There was a guy on reddit a few years ago who started a dental practice with entirely open-source software and his own EHR system. Really interesting stuff, don't think anyone's posted about it here. Can't view his reddit history but he must still be using it, last commit 1 week ago.
Surprisingly it had 100 comments but no open source questions iirc so that was a bit of surprise from what I could check.
Also Offtopic or not but its sad that you can't use reddit because you are in UK but just for the sake since I want you to see the comment, I perma-linked it and uploaded it to wayback-machine/archive.org and here's the link so that you can view what I wrote
I am going to archive the whole reddit page later for you to read as well
Hope this helps OP and maybe I will keep the archive updated for few days or give ya updates if that's something you are interested in I suppose I am not sure, just like many other things in my life.
No, but just put something like rl.bloat.cat instead of reddit.com. That'll direct to an alternative community maintained interface for Reddit that will work.
I know that alternative frontends for reddit were a huge thing which I used to use before the api fiasco
There are still some alternatives but most of them now scrape or have extreme rate limiting from what I know.
They use redlib but If I remember correctly that's similar to libreddit but patched to work without api but still, its a very finnicky solution.
Like these solutions can work but I think at that point, just use a VPN but oh boy reddit detects those VPN's from what I know.
WOW UK censorship law is really something huh, can people living in the UK somehow vote to repeal that or something?
I was thinking on the scary part of as to what if many countries can seemingly connect together these pieces to genuinely have internet authoritarianism and what if they have such eggregious fees or just even a threat of it, have a little mixture of getting sanctioned if you try to move around it but damn, this is so weird, if they really want, they can genuinely escalate this more and more to block VPN's and more and more to effectively soft-lock a person from the internet. This needs to stop. Right now. Otherwise I am scared if what if multiple countries come together to stop something like tor nodes by somehow putting them in such a law. Once tor stops, all hell can break loose on the internet, its certainlypossible, I never expected this but the only thing stopping UK censorship might be hopefully their incompetence of maybe not removing VPN's or this goose chase or just the fact that this is the beginning, not the end. They are testing how much they can get away with which is increasing a lot... This really made me pessimistic actually.
The only hope is that such websites can spring up more quickly than UK can take them down but what if UK sets a dangerous precedent by suing them, its definitely possible to track them down by the UK govt.
They say on their blog that https://bloat.cat/blog/updates-may-25/ that Redlib is the most resource-hungry service. The traffic figures run into terabytes a month
Some % of these could be for bypassing the UK as well
though I suppose that not even govt. can catch them,their Opsec is genuinely really good, they use monero for the servers and etc., its fascinating to see their Opsec be so secure.
Edit: I got so curious and found out that they run some servers on senko.digital which is in fact UK based but they won't still get much (I hope) because senko.digital supports monero so their opsec is secure but if they had slipped up, it wouldn't have been hard to see them being framed as they get terabytes of data and some % of data can help loop around UK censorship evil laws and they could've tried to frame him and senko being a UK company, it isn't hard to follow that they would've complied. But they use monero and I am sure that they use a vpn as well but it was certainly fun reading their Opsec and I think that its sort of perfect, I need to learn more from it actually.
So I guess its still possible to run websites without incurring the hefty fine in UK but its certainly very hard / borderline impossible and I just hope that this UK thing / similar things in other countries doesn't get any further and gets banned/repealed otherwise the internet might die.
Edit 2: maybe I gave them too much credit since either its saying Reddit is blocking redlib as always... when I try to click on any username or it just gives a flat out nginx 502 bad error... I really gave them too much credit but it was fun learning something about opsec.
It means you can't view people's reddit profiles in the UK.
( Yes, seriously. )
Many many profiles are tagged NSFW, its' not clear why, I can't imagine the majority of those have done so deliberately, perhaps it's automatic for anyone who's posted any NSFW posts ever. ( Which includes people doing so to be funny such as someone posting a huge loss in a sports sub as NSFW. )
Recently Reddit also made it possible to private your post and comment history, which I found a surprising number of people already do too (default for new accounts maybe?), so this is about to become a very worldwide experience anyhow :)
I've been seeing a lot of profiles have their post history invisible, and thought it was a bug. I tried to search for whether or not this was possible and couldn't find it. I'm elated to hear that this is a thing, as it protects my privacy. Just enabled it (:
Only thing, shame you can only set these things in new Reddit.
