[PLUG] OpenEMR, doctors, and "chickens"

Keith Lofstrom keithl at kl-ic.com
Fri May 13 18:29:47 UTC 2011


The lead volunteer coordinator of the OpenEMR medical records
software ( http://oemr.org ) is Tony McCormick, who lives in
Tigard.  There are other open source medical records packages,
most notably WorldVista (not the so-called OpenVista, which
is proprietary!) but OpenEMR appears to be the most complete,
has the most certifications ($$$!) and the most likely to
integrate with clinical practice and future requirements.

In the Portland area, most doctors are getting absorbed
into Providence, Legacy, Kaiser, or big practices such as
Portland Clinic and Cascade.  Most of these are moving to the
proprietary EPIC software.  Although this is allegedly fully
interchangable with HL7 data interchange standards, folks
here are familiar with the effects of "embrace and extend".

There are about 300 small/individual practices left in Oregon;
at the rate things are going, there will be none in 5 years.
The small general practitioners are being squeezed out, partly
because of predatory pricing for EPIC (it can be upwards of
$20K/seat/year).  It is not quite so bad in most parts of
the country, but for some oddball reason, the insurance and 
medicare reimbursements are lower here than elsewhere.

Practice margins are slim, and for some doctors take-home
is less than 15% of clinic revenue.  That's why the visits
are expensive, short, and delayed - 12 patients/day rather
than 14, and you go bankrupt.  When the squeeze gets too
high, doctors retire early, or retool for other trades. 
I know one MD who is working as a software tech writer.
She says the hours and pay are better.

There are stories from the 1930's depression about patients
paying doctors with chickens and garden produce.  Obviously,
that will not work with big clinic industrialized medicine.  
However, there still might be a niche for that in Portland's
"weird" open source culture.  Coding, customization, and
adapting to EPIC "embrace and extend" shenanigans, in return
for visits to the doctor?  I don't know whether such a thing
is practical or even legal, but it might be both lifesaving
and fun if we can figure out a way.

OpenEMR is a web app based on php, with a mysql back end.  Lots
of room for customization to individual practices (which are
often idiosyncratic, patient and not business standards driven).

Further, being open and web based, OpenEMR may be compatable
with new kinds of patient interfaces, new kinds of apps, etc. 
Two examples might be bicycle exercise management (perhaps
connecting to apps for safe routes and air pollution) and
allergy exposure management ( which parts of town have the
fewest or most allergenic plants?).  A healthy EMR system could
be part of a large fabric of life-management applications,
supporting a lot of new software startups in Portland.

Let's not just be weird, let's get rich exporting weird!

If some of you might be interested in participating, perhaps
we can pull Tony away from his code and his family for a 
presentation to PLUG.  I don't think he has time to perform
in front of non-participating looky-loos.

Keith

-- 
Keith Lofstrom          keithl at keithl.com         Voice (503)-520-1993
KLIC --- Keith Lofstrom Integrated Circuits --- "Your Ideas in Silicon"
Design Contracting in Bipolar and CMOS - Analog, Digital, and Scan ICs



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