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=

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

[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

[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

[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.

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.

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.

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.

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

[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.

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.

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...

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: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.