Comment by toomuchtodo | Hacker News Reader

Comment by toomuchtodo | Hacker News Reader

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> I wish more FAANG-calibre devs would look into contributing to and evangelizing these platforms rather than writing yet another note-taking/"productivity management" app.

I would like to see the US Digital Service continue to task technologists with improving EMR systems at CMS (Centers for Medicare and Medicaid Services), but made free to use by all practitioners and citizens (and of course, open sourcing the resulting codebase). It seems sort of inefficient we keep reinventing the wheel (Epic and the like, which are crazy expensive, or self hosted solutions, when practitioners should not be spending time maintaining EMRs), when your records should be stored for your benefit by your government over the course of your life. This is where, imho, high calibre engineers provide the most leverage (one way ratchets on public goods at scale).

[1] https://www.usds.gov/resources/USDS-Impact-Report-2020.pdf

[2] https://www.va.gov/health-care/get-medical-records/

The VA sort-of does this, at least when I worked for them. The issue they had when I was there was depending on where you went, you may or may not have access to the record, because the VA didn't use a central system, it used many systems across the country, each with their own records(basically their own mainframe). We once added a hospital to our system, and had to have dual workstations because the systems couldn't be easily merged, and they had to look up patients in both systems.

Also, with Veterans Choice, I don't know how much there was an effort to bring this data back. Same thing with the DoD, for a while there was an agreement to send medical records for active duty to the VA, but then that got pulled for a time.

I believe there was a huge undertaking to consolidate these to fewer systems in the last few years, but Vista[0] (the VA's EMR) is pretty scary. I wouldn't wish it on anyone.

https://en.wikipedia.org/wiki/VistA

The VA has something called BlueButton that looks really cool (https://www.va.gov/bluebutton/) and I think should be standard practice across all EMS systems (one click export of all a patient's data to a single text file).

The file format itself seems like a bit tough to parse, but the concept I love.

Blue Button technically is an industry-wide standard though its origins were indeed in the government. I've seen it supported in a couple of the private healthcare systems I've used (though I haven't ever used the resulting data download unfortunately!).

https://en.wikipedia.org/wiki/Blue_Button

There's a pretty good library that helps parse those bluebutton documents:

https://github.com/amida-tech/blue-button

> Vista[0] (the VA's EMR) is pretty scary. I wouldn't wish it on anyone.

why do you say that? From a doctor's perspective, Vista is one of the more user friendly EMRs.

The US government has a public domain EMR system which they are in the process of replacing with a commercial system.

https://news.ycombinator.com/item?id=25042125

TIL that the new system is Cerner. That's depressing. Thanks.

EDIT: Still a win I suppose if it improves care delivery over the status quo. Nice to know there's still some progress on this front [1] [2]. Looks like I owe OpenEMR a financial contribution.

[1] https://news.ycombinator.com/item?id=25040076

[2] https://playbook.cio.gov/#play13 (Digital services playbook: Default to open)

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