoger6424]

PSSSST. The first "A" in HIPAA stands for "Accountability"

Re:I don't see this happening any time soon

[RingDev]

Yeah, so they just have to record when they sell or lose your medical records, or if they are stolen.

-Rick

Re:I don't see this happening any time soon

[Dadoo]

If you don't mind me asking, which package are those companies using? It sounds like it's the same as mine. If not, I'd be inclined to believe most claims processing software is garbage. Ours certainly is, even though it's known for being the best available.

Re:I don't see this happening any time soon

[WebCowboy]

If you force open source, you'll quickly bring to the forefront every security issue in the code

You say that like it's a bad thing...why would that be a bad thing? What sort of "HIPAA nightmare" would it be...a nightmare for health care administrators? Hell, that's their JOB they shouldn't whine about it. The whole of corporate America had Sarbanes Oxley foisted upon them and were told to "suck it up". If public companies must scrutinise their operations with a fine-toothed comb I'd expect no less from the medical system.

Medical information management systems perform a vital role involving sensitive information, and I can't think of a better way to make sure application code is thoroughly vetted than to foster the use of open source that can be examined by everyone without the need to pay large sums of money, sign NDAs or jump through other legal and financial hoops.

I don't think the industry is ready to give up all its little proprietary secrets

I can tell you from experience working with some of these kinds of systems that the secret is not some innovative idea that gives them a competitive edge--it is almost universally that the system is of embarrassingly poor quality or obsolete.

Open interchange of information, on the other hand, is a big necessity and has been happening for a long time now.

I'd have to say that I'm not convinced to the degree that you are on the effectiveness of information sharing in the medical system. You still can't walk into a doctor's office and get your own comprehensive, accurate medical history right there.

It's not that there are legal blocks or that medical professionals are not forthcoming, there is still to much physical paper pushing in hospitals, still too may disconnects in the system. At a hospital I did work at I believe they STILL have a functional pneumatic tube system they use to transport reams of multi-part carbon paper forms around.

Technology is marching forward in the field, but it's happening slowly, and that is in large part due to the proprietary nature of the first generations of electronic systems. Open interchange of information is encouraged and fostered by the implementation of open standards and technologies.

Re:I don't see this happening any time soon

[Savantissimo]

It's all MUMPS / M / Cache underneath. MUMPS is old - the programming language is the OS is the database:

To give you an idea of what MUMPS is all about, following is an abbreviated list of features pulled straight from the MUMPS FAQ:

        CASE SENSITIVITY: Commands and intrinsic functions are case-insensitive. Variable names and labels are case-sensitive.

        COMMANDS: may be abbreviated to one letter, case-insensitive. Includes commands such as IF, ELSE, GOTO, WRITE, and XECUTE [which is my personal favorite, it allows arbitrary execution of code contained in a variable]

        OPERATORS: No precedence, executed left to right, parenthesize as desired. 2+3*10 yields 50.

        DATA TYPES: one universal datatype, interpreted/converted to string, integer, or floating-point number as context requires.

        DECLARATIONS: NONE. Everything dynamically created on first reference.

        LINES: important syntactic entities. Multiple statements per line are idiomatic. Scope of IF and FOR is "remainder of current line."

        LOCAL ARRAYS: created dynamically, any number of subscripts, subscripts can be strings or integers. Stored in process space and expire when process terminates.

        GLOBAL ARRAYS: arrays that start with a caret symbol. Stored on disk, available to all processes, persist when process terminates. This is M's main "database" mechanism.

.

There are different vendors and layers on top, but it's all the same underneath. VistA, the VA system is the underlying MUMPS open-source system that has been forked into many versions around he world

Re:I don't see this happening any time soon

[tg2k]

Please tell me you don't work in the industry.

If one of our clients has a security problem due to our software, you can bet we're in big trouble.

And starting next year the rules will get even more stringent. Basically every kind of protection that our clients are required to have, we'll have to have internally, especially wherever we have to handle patient health information.

And BTW, "portability" doesn't mean you get the code, it means you can take your records somewhere else. That's what I meant about "open interchange".

Re:I don't see this happening any time soon

[Dadoo]

Wow, I wouldn't have though there were so many languages that way. The system we use was written in a similar language:

        http://en.wikipedia.org/wiki/PL/B

I know there are several dialects of BASIC out there, with database extensions, too, but they all (like Databus) use ISAM files.

Re:I don't see this happening any time soon

[RingDev]

My statement about the P standing for portability is due to the majority of US consumers thinking that the P stands for privacy or protection. They believe that HIPAA is designed to prevent their medical information from being shared with organizations/groups other than their own doctor. Which is not true. HIPAA is designed to make is easier for doctors to share your private data and to protect them from lawsuits for doing so. Yes, the bill also puts a lot of requirements on how the sharing is done, but HIPAA was designed, IMO with insurance companies interests over consumer interests.

I do not currently work in the industry, but I have previously done work for insurance agencies and clinical medical research organizations that dealt with HIPAA. My understanding of HIPAA's rules and regulations is not at what I would consider sufficient for significant legal debate, but my experiences with how it is being used in the medical industry have lead me to having almomst no faith in its ability to protect my medical records according to my interests.

-Rick

Re:I don't see this happening any time soon

[tg2k]

I can't speak for other companies, but my company takes HIPAA very seriously. And I think audits over HIPAA concerns are being taken more seriously across the industry as well.

At the same time, we have millions of lines of code, many dating to well before the days of HIPAA, and if we exposed it all to public scrutiny I'm sure it would make it easier to hack...particularly anywhere a developer was thoughtful enough to mention that in a comment.

Re:I don't see this happening any time soon

[Thinboy00]

In the long run, open source is more secure than closed source. But in the short run, opening up a closed source program is totally insecure, because it has the worst of both worlds: Limited # of dev's have actually worked on the thing (it's only recently been opened) but black-hats can read the code. Next time, build an open-source system from the ground up.

Re:I don't see this happening any time soon

[Mumpsman]

My name obviously implies bias, but the reason that many of the Medical record systems out there now - VistA, EPIC, GE/IDX, Amtrim for labs ect. - are based on MUMPS is because of its string handling capabilities. Much of a medical record is transcribed notes, character strings which need to be manipulated and stored. MUMPS was designed to do this from the start, which is why it's the right tool for the job. Take that DailyWTF with a very large pinch of salt. The source for VistA is already available though a FOIA request, and GT.M (the MUMPS platform it runs on) is open source. Run the whole shebang on Linux and presto-changeo, Open Source EMR. This is what Medsphere is doing, selling services and support as the core business. http://en.wikipedia.org/wiki/MUMPS

Good place to start

[orclevegam]

After talking with some people in the medical field, it seems like an excellent place to start would be in the medical imaging records. Just about all the advanced imaging equipment out there saves the images to a "standard" format that's about as standard as a MS Word file. Every manufacturer has their own custom version of the "standard" that's incompatible with everyone else, and regularly updated, thus ensuring a constant (and broad) income stream.

