NOSH ChartingSystem

A new open source health charting system for doctors.

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What makes the GUI for NOSH so special?

If you just read the title of this blog, for some people, it sounds like I’m talking about the chewing consistency of snack food!  Although I love to talk about yummy food, GUI actually stands for Graphical User Interface.  Some have been asking me, what makes the GUI so special in this electronic health record that I made?

Well, most doctors I know generally do not like their current EHR because the GUI looks like it got pulled from the 1970’s and it looks like  a spreadsheet.  You have to click on hidden windows and buttons and what could have been a simple flick of the hand when you open a paper chart, is a series of pre-learned steps to get just one piece of information (like finding out a medication allergy).

If you check out my live demonstration, you can see that I don’t really need to give someone a tutorial about how to get the information that you need as a doctor.  If you know how to use Gmail, Yahoo Mail, Hotmail, or any other web-based mail program, you pretty much know how to get what you need in a flash.  Here are some examples of the intuitive nature of this GUI…

  • Type a few letters in the Search Patient bar that is at the top of the page (where it’s clearly visible) and the  system automatically gives you a list of patients without clicking an extra button to search.  This is everywhere in NOSH ChartingSystem where a doctor usually types in something to search for, like a medication name, diagnosis code, supplement, procedure code.  When you get the list, it doesn’t obliterate the page you’re at and switch you to a different page, you’re still right where you are.
  • Hover your mouse over Demographics, Medications, Issues, or Allergies and instantly, you get a snapshot of the information seek.  No button clicking and you get to see it anywhere you have the chart open, whether you’re typing in a telephone encounter or an office visit.
  • The main patient chart is simple and uncluttered, yet informative at the same time.  It just looks peaceful (most doctors I know need it in the hustle and bustle of work!).

Although talking about the GUI may seem mundane to some people, it is the number one reason doctors hate EHR’s (if you are in the doctor’s forum Sermo, there’s a lot of complaining out there!).  Out of frustration of all the other EHR’s I’ve used, which made me cringe every day, I became my own harshest critic when I made my system from scratch.  My testing bed was my own practice, and I continued to refine it over time until I knew I got it right…until it just made sense.

I believe an EHR should be built for physicians not for system or health administrators (full disclosure…I am a physician…obviously),.  I always got a feeling that EHR’s were designed for someone else in mind and the doctors were not even consulted in understanding how a doctor thinks or works when they treat a patient.  I want to change that for good…  Like what I’ve mentioned in my About page, the greatest compliment for me is that NOSH ChartingSystem will have made doctors free do do what they do best, treating patients.


To certify or not to certify, that is the question…

As I’m planning the rollout stage of my project to interested developers and physicians, I am pondering the implications of certification for the NOSH ChartingSystem.   As a background, an electronic health record system has to be certified by one of 5 Authorized Testing and Certification Bodies approved by the Office of the National Coordinator for Health Information Technology (ONC-ATCB) so that a user (physician, practice, or hospital) of the system can claim for monetary incentives from Medicare or Medicaid when the system has demonstrated “meaningful use”.

These ONC-ATCB’s (the largest being CCHIT) ask for pretty hefty fees to test your system to get the certification, ranging between $20,000-$40,000.  Furthermore, as I understand it, the certification applies to the specific version of the software only, so if you have continued updates and modifications, you’ll have to re-certify your product.  No wonder most EMRs cost so much to the doctor – the costs likely get passed down to the doctor for the certification.

Furthermore, based on the HITECH Act that was passed in 2009, physicians who see Medicare patients and who do not use a certified EMR by 2015 will see a gradual reduction in payments (1% per year) as a penalty for not using a certified EMR.

In my own personal experience as a solo family doc, I used an EMR ever since I began my practice in 2004.  Unfortunately, I had a version of an EMR that was not certified and I wasn’t able to upgrade due to the significant increased cost for a certified product (being a primary care physician).   Looking at all the core standards that attest to meaningful use, my practice and system met all the standards, but I would not be able to claim incentives due to my EMR being uncertified.  Knowing that I was going to see reduced payments (with already reduced payments across the board from Medicare and insurance companies by not keeping up with inflation), I felt that the system was somehow rigged against me even though I “did the best thing” with electronic health records.

CCHIT then came out with a separate program (called the EACH program) for people with “legacy” systems that did not qualify for certification but if all the technology that was used in the entity met “meaningful use”, then they could alternatively certify the system.  Unfortunately, I got a heart attack with the price tag of “gasp!” $40,000 (that was more than 50% of my income!!!).

And so, regrettably to my patients, I opted-out of Medicare as I saw no light at the end of the tunnel.  (More about that at my other blog).  So now that I have my electronic health record system waiting in the wings, an open-sourced product with the aim of being low-cost to the physician, does it even make any sense to be certified?  Is the risk of Medicare payment reductions worth it for physicians wanting to use a low-cost system?  I also think (but I can’t confirm) that most physicians would rather buy a certified product just because it is.   But if an uncertified product was incredibly intuitive to use and that it would actually help their productivity so that they can spend more quality time with their patients and improve outcomes, would it offset the risk?

At this stage in the game, I obviously cannot afford to certify my product.   Even if I could afford to certify it one time (I was thinking of Kickstarting my project for the aim of certification), the whole concept of this type of certification is antithesis to the open-source way (updates, modifications, improvements, low cost).  But I think if there was a growing community of doctors along with like-minded computer programmers and developers who stand in solidarity against this rigged game and somehow these rules were reversed through political means or by sheer mass protest, I’m all for it!

What are your thoughts?



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Countdown commencing…

The live demonstration site was down and out intermittently over the past few weeks due to server configuration issues.  However, all kinks have been worked out and it’s running again!  Just a reminder that no patient information should be saved in the demo and periodically, data will be cleared and reset from the database.  Thanks again for your patience as my work is being completed on NOSH.  Sometime this month, NOSH will be ready to go for doctors and clinics to get started.

New information regarding services and consultations to implement and customize your NOSH system will be coming shortly.  Meanwhile, check this out…