OpenEMR is Ridiculous
March 18th, 2008
Having “open” electronic medical records (EMR) is absolutely ridiculous.
ReadWriteWeb believes that we should be able to control and transfer medical records personally. However, this is felt impossible because health care is “controlled by big business and government.” Furthermore, they state that “decentralizing this network and giving the power for each American to control their own medical record could ensure higher reliability, less poor diagnoses, and can handle scale.”
Wrong. Wrong. Wrong.
Yes, our current medical record system needs to change. As a practicing physician, I frequently see test duplication and delays in diagnosis due to our current closed system. Doctors at one hospital will likely not get results from other hospitals in a reasonable amount of time. Even if a physician knows to request the records, often the physician may not know specifically what to request. Worse yet, these records are usually faxes from one hospital to another.
With these problems, the brainstem reflex is to let each person control his or her own medical history. Let me, the patient, control who and what accesses my medical records. It is romantic. It is crazy and flawed.
Actually, if the patient was always YOU, then an open EMR might work. You are probably not crazy. You probably do not abuse the system, drugs, or your body. But you are the same person who actually accurately keeps up with medical history now. Any medical record system works well for you.
Let me a take common ICU admission for you. Young lady found down unresponsive and barely breathing. Maybe by searching her house or testing her urine we can estimate that she has overdosed. Maybe she has been in the hospital before and we know that she has been depressed or has a history of overdose. Maybe she also has a rare disease like adrenal insufficiency that can be fatal if not also concurrently treated.
Assume that we fix this lady up and forward her medical records to her EMR carrier of choice. If it is truly open, she can forward it to anyone. Perhaps she forwards it to a “lockbox” carrier who promises to keep it hidden from other systems. Her physicians will never know about her suicide attempt or her potentially life threating illness. Perhaps she forwards it to a “edit” carrier who promises to sanitize or grossly edit the medical record for her. She pays a little extra so her medical record will now show that she has a crippling pain syndrome and requires narcotic pain medications.
Open is open. An open medical record system is an untrustworthy medical record system. Now, I agree that people should have the ability to view and make comments about their personal medical records. Doctors and tests are not perfect, and a patient should have the right to make his/her opinions known.
Luckily, this is not complicated. Just get the EMR companies to come together a establish a universal document standard and communication API. The government would host and secure the common database that would store all the information. Patients could log in and make comments to clarify the record, but information could not be removed or edited.
Medical records are as essential as legal records. Should legal records be open too? Frequently life and death decisions are based upon these documents. A truly open EMR system allows for manipulation and abuse. A universal medical records system will save money and lives. It is vital and essential to insure that the record is inclusive and precise. In this circumstance, being “open” is not the solution.
I will be glad to detail and debate further issues in the comments below.
Technorati Tags: emr, open emr, electronic medical records
March 19th, 2008 at 12:29 am
[…] tests are not perfect, and a patient should have the right to make his/her opinions known.” Article Davak, See One, Do One, Teach One, 18 March […]
March 19th, 2008 at 7:12 am
I said many of the same things a little while ago.
The very idea that health records should be open for the public to manipulate is absurd. These are the same people who take double their blood pressure medication just because they feel like it. After all, if one is good, two is better, right?
Just a terrible idea.
March 19th, 2008 at 10:09 am
Hey I completely agree about the absurdity of open EMR’s… I also wanted to let you know your RSS link is not working. I was hoping to subscribe but no luck yet. I look forward to hearing more from you.
All the best.
March 19th, 2008 at 11:33 am
@RJS Thanks for the comment. I’m glad to have your article linked here.
@Bo Sorry for the feed problems. The RSS link seems to be working now… and validates.
March 19th, 2008 at 11:48 am
It should be noted that this idea has nothing whatsoever to do with the prominent open source EMR project OpenEMR. oemr.org
OpenEMR the project does not compares to OpenID and has nothing to do with patients in full control of their own records.
-FT
March 20th, 2008 at 4:18 am
@Fred Trotter
Thanks for pointing that out. Unfortunate clash of names…
March 21st, 2008 at 10:31 pm
Yours is a point of view, but let me tell you there are others.
There are lots of benefits for the patients having theirs personal health records available all the time, you must understand that:
- World is bigger than a country (and sometimes is good to travel around the world). And things could happened to you when you are traveling.
- Cross checking and share experiences between users in communities will be possible. Even you could get a diagnostic for free if there is a doctor willing to help to honor the Hippocratic oath.
The personal Health records will probably not replace the proprietary HIS… but hopefully could get some info when both talk the same language (hl7 based).
To understand Open EMR, first step is open your mind.
March 22nd, 2008 at 9:46 pm
I am family physician, and have developed a Personal Heatlh Service online: http://www.keyose.com/
The reason is my concerns about big companies missing the point. Most of the leaders of that projects are not doctors (nor patients).
I agree with you: a open clinical record has not sense at all.
BUT… what it has sense is a PERSONAL HEALTH RECORD (PHR). In keyose, we do not want to remove the EMR. We see our PHR as an aditional source of information (and a very useful one).
It is curious how I saw the same limitations for keyose that you have pointed out here. You can read, for example the “FAQ” in our website:
http://www.keyose.com/help/#q10
“What if the patients lie about their data?
Patients don’t usually lie about their condition. However, Keyose is a “personal health record”, so it cannot be seen as a certified medical document. The truthfulness of the data stored in Keyose is equal to the truthfulness of the patient, or the truthfulness of a medical report given by the patient (that can also be made up).
Doctor can trust Keyose data at the same extent at which they can trust their patients. Keyose cannot be used as evidence in court (since it is not a certified medical document).”
My second concern was privacy. And we have solved it by building the first totally ANONYMOUS PHR.
In keyose we use to say: “Confessors and prostitutes do not ask your name.. so why do we?”
May 3rd, 2008 at 9:37 am
As a practicing physician, you should attempt to know of what you speak!
OpenEMR is a free software package for electronic medical records and practice management that is entirely housed within the private offices of a physician. It has the potential to replace terribly expensive commercial software packages with a quality, very low cost alternative. No access by the outside world is allowed to your patient’s data unless you provide for it.
The concept of an “open medical record” is something entirely different. Check your work!