Re:Good place to start

[davek]

I work for a company who's EMR software was started as exactly that: an image archiving program. It then added procedure records, report printing, patient demographics, and eventually billing and statistics. I'm trying to convince the boss right now to release the early versions of the image archiving program under a commercial-friendly open source license, so that we might be able to take advantage of some of this government hype.

Re:Good place to start

[flink]

Depending on the intended use of the image there are several standards out there for capturing, transmitting, and archiving imaging data. If you have some free time you might want to try looking up DICOM (Digital Imaging and Communications in Medicine). DICOM images are typically stored in a PACS (Picture Archiving/Communication System).

Alternatively, if you are talking about building up an electronic health record, you could create a CDA (Clinical Document Architecture) document for the encounter with the image embedded in it and store it in an XDS (Cross-site Document Sharing) repository.

Re:Good place to start

[VoidEngineer]

The DICOM standard that you're referring to happens to be 3000 pages long (there's alot of ground to cover, as medical imaging is a very large field, actually). The problem is that there are different interpretations on how to implement the standard. But generally speaking, it's an open standard and if a medical device is DICOM compliant, you have pretty good assurance that it will be interoperable with other DICOM equipment.

And for what it's worth, there are already plenty of open source medical imaging programs out there, such as ClearCanvas, DCM4CHEE, OsiriX, and KPACS.

Re:Good place to start

[Anonymous Coward]

Err ... no, the DICOM standard is actually the shining star of medical information interchange. There is an open source reference standard (Wash University's CTN software) ... and doctors both can and actually do transfer images between computers every day. Although manufacturers may *store* the images using a proprietary format, the DICOM network protocol mandates transfer using a standard format.

A person should own their health record

[presidenteloco]

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

[characterZer0]

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.

Re:A person should own their health record

[MrMarket]

The problem is you need an entity to manage/host the life-long record. Just calling it a cloud doesn't make it a natural phenomenon.

Re:A person should own their health record

[Dan Ost]

A patient's medical history may be about the patient, but it is the doctor's tool. It allows the doctor pass information to future doctors who care for the patient. Some of the stuff in the record may not be flattering to the patient, but it's there to protect the doctors from making avoidable mistakes forseen by previous care givers and to create a context for diagnosis and treatment. Allowing the patient to "edit" their medical history would be a huge mistake.

Seriously, how could a patient be better served by giving their doctor a censored view of their medical history?

Re:A person should own their health record

[RingDev]

Seriously, how could a patient be better served by giving their insurance company a censored view of their medical history?

Fixed.

-Rick

Re:A person should own their health record

[VoidEngineer]

That entity doesn't necessarily need to be a a business or government. Why not something like an exocortex with medical record installed on a virtual appliance that follows a person throughout life? You would simply install the virtual appliance with medical history, personal photos and files, and what ever else, onto the cell phone or other PDA device that you're using. And simply migrate the virtual appliance to whatever hardware you're currently using. It's basically what I'm doing.

Re:A person should own their health record

[winwar]

Do you seriously believe that doctors take the time to actually READ the records? They already complain about the time that record keeping takes.

If they did then I wouldn't have to repeat the same information to ever nurse and doctor that I see in the same office, much less after I am referred to another doctor.

Re:A person should own their health record

[rts008]

The information should legally belong to the patient...

Well, the way it is set up in the USA, it will either take making medical records being exempt from most IP law, or big changes in IP law to get to the point you are wanting.

Basically, you 'own' the 'facts' in your medical records, but the records themselves are the Doctor's IP. It's difficult to explain in a way that actually sounds rational or reasonable.

For example: *note: I am not an M.D., but work with me here!*
Let's say I am a M.D.(general practitioner), and you come to me with a rash. I(or more likely a nurse or assistant) will 'get your history' by giving you all of those PITA questionaires, and asking you questions. All of this gets entered in a format that becomes your med records.
I will then look at your 'history' before I even see you, which gives me a chance to narrow causes down some. I will then enter the exam room, and try to get more info to help diagnose your ailment. This also goes into your records.

I then refer you to a Dermatologist, as all I can figure out is that you seem to eat a lot of CheezyPoofs, and may be allergic to them.
Up to this point, it seems pretty simple. You own the 'facts', but I hold the copyright/IP of your records.

Now, as far as the Dermatologist is concerned, you have no 'history' or records yet. You will have to sign some papers giving me permission to pass on a 'copy' of your 'facts'(history) to the Dermatologist you were referred to. I also have to give permission to him for access to your medical records, as they are my IP.

I can give you a copy of your records, but they are my IP, containing your facts. Legally, you can't pass them on to anyone else without getting my permission.
At the same time, I can't pass out copies of your records to third parties without getting your consent, to protect your privacy/facts unless I was sneaky and slipped some waiver in the mess of paperwork you filled out and signed.(I doubt this happens often-my post is an extremely simplified version, not getting into med regs and privacy regs/laws)

Now, if I decide to retire, I will sell your records along with my patient list, notes, etc. as IP, and the office/land and equipment/furniture as real property. (Yes, I have just sold your 'facts' without your consent-legally)

Pretty wacky, isn't it? The wiki was not overly helpful here, some digging will be required for the 'full story', but here is what there is.

It would seem similar to a writer(patient) dictating a book to someone(Doctor), having that someone turn it into a manuscript for publishing. The writer may own the words used in that manuscript, but that someone legally owns the IP on the manuscript. Both would have to agree to turn it over to a third party for publishing. Writer's consent is needed mostly due to privacy laws and regs, while that someone actually owns the copyright/IP.

Not the best analogy maybe, but trying a car analogy here...*head a splodes*

I haven't had to deal with this stuff for over 15 years, so maybe someone more current and knowledgeable can chime in here.

On the surface, it doesn't seem too difficult or tricky, but it really is a big mess when you lift the lid.

Re:A person should own their health record

[rts008]

It doesn't belong to the patient. You can ask the Doctor/clinic to correct mistakes, but the Doctor actually owns the IP of your medical records.

Re:A person should own their health record

[ThatsNotPudding]

So the records would live in an independent information infrastructure, not owned by any particular health care provider.

Until some bright healthcorp bean-counter comes up with the idea of labeling their treatments as proprietary, requiring you to sign a non-disclosure agreement that forbids information sharing.

I am only vaguely kidding.

Re:A person should own their health record

[Trahloc]

Hey how about just keeping the records the same, but the patient has the right to black out bits like the NSA and other government agencies do on sensitive documents? The patients authorized Doctors have privileged status and get a fully unedited version but the insurance companies and anyone else just get a binder full of blacked out documents if the client so chooses. Couple that with laws that say an insurer can't reject patients based on medical history and they should be safe. They might have to pay the highest premium they can legally charge but they can't be rejected.

Re:A person should own their health record

[Trahloc]

I strongly believe in a small government, things like fire/police/military should be within their control. As should something like this, things that can't be trusted to a for-profit entity are controlled by the government. The maintenance can be outsourced to a non-profit corp but the control remains with government.

Re:A person should own their health record

[Dan Ost]

If they did then I wouldn't have to repeat the same information to ever nurse and doctor that I see in the same office, much less after I am referred to another doctor.

