OpenEMR v5.0.1(openhealthnews.com) |
OpenEMR v5.0.1(openhealthnews.com) |
Be a force for good in the developing world !
-Matthew (OpenEMR Admin)
As a clinician, I find Epic to be horribly clunky - it definitely detracts from time with patients and impairs collaboration among clinicians by 'hiding' important details in multiple sections/submenus. It's like a Frankenstein's monster of Windows 3.1 and Atari 2600 Basic.
As a researcher, the very restrictive agreements that Epic insists upon have a profound impact on our ability to a) make good use of health records data for research and b) develop extensions to Epic, for things like decision support and risk stratification. (In the latter case, they essentially 'own' anything that touches their code.)
BUT - like the old saying goes, no one ever got fired for buying IBM.
Moral of the story: Hooray for OpenEMR, VistA, and all the open platforms! This round was lost to Epic, but hopefully the next round we can do better.
(edit: - academic medical centers in the US. Rest of world, you can do better!)
1. Have the data you need
2. Charge a huge premium for integration
3. Don't like giving up their data
4. Always have their slight twist on message format
Of course, your points are valid though! That is the state of the "behind the scenes" side of things :).
EDIT: Just saw your edit and your correct assessment of the need for a great UI (we have gaps, but a good team working on it).
I stumbled across OpenEMR a few months ago (as I was cursing Epic and praying for a better open source option) and must say that I’m impressed with the speed of progress. I’m certainly not a developer but I am a physician—if you need any more volunteers from medical personnel, I would be more than happy to help.
We are better off for you!!!
In general, I think that EMRs try to cram as much information onto the screen as possible, without enough thought toward what pieces of information are useful at particular times. It's like the opposite of the experience that I have on a well-designed website. Most of my complaints are around that phenomenon, as well as all of the unnecessary clicking / scrolling required due to poor design. I also think that the cost of implementing / migrating these systems is insane, especially when that just adds to our already overpriced health care system. It's hard not to think that companies that build EMRs prefer to be as closed and proprietary as possible, to prevent an easy switch to a competitor.
A few things that I do like in Epic and think are generally good features in EMRs: -lots of shortcut keys -saved phrases (I think they're called "smart phrases" or some nonsense like that) -single click connectivity into clinical resource websites and some hospital portals -modern browser support (I seriously used to use an EMR that could only be accessed on an old version of Internet Explorer -- "just make sure you don't let the computer update the browser") -eprescribing
My favorite EMR of the 10 or so that I've used was at the VA. (I've heard, though not verified, that that EMR was licensable for almost no cost outside of the VA, but was ignored in favor of "nicer" systems.) I don't know if it is the same now, but it was extremely simple in appearance with some basic fields for writing notes, an image viewer, a quick way to order and review labs, etc. Looked almost like a terminal. Copy/paste functionality. Most importantly, because it was used at every VA in the country, I was able to easily review records/labs/images from, for example, a 65 yr old veteran who had just moved from across the country. No faxes, no scanning. It is this sort of uniform system for data access that we are missing right now in medicine in the US and it is wasting time, costing us a lot of money, and damaging patient care.
I would not expect the commenter to have had an experience outside a hospital affiliated clinic if they work as an AMB provider.
Users control the backup routine. Our AWS packages make it seamless, however.
The thing is, healthcare has so many variables it's hard to know what is relevant and useful at any one time. It's not a static website where the designer knows the exact content. The best solution has been to make sure it's all available to the physicians and nurses that can then decide what is relevant. It becomes a trade off of what to hide behind more mouse clicks or to cram into a small window. Now that data analytics are advancing, the system can be designed to show the most relevant stuff, but obviously it takes work to write that system and ensure it's trustworthy for being used for healthcare.
>The VistA system is highly rated by physicians, receiving the highest overall score in Medscape surveys of over 15,000 physicians in 2014 and again in 2016, receiving particularly high marks for connectivity and utility as a clinical tool. https://en.wikipedia.org/wiki/VistA
and available free open source http://worldvista.org/AboutVistA/copy2_of_index_html
but hospitals instead spend hundreds of millions on Epic and Cerner who I presume have fancy sales teams to push those to hospital managers.
I am not sure when you last interacted with Epic but it has come a very long way in the last 8 years in the realm of personalization, macros, mobile access, and alerting (you can subscribe to results and be notified on your phone or watch when it returns as one example).
My goal with the providers I work with is to provide minimum scrolling, limited clicks, and easy ordering, all while being as workflow agnostic as possible through personalization of the user experience.
As to the need for faxing and scanning, the VA benefits from being completely uniform and, frankly, socialized in its data. The non governmental hospital system consists of millions of data sinks (data centers, file rooms, etc) and all of them are owned and controlled by different entities. The fact that even the level of data that can be requested and accessed instantly between health care providers exists as it does today is impressive.
I'd love for you to take a look at what we've got going on -- the day might come when we're a good fit for somebody's clinic.