Being able to inspect post and comment history allowed for finding people who are absentmindedly lying, or are otherwise intentionally and persistently abusive. I believe this was the whole original motivation about such a history being available, even.
On the flipside, it does lessen the potency of various avenues of abuse. Some people would get harassed and stalked thanks to this history feature for example, and it trivialized targeted information extraction too. It also allowed for petty censorship, i.e. some subs would auto-ban people who commented in various other subs.
One might also criticize it for being a minor bandaid over a gaping hole. Your username and user avatar you still carry across subs and are not autogenerated. This means that with sufficiently wide scraping, your posts are still perfectly correlatable, collectable, and subscribeable. Within subs, the same applies to your user flair. This has benefits, i.e. it allows you to block users who you identify as inherently malicious, but it also means that all the aforementioned benefits apply only in limited ways.
Trust requires the sharing of information, privacy requires the obfuscation of information - and so I think these concerns run contrary to each other, resulting in the many solutions of the world not committing fully to either, as they are extreme and unrealistic positions in isolation. Difficult world.
Heath centers pay unreal amounts of money for these kinds of commercial products, but in my experience the health centers themselves have very few technical resources. So the real "value" being delivered by the commercial software providers is often the setup, support, and hand-holding provided to customers who pay the crazy amounts.
I imagine there will be a niche but high-paid market integrating these GNUHealth products with existing commercial systems, and ongoing opportunities in supporting health centers using the software with planning, upgrades, and lots of phone & email support.
I'd love it if my government created a civil reserve for technology workers. Let me volunteer every weekend to help fix infrastructure so I don't have to give up my existing job.
If it was a volunteer effort without ulterior motives, it would be beneficial to society, but ultimately who is on call? Who pushes for hard, but beneficial changes that might not have immediate obvious value? Who accepts risk or responsibility.
Ultimately that’s the point of the market. Incentivize people to take risks for rewards. Allow others to improve on proven models for lower costs. Unfortunately, government does not have any risk/reward or other market pressures.
It's pretty common for traditional organised volunteer services to have "on call" aspects.
Think of like volunteer firefighters, The Samaritans, St John Ambulance, the UK lifeguards and lifeboats (RNLI). Such organisations do usually have full time paid staff too, but the bulk of the front line work is part time volunteer.
In the US, the Veteran's Administration wrote their own EHR (Vista) which was released as public domain. They've been trying (and mostly failing) to migrate to a commercial EHR for the last seven or eight years.
VistA has some great functionality and end users generally like it, but unfortunately the underlying platform and developer tooling is hopelessly outdated. It's approaching a technical dead end and there's no practical way to keep it moving forward unless someone steps forward with the funding and resources for a major refactoring / rewrite engineering effort.
No, MUMPS (or M) is a remote descendant of JOSS, an interactive language of the 1950s. JOSS has all sorts of variants (DEC's FOCAL language of the 1960s was a dialect), but I think MUMPS is the only living one. MUMPS code is mostly unreadable, as the commands can be, and often are, abbreviated to the first letter. As a result, it looks a lot like line noise.
Regardless of its many warts, Cobol cannot be accused of being unreadable. Verbose, yes.
MUMPS was originally developed in the 1960s for use on minicomputers that had maybe 64KB RAM. At the time it was a lot more important to keep code size small, hence the single letter commands. Readability wasn't a concern then but it sure looks like a mess today.
I wonder what would happen if EU harmonized the legislation so that the EU states could go together and develop an OSS journaling system. The amount of money saved would be astronomical.
Spending money is what drives the economy. No diverse expensive healthcare software means thousands of employees don't get paid and don't spend earned money within the economy.
Seems like a wonderful win/win opportunity to have the software be FOSS but enable small businesses to provide hosting/support/customization.
The biggest win of all is if we had an open/extensible/maintainable data exchange format so that we could eliminate the need for paperwork. How many times must we fill out the same information, and then require the providers to keyboard it in?
There are in fact multiple data exchange formats published by standards development organizations including HL7 (V2 Messaging, CDA, FHIR), DirectTrust, NCPDP, DICOM, and X12. Some such as HL7 and DirectTrust are very open, others may require a paid licensing agreement. Usage of some of those standards is mandated by CMS interoperability regulations and/or ASTP (ONC) Health IT Certification requirements.