They have read your file. What they're doing is called a History and Physical (H&P).

They are doing this to verify what's been recorded in your record (the current complaint) and, very likely, the questions that they're asking are tailored by what they read to try to cover gaps and identify mistakes in your record or to connect the dots in your symptoms to help reach a diagnosis.

If the doctor has a good idea what your problem is, the H&P might be very brief, asking only probing questions related to the suspected diagnosis. If you're being admitted, even if it's obvious what's wrong, the admitting team is expected to do a full H&P if possible.

Think about it, if someone had a problem and you were given a write-up of their complaint before you met with them, wouldn't you want to verify the contents of that write-up before you ordered potentially life-threatening procedures/drugs based on its contents?

Why open Source not open Standard?

[mdf356]

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?

[DoofusOfDeath]

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!

Re:Why open Source not open Standard?

[ivaldes3]

Because it is a public good like a lighthouse and not a private good like cars of furniture. Since medicine is a small market with massive computing requirements. Free/Open Source is really the only way to go but proprietary vendors are keeping it hostage. -- IV

>>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.)

Re:Why open Source not open Standard?

[Gramie2]

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 bonuses for using electronic records and tracking various preventive measures (e.g. vaccinations) with them.

Re:Why open Source not open Standard?

[elBart0]

The standards for the data already exist. HITSP 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.

Re:Why open Source not open Standard?

[rliden]

This is it exactly. There are many systems that use their own bastardized version of HL7 (the medical file format).

There needs to be an open, easily accessible standard for recording and storing health information. Before this can happen the way we describe and reference medications, immunizations, problems, and procedures also need to be standardized. It does no good to standardize a record format when the information it contains is inconsistent and changes depending on regions and vendors.

The US health care system needs complete standardization starting from the top down not just with health records and insurance.

Re:Why open Source not open Standard?

[Anonymous Coward]

A standard already exists http://www.hl7.org/

Re:Why open Source not open Standard?

[PotatoFarmer]

You're asking for the wrong thing - message standards for different record types already exist in the HL7 spec. However, as you mention, there are lots of systems that ignore those and just deal with Z segment (arbitrary data) HL7 messages. Kinda defeats the purpose, but that's the medical data industry for you.

The problem is not a lack of standards, the problem is getting providers to actually use the standards that are there right now.

Re:Why open Source not open Standard?

[Ironica]

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.)

Because you're talking about highly sensitive data, and it's reasonable to know just what is happening with it. A doctor's office can't just hire Joe's Software Shack to whip them up an EHR; they need certain guarantees that the data is secure (HIPAA final security rule). To this end, there's a certification program... but of course, it's quite pricey to get certification, so only the folks making lots of money off of proprietary systems have done so.

Health care is expensive in this country. We all know that. When we (or our insurance companies) pay the doctor, we're paying her compensation for the education, hours, and care she's putting in; we're paying for the office space; we're paying for the proper handling of sharps and medical waste; we're paying for malpractice insurance. Now, if they have an EHR, we're also paying an extra $8/visit plus pro-rated one-time costs... or we're paying a per-provider license fee that's a few thousand a year... or whatever pricing scheme their vendor uses. Unless they use an open source solution, in which case, there are no license fees. Plus, because it's open source, you actually know what it's doing with your data (or at least, you have the ability to inspect it if you have the skill to understand it).

Re:Why open Source not open Standard?

[VoidEngineer]

That's a transmission standard, not a storage or document structure standard.

Re:Why open Source not open Standard?

[texas neuron]

Actual there is a lack of standards. There is no standard, as far as I am aware, as to how an office visit note would be exchanged. There are standards for labs (HL7), radiology images (DICOM) but no standards for radiology reports. From being in the hospital, there are consults, things like EKG, admissions histories, discharges, nursing notes, med sheets, vital sheets, etc. all of which need standards for transfer. More importantly, if we have access to all of this info is how to authenticate the transfers. I would not want a central storehouse to have all of the information but rather it should still go from place to place as authorized by the patient.

Another issue that no one in government wants to address (by the lawyers, for the lawyers) is the issue of malpractice law suits. Some patient will have a nursing note buried in their chart that mentions something that some lawyer will insist I should have read if I wanted to know everything about my patient before I treated them. It is not unusual for hospital admissions to produces hundreds of pages per admission and there is no one who is going to read and remember everything from each page.

Re:Why open Source not open Standard?

[PotatoFarmer]

Many of the things you describe would normally be encapsulated in an HL7 OBX segment. That being said, it's actually a lot harder than it probably should be to get a complete HL7 reference, so it's not really surprising that implementations are lacking.
The last time I had access to a full specification was when I was working for a company that was a member of the HL7 working group a few years back. It really shouldn't be as difficult as it was (still is?) to get a full spec.

Re:Why open Source not open Standard?

[ThatsNotPudding]

Absolutely. As has been shown, you can't spell ISO without Microsoft.

Re:Why open Source not open Standard?

[mattwarden]

> However adoption of the standard is optional, and healthcare IT is
> very very slow to update technologies.

You say that so matter-of-fact, as if there's no reason. The reason is that it is incredibly costly to convert legacy systems. You can't change that with legislation.

I know we're all supposed to cheer this legislation because it has the words "open source" in it, but the real question is: if this is the right decision from a cost-benefit perspective, then why aren't companies already making it?

Re:Why open Source not open Standard?

[badkarmadayaccount]

[user@machine] netcat blah.foo.bar > ./patients.db

Not Good

[Anonymous Coward]

The last thing our health care system needs is open sores.

VistA

[Quato]

Why not use the one our tax dollars have already developed? VistA is the VA's EHR system.

http://en.wikipedia.org/wiki/Veterans_Health_Information_Systems_and_Technology_Architecture

Re:VistA

[Anonymous Coward]

MUMPS. That's why not.

Re:VistA

[Random BedHead Ed]

Because it would draw attention to the VA. You know, the socialized healthcare system that severely reduced care costs. And we can't have people noticing the VA, because everyone knows that Socialism Doesn't Work (TM).

Re:VistA

[orclevegam]

You are remiss in not properly linking to some source material on MUMPS.

Re:VistA

[Curlsman]

Vista won't be used because it already works.
Nobody makes a lot of money from something that works...

Re:VistA

[orclevegam]

Socialism works sometimes. So does capitalism. Communism can work to when the planets are aligned just right. But as a overall economic policy Socialism doesn't work, as it quickly turns into a race to the lowest common denominator, and it can always go lower. There is no one supreme economic system that's always going to be better than all the others in every situation. Likewise some economic systems are doomed to failure in certain situations.

Re:VistA

[Anonymous Coward]

Because it would draw attention to the VA. You know, the socialized healthcare system that severely reduced care costs.

...and instituted high quality health care using innovative new techniques and maintaining rigorous quality standards.

If that's what reducing care costs is going to do, I'll keep sucking up the insurance payments.

Re:VistA

[VoidEngineer]

1. VistA is a hospital information system that isn't appropriate for all clinical practices. It would be overkill many times over for a single physician practice, and would even be too complicated for most Radiology practices even.

