[PLUG-TALK] Open EMR opportunities

Keith Lofstrom keithl at kl-ic.com
Thu Aug 19 08:38:18 PDT 2010

This is a copy of a posting to the Personal Telco mailing list.
The discussion probably belongs here.

On Wed, Aug 18, 2010 at 11:59 PM, steve tree wrote:
> This week's cover story in the Willamette Week is "The Geek Cure".

On Thu, Aug 19, 2010 at 07:08:13AM -0700, Patrick J. Timlick wrote:
> Online: http://wweek.com/editorial/3641/14401/

As Tony McCormick of mi-squared points out in the comments to the
WW article, Oregon does indeed have an open Electronic Medical
Records project, openemr, which Tony's company is helping to
develop.  The software is advancing rapidly.  Openemr is deployed
in Texas and North Carolina, and random places around the world. 
Email Tony and ask him how you can help (there is a steep
learning curve, don't expect to be spoon fed by this busy fellow).

Openemr is not being deployed (enough) in Oregon.  Part of the
problem is that the software is only partially fleshed out. 
It is best for urgent care, only partly developed for clinical, 
hospital, and alternative medical practice.  With some study of
medical practices and doctor/clinic interaction by broad-minded
software designers and coders, that could improve, rapidly.

Most programmers are Really Good at scratching their own itch, but
lousy at system design, listening to customers, and scratching the
itches of others.  Especially scratching the itches of doctors,
who "live in a different place" than us.  Indeed, the main limit
on the uptake of EMR systems is that programmers attempt to
automate a process that is very emotional, person-centered, and
intuitive.  They attempt to make clinicians and patients behave
more like machines.  Which misses the point entirely.

Your doctor's main task is to coax you to change your harmful
habits and live healthy.  Most patients' motivations are to
ignore the needs of their bodies, eat the crap advertised on
TV, and get a cheap pill from the doctor that fixes everything. 
Maximizing the efficiency of the medical repair process is
laudible, but it may not help doctors and patients move towards
healthier living.  It is like replacing strong system security
with better file repair tools.

Health care is like changing your car's oil.  Medical care is 
like tow trucks.  If you depended on tow trucks to get around,
what would your cost-per-mile be?  If we depend on doctors to
haul us around after avoidable medical disasters, what will
our cost-per-patient be?  Skyrocketing.  Well, guess what ...

Attitude adjustments are difficult to automate.  However,
person-centered apps like Facebook or Twitter are so popular
it is scary.  There is nothing inherent in software itself
that makes "obsessively usable" EMR software impossible,
although the goals of roboticized interaction and universal
knowledge representation may need to be abandoned in the
short term.  Can you imagine a forms-based checkbox Twitter,
and how extremely pointless it would be?

Ask your doctor.  Indeed, see if you can schedule some off-
the-clock time with your doctor to look at your own chart,
and have her explain the thinking that goes into what gets
recorded.  Don't waste time criticising how they do things
now, just absorb the charting process and realize that it
is individualized, an aid to the physician's work flow,
and the result of a century of development.  Maybe (just
maybe) you have the broadness of mind to find a new way
to help your doctor help her patients.  Including you. 

Perhaps you can trade code for medical care if you are
financially challenged right now.  Hint, so is your doctor,
who can't afford MedicaLogic at $10K/seat-year, when many
patients can't afford to pay their bills.

Or perhaps you will develop the next Facebook.


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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