NOSH ChartingSystem

A new open source health charting system for doctors.

The Ten Commandments

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I recently came across this in a Sermo posting and although I vaguely remembered the history behind it, it was refreshing to see what health IT leaders back in the 1970’s imagined what health IT would be in the future.  So sad that health IT right now has broken all of these commandments…

Dr. Octo Barnett’s [Harvard] health IT Ten Commandments, 1970: 
1. Thou shall know what you want to do
2. Thou shall construct modular systems – given chaotic nature of hospitals
3. Thou shall build a computer system that can evolve in a graceful fashion
4. Thou shall build a system that allows easy and rapid programming development and modification
5. Thou shall build a system that has consistently rapid response time and is easy for the non-computernik to use
6. Thou shall have duplicate hardware systems
7. Thou shall build and implement your system in a joint effort with real users in a real situation with real problems
8. Thou shall be concerned with realities of the cost and projected benefit of the computer system
9. Innovation in computer technology is not enough; there must be a commitment to the potentials of radical change in other aspects of healthcare delivery, particularly those having to do with organization and manpower utilization
10. Be optimistic about the future, supportive of good work that is being done, passionate in your commitment, but always guided by a fundamental skepticism.

I think these commandments are laudable and relevant for us, even in 2012.  Unfortunately, current health IT broke the first commandment in the 1990’s and never recovered.   The first commercial EHR’s at that time began to be designed for productivity in purely economic terms and the schism between economics and medicine became apparent.  Those “EHRs” were designed from a database and a user interface standpoint to be optimized for a business administrator and a billing person.   But what was truly missing was how the information gets entered and the one individual that enters the most is the physician.  That’s why back then, most clinics just had a “practice management system” – what I term as a castrated EHR, where billing and diagnosis codes are entered but the clinics still had a paper chart for the doctors because back then no one knew or cared how a doctor “operated”.   Then, someone decided that to make a full fledged EHR, they just have to add a feature for entering doctors notes onto an existing practice management system.  When that idea became mainstream, this is what we have – a multitude of EHRs that function as a practice management system and the doctor’s notes are an afterthought.  Is there any reason why doctors feel neglected and frustrated with the systems that are out there?  On top of that, commandments #5 and #7 are a complete joke to most systems out there.

When I saw these commandments, I began to realize that maybe all my frustrations before I made my EHR were coming from a true inner conflict.  It was reassuring to me that I thought much the same way that Dr. Octo Barnett did back in 1970 (it sure was a long time ago, these commandment are even older than me, and I feel old!).  In my next few posts, I’ll go over each commandment and discuss what NOSH ChartingSystem will address for each one so that we can find our path back to redemption in this health IT wasteland.

BTW, the live demo link has been fixed!


Author: shihjay

I am a family physician and previous medical director for a child abuse assessment center. I am now promoting my new electronic health record system (NOSH ChartingSystem) that I have developed and used for myself in my private practice since 2010 and now I want to share it to the rest of the doctoring world.

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