2. The technology that VistA was developed on is *very* antiquated, and makes most developers cringe. In fact, it's nearly impossible to find MUMPS programmers anymore, and the entire project is stagnating horribly. The computer industry has simply moved on. There are 100x more C, C#, and Java programmers than there are MUMPS programmers, so new open source projects are being written in the newer languages, and the older projects in MUMPS are slowly stagnating into obscurity.

Re:VistA

[ColdWetDog]

Well, from that helpful little article:

he primary design goal MUMPS was to create code that, once written, can never be maintained by anyone ever again.

Should be something that any perl developer could just jump right in to.

Re:VistA

[Mumpsman]

Hi-o! Over here! In the corner...in the big empty room...How come nobody ever wants to play with me?

Seriously, any decent programmer can pick up the basics of MUMPS in a weekend. There are plenty of compelling reasons to do so. Developing VistA is both patriotic (helping US vets!) and globally humanistic (Open source helps 3rd world countries deploy better medical technology!). Not to mention the massive amount of money currently floating around to help develop and deploy EMRs.

As for projects which cover the same ground as VistA...where are they? The 2 biggest commercial players in EMRs - EPIC for large hospitals and Meditech for smaller, community hospitals - are both M-type platforms. There are NO other competitors written in other languages because building a hospital automation system is really complicated and takes decades to mature. Yes there are 100x more Java programmers out there, but we'll never see a commercially successful EMR written in Java because there is 0 business need for one now.

I've got a dollar...

[Banichi]

...that says high ranking government officials are exempt from whatever this bill actually enacts, that it's only the "common man" who will require "Open" medical records.

What is planned to be done about public leaks of, or illegal alterations to, confidential information of an individual's HIV/AIDS/Other Social Disease/Embarrassing Medical Ailment status?

Re:I've got a dollar...

[DragonWriter]

...that says high ranking government officials are exempt from whatever this bill actually enacts, that it's only the "common man" who will require "Open" medical records.

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.

What is planned to be done about public leaks of, or illegal alterations to, confidential information of an individual's HIV/AIDS/Other Social Disease/Embarrassing Medical Ailment status?

Since nothing that I've seen published about this bill suggests changes to HIPAA's privacy protections, including the criminal penalties for improper disclosures, I would assume, at least until the text of the bill is available so that we know for sure, that there is no change on that front.

Re:I've got a dollar...

[Ironica]

I've got two dollars that says you didn't RTFA, since you're talking about something entirely different.

This bill will put forth funding for the implementation of OSS EHR systems in medical clinics, particularly safety-net clinics that can't currently get funding for non-CCHIT (i.e. non-proprietary) systems. It doesn't open anyone's record, or require anyone to use Open Source; it just requires the gov't to put some money toward building out OSS solutions.

Re:I've got a dollar...

[sexconker]

No, I'd figure on /. I'd get arguments about health records just being more information that wants to be free.

How can an EHR be built on open source?

[thepainguy]

Isn't an EHR just a file format? That goes for both the files and the interfaces.

The only thing that would really be open source would be the underlying system, but that could be implemented using either open or closed source systems.

I absolutely believe that the file formats and interfaces for EHR systems should be open standards, but that's not open source.

I'm all for open source, but sometimes people take this a bit too far.

Re:How can an EHR be built on open source?

[thepainguy]

This whole thing reminds me of this absolutely classic Dilbert...

http://tijil.org/gallery/v/dilbert-eunuch-c.jpg.html

Re:How can an EHR be built on open source?

[DragonWriter]

The only thing that would really be open source would be the underlying system, but that could be implemented using either open or closed source systems.

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) simultaneously to get the maximum public benefit for the buck by only providing those subsidies where the iplementation is done using OSS, and providing support for interoperability workgroups, and doing a number of other things to promote standards.

I absolutely believe that the file formats and interfaces for EHR systems should be open standards, but that's not open source.

Open standards are a great starting point, but it still doesn't deal with the problem that small providers, especially those that participate in public safety net programs that often require that providers be non-profit and limit reimbursement to actual costs, don't have extra funds to implement EHR even if the standard is open. This bill provides funding to enable them to implement, provided that they implement with OSS.

Re:How can an EHR be built on open source?

[MrMarket]

Development and implementation costs are a huge barrier to entry for EHR systems at hospitals and doctor's offices. An OS solution would at least lower the license costs. Then you would just have different flavors of front end and support packages (much like RH vs. Umbutu for linux)

Re:How can an EHR be built on open source?

[Ironica]

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 can. You can build some of that into a file format, but not to the extent required for your doctor, nurse, receptionist, and all the folks in medical billing to each see everything they need and ONLY what they need of your health record.

Re:How can an EHR be built on open source?

[Ironica]

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) simultaneously to get the maximum public benefit for the buck by only providing those subsidies where the iplementation is done using OSS, and providing support for interoperability workgroups, and doing a number of other things to promote standards.

Well, almost. There is quite a bit of funding available for (safety-net) clinics to implement EHRs. Unfortunately, it all has strings attached that make it virtually impossible to implement an non-proprietary solution. This legislation seeks to address that imbalance (for very good reasons as you've stated).

Doomed to fail...

[charlieo88]

as Microsoft just announced Doctor's Office 2009.

Re:Doomed to fail...

[rackserverdeals]

as Microsoft just announced Doctor's Office 2009.

Yeah, but it won't be released until the second half of 2010.

Re:Doomed to fail...

[neowolf]

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.)

Re:Doomed to fail...

[rts008]

Yahoooey!
I've pre-ordered it already 'cause I heard it was built using the Railroad Tycoon game engine and Leisure Suit Larry code!

Now I can not only bill like a Doctor, but can play 'Doctor' while I do it!

Health IT Federal Advisory Boards

[Presto Vivace]

There are going to be Federal Advisory Boards, much depends upon who gets on those boards.

RTFA

[DragonWriter]

Why not use the one our tax dollars have already developed?

Why not RTFA?

VistA is the VA's EHR system.

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.

Dodging the bullet

[marco.antonio.costa]

Your medical records should be PRIVATE.

Even if they now store your data in 'free software' it still means you are now less free.

Re:Dodging the bullet

[Curlsman]

I would hope for public access to non-personal details, so everybody on the planet can to performance analysis on the care and outcome of treatment.

Then private (encrypted) access for when I'm in the doctors office and hospital.

The hard part is going to be tracking changes for use in malpractice cases.

Re:Dodging the bullet

[Ironica]

Your medical records should be PRIVATE.

Even if they now store your data in 'free software' it still means you are now less free.

As opposed to how "free" you are when someone making $8/hour has to run your entire, plain-text paper chart to and from the front office, nurse's station, doctor's office, and file it back in the medical records room?

Yes, your record should be private. It's far, far easier to control access to an electronic chart than a paper one.

Re:Dodging the bullet

[marco.antonio.costa]

Yes, your record should be private. It's far, far easier to control access to an electronic chart than a paper one.

Agreed.

What I don't get is why do we need the Senate to pass a law for something private hospitals can perfectly do on their own, if it is as economical as you argue.

