OpenEMR: Open-source medical record software

I was the main contributor and maintainer to OpenEMR about ~20 years ago and then decided it was irredeemable and started over with ClearHealth/HealthCloud. Shockingly some of my code code lives on (from PHP 3). I am reluctant to say don't use it but if you do please don't expose it to anything public, which sadly happens most of the time. There are some real problems that exist in that code base from a security and HIPAA perspective.

Related:

Open EMR - https://news.ycombinator.com/item?id=25141287 - Nov 2020 (127 comments)

OpenEMR v5.0.1 - https://news.ycombinator.com/item?id=16949974 - April 2018 (37 comments)

OpenEMR is Accepting Donations on OpenCollective - https://news.ycombinator.com/item?id=15951191 - Dec 2017 (43 comments)

OpenEMR: Electronic Medical Records and Medical Practice Management Software - https://news.ycombinator.com/item?id=13888893 - March 2017 (203 comments)

Ask HN: Anyone interested in working on an OpenEMR modernization project (OSS)? - https://news.ycombinator.com/item?id=13807371 - March 2017 (4 comments)

I worked in EMR company and the amount of monthly legislative changes was insane. Insurance companies always changed their data formats every month. I think they did it because if hospital's monthly export contained some error they could hold their money for couple days more.

So anyway when our country switched to euro, the deadline came and the insurance company still didn't publish format for the new month. They were too busy with the euro switch that they didn't have time to mess with the export format. Few hours later they published new format. They just switched orders of 2 columns.

But back to churn. Month old EMR is useless. Forget about working 2 years on something, publishing it on GitHub and calling it a day. In a small 250k town we needed 7 full-time programmers and 5 servicemen to keep it going. Patient arrives at v7.13.148 and leaves two weeks later at v7.15.203 and you need to keep their data in some kind of consistent way.

Doctor here, I hate EMRs, they are oppressive, in many ways they make things worse for patients. I think the future of EMR is no EMR.

An LLM that takes multimodal input (audio, video, images, observations etc etc) and outputs whatever is required (a podcast summary of clinic patients, a checklist relevant to a patient’s condition in preop) is the future.

Forcing doctors, nurses and allied health to manually document everything they do in annoying web forms is stupid and soul destroying.

Multimodal LLMs will also replace much of medicine and nursing which is good.

There has been decent traction for Frappe Health (GPL) in Kenya. Not spending on expensive contracts and losing valuable forex is a big driver.

Here is a talk by Dr Mwogi on implementing at one of Kenya’s largest public hospitals https://youtu.be/yL6akPy2X5c?si=4UzUSJYm3PjxA3hL

Ok. However.

If I'm running a hospital, I want my record software to be developed and maintained by a company that can pay its developers.

The place for openness, vendor neutrality and transparency are protocols and file formats, which define how different software communicate.

OpenEMR seems like it could have a market opportunity, in principle. The EMR market in the US is dominated by two big, unpopular systems (Cerner and Epic). A smaller, nimbler competitor could make inroads among health systems that don't like that duopoly.

Does anyone have any stories about setting up / using OpenEMR?

I think nowadays OpenEHR [0] is the most credible option for a FOSS EMR/EHR solution. In my understanding (not 100% sure) in Sweden OpenEHR is obligatory for hospitals.

[0] https://openehr.org/

I want to love this, as someone who has dealt with multiple EMRs as an engineer, and as a provider...

but no EMR is going to gain traction with documentation that has five bullet points for its backup discussion.

Even the linked "back up using our tools" is just "tar things up and run mysqldump".

There's no discussion of how to handle and maintain this on a system that may be available 24/7. It's possible to do these things, certainly, but no credence or weight is paid to the real world concerns of how often you should be backing up, state management, intelligent restoration. It's as much about the business continuity aspect as it is the technical.

I know basking projects based on their choice of language is controversial, but PHP really is pushing it for me. And for medical data, too. PHP isn't boring technology - Java is boring technology - PHP is downright dangerous.

A friend of mine running a subscription service to obesity drugs used OpenEMR and it was far too complex for them. They just hired two NYC engineers and they moved to SF and built them a sufficiently capable EMR system. I was asked to inspect the code. It's perfectly fine. My impression is that the software is very capable but is not a good tool to bootstrap from.

There's a saying in hospital tech sales: if you've seen one hospital's stack, you've seen one stack.

The sheer amount of bespoke deployments and lack of interoperability in these facilities would blow the average HN reader's mind. And through the inertia of these deployments and their (absolutely necessary) adherence to HIPAA and SoC, getting any kind of competitor in, much less one with the lack of support resources like an open source project, is nearly impossible.

I do believe in the mission of these guys, though! I just think EMR is so complex and entrenched that they don't have much hope of success, at least not the way most OSS does in the SaaS world

Their demo seems incomplete. I see what looks like a test patient (I hope), but I can't enter a lab order as a physician because there is no list of tests (cbc, lytes, etc).

That said, I hope they have more luck than OSCAR did.