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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.'"
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.
Curiosity was framed, Ignorance killed the cat.
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.
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.
Why not RTFA?
FTFA: The Health Information Technology Public Utility Act of 2009 will build upon the successful use of "open source" electronic health records by the Department of Veterans Affairs as well as the "open source exchange model," which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.
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.
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.
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.
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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.
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.
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.
Don't you wish your girlfriend was a geek like me?
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.
Don't you wish your girlfriend was a geek like me?
You know Brazil already has been doing this fro quite some time and their system is open sourced - by them.
Actually, Smidge is a medical doctor.
Doctors can't treat themselves, you know.
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.
Where are we going and why are we in a handbasket?