Re:Dodging the bullet

[DragonWriter]

What I don't get is why do we need the Senate to pass a law for something private hospitals can perfectly do on their own, if it is as economical as you argue.

Its economical in the long-term and reduces errors. However, there can be a very high initial cost, and the "safety net" providers which this bill targets (which may provide services largely, or even exclusively, under public programs which often limit reimbursement to the lower of actual costs, standard rates, and charges to third parties) don't tend to have a lot of cash lying around to implement systems with high immediate costs that offer cost savings in the long term. And there inability to do that also keeps costs higher than they need to be, in the long term, in those public-funded safety net programs. So, this bill seeks money to enable them to do this, which in the long term should improve the quality of the services provided at those "safety net" providers while reducing the costs in the public safety net programs that pay for the services there.

Re:Dodging the bullet

[Savantissimo]

It's far, far easier to control access to an electronic chart than a paper one.

umm... no?

Re:Dodging the bullet

[rts008]

I would hope for public access to non-personal details...

Long, uphill fight to get there. Frankly, I don't see it happening anytime soon.
I agree with you, and your noble sounding reasons, It will be a huge IP mess. (Intellectual/Imaginary Property-not playing sides here)

The hard part is going to be tracking changes for use in malpractice cases.

While difficult, I don't see that as the 'hard' part. See above.

Medical Records in the USA are currently a can of IP worms.

Quick, easy example:
Assume I am a M.D. with my own 'office' and practice. If I retire/move on, and decide to sell my 'practice', your medical records are part of my IP I include in the sale with the rest of the property that makes up 'the practice' and 'office' I am selling. Even though I am selling your med records without your permission, it is my IP, and I can do so legally. Your IP rights on those med records only exist in privacy laws and regs, but does not extend to 'ownership' or copyright, which I own.

BTWnothing to do with the resulting setup, that's just the way it is currently.
I get modded down, trolled, and flamed for my stance against the concept of IP here on /.
This is one of many reasons why I am against it. It overly complicates what should be simple shit at the expense and detriment of the populace.

P.S. When I had classes on medical records in 1993-'94, IP solely meant Internet Protocol, but the potential problems were obvious even then when all the talk was gaining ground about how the internet would change the world. I got my A.A.S. in Veterinary Technology, and my B.S. in Biochemistry-similar to a Registered Nurse/Physician's Assistant, only for 'other than human' critters. Vet Med seems to try to mirror/chase human medicine, including the bureaucracy.
On that note:
Your cat's medical records are solely the IP of your Vet.'s clinic. Your personal info required to associate and contact/bill you is protected by privacy laws and reg's, but your cat' record and history/'facts' are fair game. Now, don't 'go ballistic' here-usually your pet is just a 'statistic' to any third party that might get/be involved.
At worse case it would be: "well, I remember this one case...Fluffy the cat, where she 'coughed up' hairballs shaped like a frog...."

For example:
Iams cat food is wanting to market their product.**
A 'natural' place to market a high-cost, semi-tailored, and 'high-quality' cat food, would be Veterinary Clinics that had a 'high' cat traffic.
At most, Iams would only find out that your cat was just another of the 485*** anonymous cats seen/treated by that clinic annually. You, nor your cat would be in any way identifiable by any third party.

Your Veterinarian most likely is just as good, if not better at this 'access for the good of the patient while guarding privacy' game as your M.D. is. They get hit with the mal-practice suit just as often, if not more than M.D.'s! Still having to pay for MP insurance, but usually on a much thinner revenue stream/profit margin.

Offtopic?
** not picking on Iams, just was familiar with their cat food in relation to 'uroliths'(think 'bladder stones' as compared to 'kidney stones') in 'fixed'(castrated) male house cats. One of my research projects that earned me an unexpected, nor seeked scholarship from them in school.
At the time, they would get my recommendation without hesitation, but Proctor-Gamble bought them out in 1999, and I have heard mixed reports since then...YMMV

What I learned? Select a 'low magnesium' feed, keep the food and water bowls fresh and filled...everyday.(free choice is best for 'fixed' tomcats...male cats(most mammals really, and especially the primates, including humans) have a really 'complicated', twisted, fsck'ed up Urinary Tract) have a complex urinary tract which is prone to obstruction easily.(don't take much to clog the tubes),

Why I don't want this

[BigHungryJoe]

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:Why I don't want this

[theelectron]

I know privacy is very important, but there are two sides to this argument. To do a good job, the doctor is going to need to know as much about your history as possible even if it is embarrassing or potentially irrelevant - especially in a system as complex and dynamic as the human body.

Re:Why I don't want this

[DragonWriter]

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.

This is not about a "central, unified medical history". Its about the fact that actual healthcare providers have and use medical records, and that keeping and using them electronically has been demonstrated to have significant benefits in quality of care and cost in the long term; this bill provides funds for providers to implement electronic health care record systems using OSS. The only centralized facilities it creates are fora and programs to promote systems interoperability between EHR systems and between EHR systems and billing systems, so that data which does need to be shared and for which the appropriate consent and disclosures have been made can be shared effectively and accurately.

Nothing I've seen about it suggests that it in any way reduces the privacy protections in HIPAA which require consent for most disclosures and uses of PHI, including health records, or the even more strict confidentiality requirements of 42 CFR Part 2 that apply to confidentiality of records relating to drug and alcohol abuse.

With concerns like yours I would pay attention as more details of this bill become available (including its actual text, which Thomas doesn't seem to have yet) and as it works its way through Congress, but I wouldn't jump to conclusions about it the way you seem to have.

Re:Why I don't want this

[ivan256]

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

[ClosedSource]

"You won't get to decide what treatments you are eligible for"

And this differs from the current private insurance system in what way?

Re:Why I don't want this

[DragonWriter]

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.

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.

Re:Why I don't want this

[Anonymous Coward]

This is why its important to have a doctor that you know you can trust.

I don't normally post anonymously, but, I work at a company doing electronic medical records now. This could be interesting for us. Though, we are a non-profit thats funded by a number of hospitals, so maybe not. Who knows, maybe it means we can start replacing all the VB programmers :)

Anyway, my doctor leaves stuff about drug abuse out of my records. I don't even have to ask, we talked about it, he has said to me "I am going to leave this out of the records". I trust the man, I like him. Because of that, I don't hold back when I am in his office, and he, in turn, gives me the best care possible.

If you can't trust your doctor to have discretion, then find a new doctor. The case that you describe is definitely a concern and a good doctor should at least have some pause and ask you some questions to be sure, but... your right, it shouldn't stop him (especially since addiction is an acceptable side effect to medication).

Also... in all this... remember HIPPA. Medical records are already protected privacy wise. Mention HIPPA inside a hospital and see if anyone doesn't know what you mean. Hell... its the ONLY thing I have seen thats managed to get real movement on some things (like data encryption, password policies, etc). How many places do you know that mandate all employee laptops must have encrypted hard drives? Nobody wants HIPPA auditors on their case.

