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Re: Medical Record Exit Strategies
by George Howell on Monday June 11, 2001 @ 08:17 PM
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Let me tell you: you are screwed. We are currently locked into one vendor, whose support is marginal at best. Despite being 'development partners', we have yet to see a DB schema, let alone any source code.
That refers to our EMR. Billing is even worse. While the former employs a fairly standard DBMS, allowing for the recreation and dumping of data, the billing system uses a kludged product from which I couldn't hope to get generic dumps without assistance from the company.
Sometimes it makes me want to cry when upper management makes decisions without input from the IT folks.
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Re: Medical Record Exit Strategies
by I. Valdes on Tuesday June 12, 2001 @ 02:44 AM
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My sympathies. I have two degrees in computer science and more experience than most people in our medical center, but most things I say get ignored unless they have the idea themselves. I hope to change that with this site. Thanks for your comments.
-- IV
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Open Source: 'Of Great Value'?
by AC on Tuesday June 12, 2001 @ 04:07 AM
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He doesn't answer his own question: "Is [Open Source] the answer?"
I say yes. Open-source software has a philosophy of transparency and open-ness. Even if the documentation isn't top-notch, it's always better than a commercial vendor with secrets to hide. Having good schema documentation is 'as open as you can get'. There is nothing more useful, except maybe a signed agreement from the company saying that they will personally fly to your site and dump the data into your new product for you.
Also, you must consider that open-source allows you to run the systems in parallel after the conversion, in case you need to refer back for any reason. Keeping a "legacy system" after conversion is expensive with an ASP or a commercial program, as you will often find yourself paying for maintenance.
I am all for an "EMR interchange standard", but I think it's unlikely to ever be perfect. You can bet that open-source will support it. In fact, open-source will probably lead the effort, since commercial companies have no incentives to create the standard. (I don't buy the argument that the market will grow with easier interchange.)
-AC
P.S. I think he is barking up the wrong tree when it comes to audit trails. There is no product on the market that can secure an EMR from a programmer. For example: Digital signatures are useless without secure key management. Secure key management goes out the window if someone on your network runs Outlook or the like.
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Re: key management
by Adrian Midgley on Thursday August 15, 2002 @ 10:53 AM
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I think (the Open Source project) GNotary which is part of Horst Herb's GNUMed project actually can adequately secure the ecords and is better than the audit trail that has been regarded as sufficient until recently.
I agree that however good the cryptography is, root or the programmer cannot rely upon proving that they could not get around it (which is actually the task we need supported by these systems), particularly when the people who must be convinced of it are unlikley to be IT experts.
Judges and lawyers however do understand conspiracy and separation of powers, and notarisation, so separating the audit from the main system and putting it in the hands of an independent organisation or several makes a good defence.
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Re: Medical Record Exit Strategies
by jeff on Thursday June 14, 2001 @ 06:44 PM
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| The EMRi project (http://emri.sourceforge.net/) is something aimed at the kind of interoperability that the author was referring to. We've been working with XML-based records to start, but hopefully we'll be moving to other record types in the near future.
(Actually, it came out of the need to be able to exchange documents between open-source medical healthcare EMRs without the bloaty overhead of CORBA. So in a way, at least in this case, open-source software may hold the answer.)
- Jeff -
(Head Project Coder, FreeMED)
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Re: Medical Record Exit Strategies
by Ross C baldwin on Thursday July 19, 2001 @ 04:29 PM
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The answear for that is FreePM .com
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