
Ask HN: Anyone interested in starting a modern, open-source EHR software? - PierredeFermat
I know there are already few similar projects out there but they all seem to be lacking in almost every aspect.
This would be the Gitlab&#x2F;Mattermost of EHR&#x2F;PHR.<p>Would love to know your thoughts&#x2F;suggestions.
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salawat
Welcome to requirements and data model hell.

Which target audience did you have in mind?

Primarily Doctor/Nurse/Practitioner centric?

Primarily Administrative (Practice-as-a-whole) centric?

Insurance centric/integrated with insurance systems/standards?

The trickiest part about it all that I've found, is that at the end of the
day, practitioners tend to only need a few pages or so worth of notes, but
most modern, proprietary alternatives tend to morph into gigantic, data
vacuums actually intended for somebody's (generally an insurance company's)
data analytics department.

Which don't get me wrong; I realize that was the point behind EHR; greater
interoperability and communicability of health records between disparate
systems.

For most proprietary offerings, I believe the value is that your vendor whips
up and manages the data model and infrastructure for you (or offers a
reasonable template); and will typically integrate some sort of rules engine
because why not.

To be honest though, I'd absolutely love to figure out how to implement a
suite of tools to make EHR easy for practitioners, plus maybe an application
with sufficient and accessible enough documentation so that a sufficiently
savvy practitioner would be able to out of the box basically have a good
digital SOAP note-book, and could overtime build up the data they want to
track in a logical, but user (not necessarily developer friendly) manner.

Basically, something as accessible as making a .dot template for printing out,
or filling out blank SOAP notes forms for entry in a binder, but also having
enough back-end where if need be, that data can have ETL's cobbled together
for migration. Plus all the HIPAA goodness.

Unfortunately; I don't know as the market would see much uptake in the U.S.
since the insurance industry kind of wags the rest of the medical industry's
data collection practices due to how tightly integrated/dependent the
healthcare industry is with the health insurance industry.

The centralization increases visibility of a lot of problems; however,
everyone pays the price with requirements implication chain becoming longer
than the amount of wire between you and the insurer.

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PierredeFermat
Thanks for the thorough comment!

It's definitely a hefty undertaking and that's why I was keen to know what HN
thinks. Is there anyway we can get in touch (i.e. Email)?

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salawat
Feel free to drop me a line at sal.aw4t At gmail dot com.

I'm in the process of recovering some orphaned personal projects at the
moment, but I'd be happy to try to aid in requirements gathering, and
architecting for testabilty.

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MCSQLDev
Having worked on various sides of EHR, HIPAA is the biggest barrier. Every
organization I've worked in had a compliance officer both on the client and
customer side for this reason alone.

Even if you succeed in making past this barrier, the next barrier is finding
clients as many are not willing to chance it on a new platform given unless
they're a new practice themselves but often they want an organization that's
already established. Though, given the overall satisfaction I've seen, it's
ripe for the taking.

HIPAA and government regulatory compliance is the ghost that will next stop
haunting you. That's why the business logic layer of so many applications is
so obfuscated and runs extremely deep. Government compliance comes in waves of
quarters with the first of the year being the biggest where everything has to
be in place with a huge risk if there's a failure.

Though, it also goes without saying that healthcare IT is one of the largest
targets. So there's that.

If your exit strategy is to get bought out, you're in luck as many of the big
players readily consume any upcomers to maintain their death grip on the
industry. They have virtually limitless capital to make it happen.

Despite having said this, it would be something worth contributing towards.

~~~
PierredeFermat
Is it possible to reach out to you by email?