Its so strange to see a place go from assigned 5 character passwords that can't be changed (a legacy issue from an older system thats was in place for more than a decade), to mandatory regular password changes with a strong password policy and mandatory laptop encryption in under 3 years. Yay HIPPA, as someone who is "also a client", I love to know I am protected.

-A professional in medical IT and a pothead

Re:Why I don't want this

[ivan256]

If you don't like what your insurance company deems you eligible for, you can switch to another plan, or another provider. Even if you're in a situation where you can't, the competition pressures insurance companies to be more open to covering things.

Also, private insurers may have a profit motive for deciding what to cover, but typically no political motive...

Most importantly, and staying in the context of this discussion, you can decide to withhold your medical history from a doctor to get a fresh opinion. When your 'insurer' is the government, they can and will make it illegal to do that.

Re:Why I don't want this

[ivan256]

I'm not sure how this is 'interesting' or 'insightful'. You can currently choose whichever insurer you want, and you can choose based on what they cover. You can also purchase supplemental insurance if, for some reason, you feel you're trapped into a particular plan by your employer.

The only thing you can't do is pick after you already need the treatment... But then if you could do that it wouldn't be 'insurance', now would it?

If you can't afford anything at all right now, I don't know how you think you're suddenly going to be able to afford it when the government is taking your money to pay for it for you...

The current 'plan' is the 'Public Option'. A public health insurance plan that you can choose over the private ones. Once it exists, it will be possible to legally mandate the purchase of health insurance. It will only be a matter of time before the private insurers go out of business because they can't be profitable competing with the "Public Option". From there it's only a matter of time before they tell you that a wheelchair is a viable alternative to a hip replacement (walking is optional), or that they won't pay for a particular cancer drug because it merely improves your quality of life rather than make you live longer.

So it differs from the current system, where you're insured to the level you're comfortable with. Instead you'll have a system where decisions about your health are made in context of the general population rather than in the context of you as an individual.

Re:Why I don't want this

[WebCowboy]

For instance, I have a history of amphetamine abuse. I'm past it, I beat it, I'm feeling much better now, thank you.

And nobody should cast judgment on you pertaining to employment prospects, credit worthiness, medical insurance, how "decent" of a person you are or whatever. Kudos on getting past it--I know people who still battle with that addiction.

That said, strictly speaking from a medical delivery perspective, that such information, as "embarrassing" as it appears to be, could indeed be medically relevant. Seeing as the decisions made by medical professionals can have life-and-death consequences, wouldn't it be best to make sure the information they relied upon to make sure you were healthy and ALIVE be both accurate and COMPLETE?

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.

Doctors are trained professionals. If they are concerned about relapse they are almost universally making an informed, professional judgment. Also, keep in mind that risk of relapse is not the only influence on a doctor's decision in prescribing medication. Past drug use (legitimate or recreational) is a contra-indicator for quite a lot of prescription drugs.

To use exactly your example: A drug called Desoxyn is a treatment option for weight loss treatment. A history of sustained use of a number of amphetamines is linked to resistance to the effects of Desoxyn. Depending on how long ago you beat your addiction the doctor might chose an alternate solution.

Another example is Adderall in the treatment of ADHD. Past meth abuse can cause a permanently increased risk of heart complications, and Adderall has know links to increased heart problems in addition to any addiction concerns there might be.

When a doctor refuses to give you a treatment option he doesn't have to be passing a personal value judgment on you. Doesn't it seem quite possible he's basing his decisions on, say, actual scientific research and clinical data?

I support measures to promote the freedom of movement of medical information within the system, provided it comes with sufficient regulation and oversight. For example:

* Medical insurance companies should be required to get permission from the subject of those records or their guardians directly. Premiums and acceptance screenings cannot be based on any medical history records whatsoever--only on a medical exam of existing condition, and only then with limits.

* Patients should be able to have full access to all records pertaining to them on demand from any medical facility in a timely fashion (in an electronic system, within 1 business day would be charitable), and at no more cost than a nominal administration fee

* Medical record information should include a complete audit trail and by default permanent (for example, if a mistake is corrected, the old infor should be included as "striken and corrected"). Only the patient should be able to strike information completely, and such an action must be signed off by a medically qualified professional.

* medical records cannot be used by anyone outside professional medical practice--it should be illegal to base decisions on credit-worthiness, employment, etc. on past medical history.

Re:Why I don't want this

[sexconker]

Agreed, but why deny treatment when you can just block the treatment from being approved in the first place? (Provenge)

Re:Why I don't want this

[ClosedSource]

"If you can't afford anything at all right now, I don't know how you think you're suddenly going to be able to afford it when the government is taking your money to pay for it for you..."

Of course the devil is in the details but why do you assume that the everyone will be paying the same?

"So it differs from the current system, where you're insured to the level you're comfortable with. Instead you'll have a system where decisions about your health are made in context of the general population rather than in the context of you as an individual."

You're assuming that our current system is focused on the needs of the individual, but clearly it's not. If it were you'd get the same quote for insurance as an individual as you would as a business and that's not what happens.

Re:Why I don't want this

[Anonymous Coward]

Are you willing to sign a waiver that you won't sue your doctor for malpractice even if it turns out that a drug has adverse effects on you due to something obvious in your past medical history but that you withheld?

I've encountered the same advice numerous times: tell your doctor *everything* since you do not know what might affect the treatment. If you feel that you cannot trust the doctor and must withold something, you shouldn't go to that doctor in the first place since not only do you not trust him, you don't give him the best possibilities to treat you either.

Current State of Medical Records

[mc1138]

I used to work as an outsourced IT support guy, and a lot of my customers with medical offices. A lot of them used EMR systems, and a lot of them were all proprietary, clunky, full of bugs and issues, and just general pains in my ass. Now, a system that forces uniform standards, would allow, for data to be easily transfered from a PCP to a specialist. However, the mere thought of implementing any of this, makes me very glad I'm no longer in that job as it would be an absolute nightmare.

Re:Current State of Medical Records

[mattwarden]

Well, hey, if anyone can do it, it's the government.

Jay Rockefeller sucks.

[tjstork]

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.

Idiot

[Anonymous Coward]

It's like listening to some grade schooler parroting a few catchphrases he heard older kids saying in an effort to sound grown up.

In the future, just keep your idiotic thoughts to yourself, k?

Got it? Good.

Free data format is far more important

[davidwr]

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

[sxmjmae]

Much needed. Saw some work go by the desk for Electronic Health Records system.... about 1 million people and 2500+ different doctor's Database. Not a single doctor wants to pay to have their own DB converted to meet a new standard. Rather the centralized DB must be able to talk to each of the 2500 specialized DB and no one want to pay for that and the little realize the scope of achieve that kind of linkages.

Contact Your Senator!

[gQuigs]

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

Contact Your Senator and show your support!
http://www.senate.gov/general/contact_information/senators_cfm.cfm

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

[spotchka]

What they are calling for is a set of standards (i.e. What is a Medical Record?), not an open source solution. Once they can define exactly what comprises a medical record and standardize it (ANSI, HL7, etc.), the open source community usually takes care of itself.

Poor understanding of IT jargon by a politician's office...what a shock...

