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Comment by duffpkg | Hacker News Reader

Excluding mexico where a ClearHealth derivative still, as far as I know, powers one of the large hospital chains there, no. In my personal experience the venn diagram of countries where there is not much regulation but yet it is advanced enough medically that EMR is a primary problem is pretty much zero. To put it another way most countries where regulation is low have much more pressing medical needs than software.

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That's clearly true from talking to several foreigners I know who do medical work in developing countries.

Yet it also seems like there is a lane for a simple piece of software to do basic record keeping. For example, I wrote the app (https://github.com/russnewcomer/SeventyTwo) for my friend to solve the problem (somewhat specific to the culture they work in) where they don't have a clinic site or really the ability to make appointments but instead travel to homes or communities to do their work, and they have to cart around all their binders full of records. My simple app works for their use case, but this also feels like a spot where there are more opportunities to help.

Anyway, I definitely support open source EMR efforts, wherever they may lead, and I thank and applaud you for your service!

In hacking healthcare I talk about "the incredible bandwidth of paper". That's still true. Without really first world software and hardware in a very modern physical setting it is difficult if not impossible to solve medical problems better than pen and paper can. In the practice of medicine pen and paper are really adequate tools to deliver quality care. It is in the business of medicine where large scale data necessitates and benefits from electronification.

Thanks for that perspective. Helps me understand why their use case ( my friend talked about multiple nurses needing to have about 20in of records organized in binders and then coordinate between the nurses in case Nurse A saw someone in Place 1 but then Nurse B saw them in Place 2 a month later...) is helped by the computerization (along with the record keeping they needed to provide for grants/funding), but people working clinical settings that I've talked to are not really interested...

I 100% agree and am going to start using your "the incredible bandwidth of paper" quote (awesome!).

Even in the first world, I want an EMR system that treats paper as a first class medium, and it's easily doable.

Hi could you please elaborate on how this would work?

There have been several attempts at treating paper as first class - scanning reports, using a digital pen etc. But none of these solutions is convenient. How would you interface paper with software?

My hypothesis—and I could be wrong—is that via innovations around 2-D programming languages, you could invent languages that are natural for casual users to write with pen and paper, that are identical to what a programmer would type.

You'd never get a casual user to write {"weight": 145} on paper, but you could teach them to write:

    weight 145

And then it is really quite easy to write DSLs that parse things like that in a type checked way. Or, to put it another way, instead of trying to teach people JSON, why not teach programmers something new?

One thing we picked up on quickly when talking to doctors and nurses in the field is that most of them come up with their own short-hand dialects for scribbling notes (for later data entry, sometimes). Why not make it easy to scan these microDSLs as is, and even define them formally and cheaply, at the last mile that then compile into a more common tongue for ingestion into bigger EMRs? Epic I guess has something somewhat along those lines, but not taken to the extreme.

I'm not convinced that we can try to enforce any sort of format on blank paper for doctors. They fill templates also in weird and unexpected ways. They will write info out of order, in different orientations, outside the margins, etc.

I would be interested in discussing this in more detail. Let me know if I can mail you.

It's a good point. From what we learned each one had their own style, but the key thing was they all had a consistent style. If they are weird but consistently weird, should be okay. And we added things like anyfix to handle out of order.

Sure anytime. email is in profile.

And yet there is a need for software. I'm supporting a clinic in Asia that is using OpenEMR for records. The government is requiring reporting of diagnoses by category. This is exactly the sort of paperwork that an EMR system should be able to solve well. Since we haven't figured out how to do this with OpenEMR, the staff is doing it by hand. I hope to solve this problem soon, whether by figuring out how OpenEMR supports this or by adding this functionality.

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