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Senate Bill Calls For Open Source Electronic Health Records

Posted by ScuttleMonkey on from the wider-adoption-can-only-help dept.

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.'"

37 of 170 comments (clear)

  1. Hurray for Google Health! by Smidge207 · · Score: 2, Insightful

    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=

    --
    Is it just my observation, or is eldavojohn an idiot?
  2. Test it with the military first by HasselhoffThePaladin · · Score: 5, Insightful

    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.

    1. Re:Test it with the military first by Smidge207 · · Score: 5, Interesting

      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=

      --
      Is it just my observation, or is eldavojohn an idiot?
    2. Re:Test it with the military first by DragonWriter · · Score: 5, Informative

      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.

    3. Re:Test it with the military first by DragonWriter · · Score: 2, Insightful

      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.

    4. Re:Test it with the military first by DragonWriter · · Score: 4, Interesting

      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.

    5. Re:Test it with the military first by sexconker · · Score: 2, Informative

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

    6. Re:Test it with the military first by winwar · · Score: 2, Insightful

      "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.

    7. Re:Test it with the military first by amabbi · · Score: 2, Insightful

      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.

  3. I don't see this happening any time soon by tg2k · · Score: 2, Insightful

    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.

    1. Re:I don't see this happening any time soon by profplump · · Score: 4, Informative

      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.

    2. Re:I don't see this happening any time soon by Ironica · · Score: 2, Informative

      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?
  4. Good place to start by orclevegam · · Score: 5, Informative

    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.
    1. Re:Good place to start by VoidEngineer · · Score: 2, Informative

      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.

  5. A person should own their health record by presidenteloco · · Score: 4, Insightful

    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.

    --

    Where are we going and why are we in a handbasket?
    1. Re:A person should own their health record by characterZer0 · · Score: 4, Interesting

      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.

      --
      Go green: turn off your refrigerator.
  6. Why open Source not open Standard? by mdf356 · · Score: 5, Insightful

    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.

    --
    Terrorist, bomb, al Qaeda, nuclear, yellowcake, kill, assassinate. Carnivore is dead... long live Echelon.
    1. Re:Why open Source not open Standard? by DoofusOfDeath · · Score: 3, Funny

      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!

    2. Re:Why open Source not open Standard? by elBart0 · · Score: 3, Informative

      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.

      --
      09 F9 11 02 9D 74 E3 5B D8 41 56 C5 63 56 88 C0
  7. Doomed to fail... by charlieo88 · · Score: 2, Funny

    as Microsoft just announced Doctor's Office 2009.

    1. Re:Doomed to fail... by rackserverdeals · · Score: 4, Funny

      as Microsoft just announced Doctor's Office 2009.

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

      --
      Dual Opteron < $600
  8. Re:How can an EHR be built on open source? by thepainguy · · Score: 2, Funny

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

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

  9. RTFA by DragonWriter · · Score: 5, Informative

    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.

  10. Dodging the bullet by marco.antonio.costa · · Score: 2, Interesting

    Your medical records should be PRIVATE.

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

    --
    Send your spendthrift head of state this
  11. Why I don't want this by BigHungryJoe · · Score: 2, Insightful

    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.

    1. Re:Why I don't want this by ClosedSource · · Score: 4, Interesting

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

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

    2. Re:Why I don't want this by DragonWriter · · Score: 2, Insightful

      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.

  12. Current State of Medical Records by mc1138 · · Score: 4, Interesting

    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.

    --
    The musings of just another geek and his junk.
  13. Re:How can an EHR be built on open source? by DragonWriter · · Score: 2, Informative

    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.

  14. Free data format is far more important by davidwr · · Score: 2, Insightful

    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.

    --
    Knowledge is how to play a game, intelligence is how to win, wisdom is knowing what game to play.
  15. Contact Your Senator! by gQuigs · · Score: 2, Interesting

    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

  16. Re:I've got a dollar... by DragonWriter · · Score: 2, Informative

    ...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.

  17. Call for Standards, not Open Source by spotchka · · Score: 3, Insightful

    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...

  18. Why electronic? by hackingbear · · Score: 2, Insightful

    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?

    1. Re:Why electronic? by presidenteloco · · Score: 2, Informative

      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?
  19. Re:How can an EHR be built on open source? by Ironica · · Score: 2, Insightful

    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.

    --
    Don't you wish your girlfriend was a geek like me?
  20. Finally, funding for non-proprietary solutions by Ironica · · Score: 2, Informative

    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?