Re:Call for Standards, not Open Source

[gringofrijolero]

Poor understanding of IT jargon by a politician's office...what a shock...

I'm a doctor, dammit!

Re:Call for Standards, not Open Source

[Anonymous Coward]

Once they can define exactly what comprises a medical record and standardize it (ANSI, HL7, etc.), the open source community usually takes care of itself.

Take a look at LOINC and despair. LOINC is basically an attempt to categorize every measurement of a human possible, and assign numbers to each. Want to store your weight in a format everyone can use? Sure, just use ID numb... wait, was this clothed weight or unclothed weight? Weight before a pregnancy (are you pregnant yet? Do you know that?) Weight during a pregnancy? Weight after delivery?

Heck, there's probably 20 codes for the weight of a fetus, and I'm fairly certain the OBs I work with haven't a clue which one goes with the algorithm their ultrasound machines use to calculate it.

Don't worry though, I'm sure there's not going to be any data lost when doctor A's medical record tries to talk to your hospital's medical record.

HL7?

[Anonymous Coward]

This is bullocks. There's been HL7 for distributing records and data. Why do you need a record standard? You still have to transfer the data. The medium at the core is irrelevant when you look at the translation record. Even if you have a cingular document system that doesn't mean that you're interface will work with another hospitals? THis is an issue of transfer not document type. I would support a HL7 implementation that everyone used not a document format.

Re:HL7?

[Anonymous Coward]

Also the CDC has HL7 standards for the transmission of data to they're site from a hospital. The problem though is that they need a HL7 exchange over HTTP. Presently all HL7 interfaces are over secure Peer to peer VPN networks between providers and other interfaces. The problem though is that over the web security at hospitals is notoriously lax. I worked for a medical record company where the login to get to the server was so ridiculously unsecure it could be easily hacked if they're network firewall was breached. Maybe this isn't a issue about releasing records but a set of standards for securing health data. Even in the face of HIPPA security at hospitals is still lax.

Interoperability First, Open Source Afterward...

[ndykman]

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 things. First, a identity system that links patients at various providers. There wouldn't be one global id, it's would be set of identities tied to a provider. Think a medical OpenID, and that's a start. A ID that is tied to a provider, easy to revoke, and so on.

I think a national medical ID program would be just fine. As long as it stayed optional (you don't have to provide it, but you may need to pay upfront or provide a payment option).

The second is a continuity of care document. A interchange to track the current problem list, current medications, current allergies and list of notable procedures. You don't need everything at once, just the places to ask.

As for security, I think that patients don't mind if their doctors see their record. The system has to be useful first, and making it too secure will make it too hard to use. Also, transparency is a huge issue. You can really build trust if patients can see what is in their record and who accessed it. Health networks really need to have a page for patients to log into and see what's going on.

Also, the legal protections matter, but they have to be useful. HIPPA in its current form has many problems.

Why electronic?

[hackingbear]

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:Why electronic?

[presidenteloco]

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 search of the always-available patient history would be absolutely inexcusable, and less likely to happen.

This info, if "googly" available, would lead to better care overall.

Right now we maintain software with much better info tools, and way more care about contextual history, documentation, and procedure than we maintain people. And that's scary, because we don't maintain software very well.

Re:Why electronic?

[hackingbear]

First, 90% of patients don't need a team of doctors working together. Usually, one doctor just needs to know what other doctors have you seen recently and what illness do you have. That can be described by the patient briefly, as it is working in the rest of the world now. Again the patients (or the parents) need to learn about their illness and tell the doctor. This society is overdependent on somebody taking care of you, whereas in the rest of the world, you are expected to take care of yourself as much as possible.

Digitization won't solve the needs you described better than a folder of manila anyway, until computers can reliably recognize the cursive writings of doctors. The key of the problem has not been solved. Solving storage and transmission problems are useless. and I can bet nobody will ever bother inputting the text manually in the clinic w/o making health care even more expensive.

Re:Why electronic?

[DragonWriter]

I don't understand all these buzz about electronic health records.

The buzz is because there is evidence that using them measurably reduces avoidable medical errors.

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."

There's a lot wrong with the statement, but rather than the narrow problems, I'll point out the broad one. The roots of the problems in the US healthcare system are a lot broader than that. Inasmuch as the things you point to are accurate, they are symptoms, not roots, of the problem. OTOH, there are major legislative pushes aimed at dealing with the broader problems of access and affordability, but they don't eliminate the utility of dealing with these kind of issues, as well.

Re:Why electronic?

[presidenteloco]

Doctors' cursive writing needs to be banned, right quick. It's an embarrassment to the profession, and only they don't seem to realize it.

Data entry on a netbook would do just fine. Most people can type faster than they can write. And if you need abbreviations, a computer can assist with those too, with algorithms designed to prevent statistically likely data entry errors.

Tricks or affectations like cursive writing will have to go by the wayside. So will other similar "doctor as magician" incantations like the old trick of pretending to the patient that you know all about their disease simply because you have translated the words for their symptoms into latin, will have to go by the wayside, as information technology democratizes medical knowledge.

Existing open source PCHR

[zero1101]

Can't believe nobody has mentioned Indivo yet. http://indivohealth.org/

"Indivo is the original personally controlled health record (PCHR) system. A PCHR enables an individual to own and manage a complete, secure, digital copy of her health and wellness information. Indivo integrates health information across sites of care and over time. Indivo is free and open-source, uses open, unencumbered standards, and is actively deployed in diverse settings, in particular our own Children's Hospital Boston and the Dossia Consortium."

Re:Existing open source PCHR

[Ironica]

That's because this is entirely about EHR systems, not PHR systems.

Finally, funding for non-proprietary solutions

[Ironica]

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:Finally, funding for non-proprietary solutions

[Anonymous Coward]

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.

Ironica - check out the Resource and Patient Management System (RPMS) system from Indian Health Services. www.ihs.gov Already in use in several saftey nets (FQHC's) and it's CCHIT certified. Very cost effective.

Re:Finally, funding for non-proprietary solutions

[j303045]

Please don't call me a dittohead, but I couldn't have stated this better myself. I serve on a Safety Net panel in a medium sized city in Georgia. We are currently trying to build an HIE between the two local large hospitals, the local FQHCs, and the county Health Department. What makes us different from any other HIE in this area (don't call us a RHIO -- inside joke) is that a hospital isn't the lead dog in this effort, but rather the county health department. I'm the only rabid FOSSer on the board, and in spite of my best efforts to educate, I am still not confident that most of my colleagues even truly understand what open source is. What I do know is that all of the proposals we've received so far, with one exception, include Microsoft or Oracle in some fashion. What happened to the FOSS solution? It was eliminated in the first round of culling proposals. It was my #1 choice for many reasons, simplicity being the greatest, and I got laughed at when we compared evaluations.

On the privacy of medical records...

[yamfry]

A touch off-topic, but here is a pre-print from a JAMIA article discussing the rights a patient should have over their medical information: The Limits of Free Speech: The PHR Problem Does a patient have the right to censor or alter their record? Does a healthcare professional have the right to -know- that the record has been modified?

