NOSH ChartingSystem

A new open source health charting system for doctors.


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EHR Misery Loves Company

It seems like there’s been news after news of bad, certified, EHR implementations and experiences lately.  Is this what Meaningful Use was supposed to be about?  It’s as if the chickens have come home to roost. 

In her post (http://getbetterhealth.com/more-unintended-consequences-of-digital-data-how-an-emr-gave-my-patient-syphilis/2013.08.22), Dr. Val Jones speaks about her experiences as a locum tenens and working at various different hospitals, with most of them with seemingly horrendous EHR implementations.  One of her examples is when a hospital has to use medical transcriptionists in India to input data back into the EHR and physicians having to proofread them.   The other is an example of a hospital IT department taking up whole wing of a hospital that manages the EHR to keep it from crashing daily (!!!) and sending frequent public announcements to warn staff of a pending crash (!!!!!!).  Sounds like a skit straight out of Monty Python.

In a different article, Sutter Health in California had a EHR blackout when their Epic system went down in “epic” fashion, rendering it useless for nearly 8 hours in some facilities.  (http://ehrintelligence.com/2013/08/28/sutter-clinicians-deal-with-unplanned-downtime-with-epic-ehr/).

And more data for ransom news…physicians at Milwaukie Health Services in Wisconsin were unable to access their patient data when their contract with their EHR vendor ended.  And to top it off, this vendor requested $300,000 from them to get their data back. (http://www.jsonline.com/business/community-health-center-battles-for-patients-records-b9957634z1-216291331.html)

But seriously, this is crazy stuff when there is already fairly good “mission-critical” setups in the non-medical world (ie financial, consumer goods transactions).  What is going on here?   Is health IT really that incompetent?

I get why physicians want to go back to the good old days of paper and pens and trash the digital data.   The amount of money spent by our tax dollars to fund these expensive and out-dated (and possibly unsafe) EHR’s to medical professionals should anger both patients and physicians.  And to whose benefit?

The truth is, digital data is going the be the future.  We are in the age of smartphones, tablets, and the Internet.  Technology in every sector of our lives is advancing exponentially and it isn’t going to stop.  Medicine is already far behind the curve on this one and it needs to catch up.  But the critical point, that I’ve made before, is who should be in charge of the data?  Who should have the absolute say in the way data should be entered so that we get quality data that helps our patients, and not  the pockets of administrators, insurance companies, and EHR vendors?  Physicians had been effectively left out of the loop when it comes to EHR design and safety considerations., and now we see the result of these costly decisions.  If we (patients and physicians) tell our Congress to take the toxic financial incentives away and allow physicians to embrace digital in an organic and non-punitive fashion, we can hopefully make that transition without leaving casualties such as the examples I’ve highlighted above. 

Don’t forget…please spread the word about my Indiegogo campaign at http://www.indiegogo.com/projects/nosh-chartingsystem-a-new-open-source-medical-record.  Let’s make a start to overthrow the era of bad EHR’s.  It starts here and now.

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3 Big Myths – An excerpt from my Indiegogo Campaign

I’m very excited to share that today is the day my Indiegogo crowd funding campaign begins.  
 
Below is an excerpt from my Indiegogo campaign:
 

Before going into more about my project, I’d like to debunk 3 big myths regarding the state of the U.S. health care system and health care information technology, because everyone has a role to play to make a difference to making things better.
 
Myth #1:  Most health care providers use an electronic health record system for documenting their encounters and are easily shared to other health care providers for my medical care.
 
Fact:  As of 2012, there’s a 50% chance you’ll come across a health care provider who is still using a paper chart.  That’s pretty bad, considering most other industries (finance, technology, hospitality) have already moved on.   Even worse, even if a health care provider is using an electronic health record system, most systems do not reliably “talk” to each other…even among systems that are the same!   Even though legisltation was passed in 2009 to increase adoption of electronic systems, the costs are so prohibitive, especially to independent practices and primary care physicians, that a good percentage have chosen not to adopt one.
 
Myth #2: Health care providers make a reasonable amount of money…they ought to be able to transition to electronic health record systems without difficulty.
 
Fact:  There is a wide spectrum of reimbursement rates between various health care providers.  Currently, we have a health care system that values more on procedures and specialist care than on primary and preventative care.  Generally, those that value spending more time with their patients are in independent practices, especially in primary care settings, because the only way for a hospital or group practice to survive when reimbursement rates are so low (compared to overhead) is to increase the number of patients seen which equals less time with patients.  It is this same group (independent practices) that is also struggling with acquiring a proprietary electronic health record system, because they are so expensive to purchase and maintain.  I know this from experience because I was an independent solo physician myself.  Furthermore, most of these expensive systems are poorly designed and not intuitive to use.  When you couple high cost with the unknown impacts to workflow and safety due to a poor interface, it is no wonder that health care providers are skeptical about the benefits of electronic health record systems.
 
Myth #3:  Giving physicians a nice, low cost electronic health record is nice…but it doesn’t affect me at all. 
 
Fact:  It is fact (unless you’ve been living under a rock) that health care costs in the United States are stratospherically high(compared to other industrialized nations) and are unsustainable for our economy.  There are multiple factors that I believe contribute to this (but for brevity sake, I’d like to refer you to Stephen Brill’s excellent article in Time Magazine, “A Bitter Pill” here).  However, one of the biggest elephants in the room is the misguided concept that health care dollars and resources are infinite, when in fact, the delivery systems for health care are structurally finite.  This is what I call the “money pit” mentality of health care dollars.  It is essentially a “black hole” that sucks and drags down anything that goes near it or when we even talk about health care.  We throw more and more money at procedures and health care related technologies with minimal regard for cost effectiveness and its impacts on the quality of life for the individual and society.  Conversely, we are not as effective at directing resources at prevention where cost savings have been demonstrated to work (in other countries’ health care systems, for example).  And this mentality goes for electronic health record systems too.  Why does it need to cost an arm and a leg for health care providers, when it is just a tool (like pen and paper) to help them help care for their patients?  Ultimately the high cost of buying and using a proprietary, closed system will be passed down to you, the patient (even doctors are patients too!).  So yes, this health care cost problem, including the exorbitant costs of electronic health record systems, does affect us all.  Therefore, this open source project (where physicians and patients have a say) is a small attempt to say “No!” to the temptation that we live in this health care “money pit” and change the dialog of how we can work together to improve access to quality health care for everyone without throwing our economy down the tubes.
 
So with these myths uncovered and explained, I’d like to introduce to you my open source electronic health record system, the New Open Source Health (NOSH) ChartingSystem.

So, come see and support my Indiegogo campaign by visiting http://www.indiegogo.com/projects/nosh-chartingsystem-a-new-open-source-medical-record.  Tell your friends, colleagues, peers, and your family members.  Because even though NOSH is a electronic health record that appeals to medical providers of all spectrums, it has significant implications and ramifications for patients.  That is why this is such an important issue and one important step for medical providers to take back their data, allowing them to practice optimally for their patients, and saying “No!” to the health care money pit.