NOSH ChartingSystem

A new open source health charting system for doctors.


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Hope springs eternal?

Found this quote from Dr. Farzad Mostashari, M.D., M.S. (head of the Office of the National Coordinator for Health IT)  when interviewed by the AAFP and I found it very intriguing…

Q: You talk to physicians all the time about health IT. Are doctors happy with their EHRs? What major concerns continue to surface in those conversations?

A: The National Center for Health Statistics did a rigorous survey of office-based physicians in America and got a 68 percent response rate. Of those responders, about 15 percent said they were dissatisfied with their EHRs. I think that number may grow, because as we expand beyond the early adopters, the expectations for usable and intuitive technology are higher. I sure hope that the EHR vendors are hearing the same levels of dissatisfaction from their customers and their prospective customers that I’m hearing. I hope vendors are focusing on user-centered design in the next iterations of their software instead of adding more bells and whistles.

Call my cynical, but I doubt that will change, especially from the large vendor EHR’s.  There is no incentive for these EHR’s to focus efforts on user-centered design in the perspective of a physician because…the physicians are NOT who they are catering to!   If Dr. Mostashari believes this will change any time soon(or ever), I hope he hopes harder than I do.  If this is what was being promised when the HITECH Act and Meaningful Use was developed (through crony capitalism, no less), imagine the disarray of highly unusable, and highly suspect data generators that will be left around the Health IT environment in the near future.  It ain’t going to be pretty.


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My Generation

OK, this is a self-indulgent post, just to preface. Over the past few weeks, I’ve been working with several clients and I’m happy to announce the release of NOSH ChartingSystem 1.6.7 which has the ability inventory supplements in addition to vaccines, an especially important tool in the small doctor office. There’s some continued improvements in the user interface and bug fixes thanks to the updates in JQuery UI and the other plugins that NOSH relies on to make it all work.

I’ve also been busy in the past month working on my video for my crowdsourcing campaign. I initially applied to Kickstarter but despite my appeals to the contrary, they absolutely refuse to release a campaign that is even remotely health care related (even though my project doesn’t give medical therapy or promise health benefits and the like…). I’ll post the completed video once I’m given the OK on a different crowdsourcing platform, which I hope to hear about soon.

So here’s the self indulgent part…I’ve been having various conversations with experts and participants in the health IT field and I get this disconcerting feeling that they view my project as having no future.  They feel that the EHR market has “moved on” so to speak and the iron branding has been done with the blessing of the HITECH Act and Meaningful Use.  The future now, some say, is how to harness this data generated by these EHRs while at the same time, increasing consolidation of health care towards large corporate entities that micromanage outcomes with patients coupled with the promise of increasing healthcare dollars.  With my technological and health care expertise, some say, I ought to move towards this direction rather than messing around with open source software and EHRs in particular.  The war has been won and decided, so move on, they say.

On one hand, I can see what they are trying to say.  Many years of being in the health IT field can lead one to believe that the direction has been spelled out and all signs seem to point “that way”.  And those that have the clout, reputation, and power in the health IT marketplace right now have every reason to hold on that belief as that was what was thought to be the direction, circa 1990…  To them, the HITECH act was an achievement towards that very aim.

As with any new start up, especially for an open source software product, times can get lean and tough.  And its not a sure bet that it will reap rewards and benefits right away.  And its very tempting, having the knowledge about health IT technologies, programming, and primary care medicine, that I could be making more money doing something else that is in compliance with the existing direction.

But then I thought, I don’t think I would be happy doing that…because it is at odds with my belief system…the ideas of cooperation, equality, fairness, person engagement, and mutual competition.   Of course nothing is perfect, and no society matches the ideals that I have, or anybody for that matter.  Furthermore, to me, money is not the ends that justifies the means.  I want to be a productive member of and provide meaningful value to society.  I’m grateful that I do live in the United States where people are allowed to take risks and to test alternative hypotheses.  And perhaps living in Portlandia, I’m even more exposed to the idea that it is OK to do the alternative and I love it.

In happenstance, I see the protesters in Turkey today, many of whom are of my generation…the Generation X’ers and Millennials…that are saying “No!” to the direction that their country is going.  As of the time, they are living to the ideals of Ghandi’s nonviolent civil disobedience, the only real and effective tool for society change, absent money and power.   And I see Edward Snowden, risking his life and livelihood to expose and asking the relevant questions involving privacy and national security.  And this is what my generation is all about and it resonates with me.  Perhaps we have a different idea of our future world that we live in and that includes how we care for each other, ourselves, and our future generations.

And so, I remain steadfast in my belief that we ought to protect and enhance our primary care providers, encourage individuality rather than consolidate and corporatize it.  Instead of individual, smaller practice doctors that are lamenting their future, they can practice medicine with increased engagement with their patients which in turn encourage healthy behaviors.  There is an alternative and some of my generational cohorts are living, breathing, and practicing these alternatives (co-ops, open source software development, locally harvested food distribution, energy conservation, are just some examples) with the hope that they will be able to change their future world, in their own small way.  I pity those that moan and watch as a spectator seeing their world change before them and not be an agent of change even if the winds are blowing the other way.  Unfortunately, some doctors have done exactly that and we’re now seeing outcomes that bring more misery, worry, and pain to our profession.  I choose not to remain on the sidelines.  I choose to fight and remain passionate for the direction of health care that aims for equal access, reasonable cost, focus on prevention, and increased provisions for services that help those that experience trauma in their lives, especially for children.  I choose to fight for bringing electronic health data ownership back to the doctor and patient through open source standards and software, to further improve our health care system.

Lastly, I choose to fight even though the winds are seemingly blowing the other way.  Because, like the wind, the direction can change at any time by the contributions of seemingly small individuals who step up to the plate and take their stand, like the jagged peaks of mountains and rivers changing our weather patterns.  It’s just natural.