Would GPL code be allowed under this bill?

[karl.auerbach]

The text of the bill does not yet seem to be visible, but the Rockefeller press release suggests that open source means code that does not limit use or distribution. One could argue that GPL2/3 imposes material limitations on use and distribution and thus would not qualify under the bill.

The GPL's position under the bill may not be helped by the use of the words "free" rather than "open source" by many deep in the GPL community.

Re:Interoperability First, Open Source Afterward..

[Anonymous Coward]

That's the problem though.

FOSSies have been pushing for YEARS to have the use of FOSS mandated by law. They lose in the marketplace, they lose in the courts, so their last desperate hope at success lies in having the government force people to use it.

The FOSSies know exactly what they are doing. It's not a coincidence they are ignoring interoperability. They want a precedent set which mandates FOSS. Eventually, their goal is for the government to force everyone to use Open Office and Linux.

Stallman knows EXACTLY what he and his zealots are doing. In the future, you are going to have to g

/. Mods: Flashing Blue Lite Secial! only at +3

[rts008]

Yes, you do understand the confusion here. Or at least recognize that everyone is not using the same script/page here!
Perfect timing, right on target, and yes, the linked comic is funny!
Well done, and thanks for the laugh!

*crosses legs, and nervously looks around for a chainsaw wielding nurse*

I want the records public.

[r00t]

Doctors may sometimes lie, but random people lie very often. What do you think your date will say if you ask about diseases or hidden health problems?

I'll gladly give up my health info to the world in exchange for getting the same info about other people. Dangerous hazards, like sick people, need warnings.

This is more important than listing where sex offenders live. This is more important that listing where asbestos has been dumped. If I catch drug-resistant tuberculosis and HIV from you, I'm going to die really soon. If you're hearing voices that tell you to kill people, then I need to be careful. I certainly can't rely on you to warn me.

Your right to privacy ends where it conflicts with my right to live without getting your diseases.

notes regarding bad patients

[r00t]

The patient...

stole narcotics and syringes from our office

bounced a check

tried to rape our receptionist

is psychotic; he misreports many symptoms

fails to take his medication

"private" records kill people

[r00t]

Nobody dares to ask a potential boyfriend/girlfriend/spouse to provide all health records. It's not romantic.

Even if you did ask, you couldn't know if you got all the records.

Ommisions mean you get incurable and/or fatal diseases. Assuming you don't just die, you are less able to find somebody else without lying about your new disease.

Omissions mean that, one fine day after you've started a family, you discover that your spouse was hiding a genetic heart condition that will kill most of your kids (and spouse too) before age 40.

Re:"private" records kill people

[marco.antonio.costa]

So you would favor mandated dog tags with your latest HIV bloodwork on all nightclubs? Government enforced eugenics? Warantless wiretapping to 'save' citizens from 'terrorism'?

What an insane argument. By the same logic you could denonce the fact that thoughts are 'private', so this constitutes a danger of people planning and executing murder.

Privacy kills... Jesus...

Re:"private" records kill people

[r00t]

You're already forced to trust all sorts of troublesome people with your info. All sorts of random employees at all sorts of places are illegally looking at your info, providing it to their friends, and even selling it. We might as well toss aside all the ineffective obstructions so that we can all benefit from a fully public database.

If some stuff is embarrasing, good! Maybe it'll be an extra incentive to avoid catching that disease.

There is a pretty decent argument for mandatory testing and/or quarantine. If we did that, all communicable diseases would be gone. Think about it: GONE. All that disability, suffering, misery, pain, death... gone.

BTW, there is something to be said for non-private thoughts too. If that could work: Fraud would go away. We'd never wrongfully convict the innocent. We'd stop electing liars.

a day and a fee? for electronic records???

[r00t]

Patients should be able to have full access to all records pertaining to them on demand from any medical facility in a timely fashion (in an electronic system, within 1 business day would be charitable), and at no more cost than a nominal administration fee

That's offensive. Better: all records should be on the web within 8 hours of creation. Some *.gov website would do nicely, especially since I might forget the name of my old doctor or he might go out of business. I don't want to search 666 different places for my records!

Make it public and permanent, possibly with portions hidden by court order. Let me add a rebuttal whenever I wish.

Schemas Schemas Schemas

[Tablizer]

The most important thing is to standardize on database schemas. Converting between different schemas is one of the most trickiest parts of sharing data. If the schemas match, then it's easier for many parties, both private and public, to use, share, and transfer info. And the schemas have to be flexible, perhaps with "attribute tables" so that new info can be added without having to formally add columns.

Recent experience highlights the problem

[ctmurray]

My daughter had a stroke last week (doing find now to great care and quick action). But upon discharge they wanted follow up blood work, but she can't get to the hospital where she was treated. Another clinic in a competing health chain was closest: but they can't get at her records! She had to fill out a form and get a copy of her records and then arrange to fax them to the clinic (a kind nurse did this for us but it was not standard for this hospital to do the faxing). Then upon release she needed to adjust a drug dosage; the neurology clinic of her neurologist who treated her in this hospital did not have her records 3 days later ! A full 24 hours wasted waiting for the fax of the records. Then the neurologist went on vaction and did not leave a "backup" doctor nor a "on call" phone number. So even once the records were found another day lapsed due to her new doctor (drawing the blood and advising the change in medication) could consult with the neurology clinic about this change. Electronic records, available to anyone we designate would have helped. We seriously considered taking her back the ER to force an "on call" neurologist to show up and give us the consult on the drugs. I have great insurance, this would not have cost me anything, yet costs the system plenty. All because of "typical" behavior of hospitals, doctors, competing health clinics and faults in the system. So I am hoping this can be worked out. I do think it will save money and is a good first step toward needed changes in healthcare.

Open Source Veterinary Practice Management Softwar

[atwong]

A little off top on the topic (applies to animal health as opposed to human health) but I am the founder of VetAnyware, a startup Veterinary Business Software Solutions company. Our main goal is to enable veterinarians the ability to better manage their practice and provide better service through business software. VetAnyware's first offering is commercial services and support around OpenVPMS, an open source veterinary practice management software providing electronic health records, customer relationship management, appointment scheduling management and pharmaceutical inventory management to veterinary clinics(see more at http://vetanyware.com/products/openvpms). VetAnyware believes that by making software acquisition costs near zero and providing ubiquitous access to the practice management software through an internet browser, we can remove the largest barrier for veterinarians to adopt practice management software and an electronic animal health records system. I've been trying to get the word out about open source for animal electronic health records. If Ars or anyone else could pass this info on, it would be much appreciated (obviously Vets can just download the software code and run it themselves). Feel free to check us out at http://vetanyware.com/

Survey on Electronic Medical Records

[csibona]

Speaking of perceptions of electronic medical records - I am taking a survey on how patients perceive electronic medical records and their impact on health care. If you are interested you can take this survey here: http://www.surveymonkey.com/s.aspx?sm=RFuoAX_2fxNSTOgRt8ibHxBQ_3d_3d It takes most people less than ten minutes to take.