Beyond the wire formats, in order to eliminate the need for paperwork provider organizations also have to participate in data exchange networks. These include TEFCA, Carequality, eHealth Exchange, and some smaller regional HIEs. It all works fairly well when used correctly but many provider organizations continue to waste administrative effort and abuse their patients by failing to take advantage of the available technology. Like in many cases the necessary functionality is already built in to their EHR/PMS software but they simply don't turn it on or train their users.
You are perhaps thinking of the HITECH Act of 2009? The Obama administration didn't directly fund any open-source healthcare software. There were billions in federal grant funding available to provider organizations to purchase EHR software that met certification criteria for a certain level of interoperability and clinical functionality. This really accelerated the growth of commercial EHR vendors like Epic, as well as some smaller vendors that used FOSS within their offerings.
I don't work in healthcare but I do use their services and every intake interaction is the same paperwork dance, so it doesn't seem to have impacted providers themselves.
There's another element that needs address as well, which is the controlled dissemination of one's medical history. It should be easy peasy technology wise, with the only blockers being political/entrenched players sabotaging it.
No… hospitals use EHR to maximize billing. That is the value.
Private practices are generally shrinking in number, so there IS NO EHR that is growing in the long term to serve them, so there CANNOT BE a trend where hospitals are exceptional, their IT buying trends are the NORM and their purpose is to code for billing. It is NOT about having or not having IT resources strictly speaking.
Typing in ALL CAPS does not make your argument stronger, this isn't Truth Social.
> hospitals use EHR to maximize billing
As a person who has worked extensively with hospitals and CHCs helping them integrate technology, this is false.
EHR is being used because it's required - both by payors and regulation/law. I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
I dunno, QuadraMed that was used by at least NYC H&H for years before their imperiled transition to Epic prominently displayed “Revenue Cycle Management” on the splash screen of its decrepit provider facing frontend.
Both of you are overstating your cases. That said, it’s hard to overstate how heavily charge capture and billing are prioritized to the detriment of other aspects.
> I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
There were major EHR deployments in the 80s through early 00s, before most government mandates. Surely later mandates were an incentive This reflects a lack of tenure.
> EHR is being used because it's required - both by payors and regulation/law. I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
Your argument fails in cases where hospitals switch from bespoke EHRs to use one large EHR that has better revenue features. This is quite trivially discovered if one follows the news of large hospital chains who have moved to Epic recently.
> This is quite trivially discovered if one follows the news of large hospital chains who have moved to Epic recently.
Epic is one of the few providers who can meet a larger organization's overall needs
The competitors, like eClinicalWorks, are a shadow in comparison
No doubt companies increase revenue with more efficient capture of services, costs, labor factors, etc, but I've actually been in the room with people from Epic and have heard the sales presentation. I'm betting I have a decent grasp on both what they're selling and what the buyers are asking for.
Revenue cycle issues are important but not the only factor. It's simply no longer economically feasible for provider organizations to maintain bespoke EHRs. The costs have gone up too much. They can't afford to pay developers to build and maintain all of the functionality now required due to federal interoperability rules compliance and escalating user expectations.
The problem open-source, and social media, and everything digital, has never overcome is accountability. Who do I sue, and who has insurance, if something goes wrong?
Combine that with most small businesses having more money than time (just pay Gmail, don’t spend the required amount of time to self host), and open-source is stuck at being hobbyists if there is no corporate sponsorship.
> Who do I sue, and who has insurance, if something goes wrong?
You sue the Red Hat-like support company with whom you ostensibly signed a contract.
If your question is who does the Red Hat-like support company sue if they want accountability for the code they are leveraging, I guess I don't understand the question or its relevance. E.g., with regard to proprietary code, who does Microsoft microsoft when Microsoft microsofts Microsoft? (Fun to write, but I don't think that sentence really makes sense.)
Do you think a small mom-and-pop dentist can win a lawsuit against Google?
There's absolutely no way that dentist will have a well-negotiated contract with SLA's and damage compensation with Google. The extent of their business relationship is that the dentist clicked a checkbox and put in their credit card details. Google does not even know they exist.
If Gmail loses all your email and accidentally kills your entire business, the absolute best outcome is a refund of your $10/month business subscription fee. The idea that they could in any way be held responsible is ludicrous.
> just pay Gmail, don’t spend the required amount of time to self host
Are you seriously suggesting a business put their contacts in the hands of Google, who has reportedly been totally capricious with account actions in the past and is notoriously difficult to contact when problems arise?
> and open-source is stuck at being hobbyists if there is no corporate sponsorship
Corpo sponsorship required for success? I guess I better tell all the open-source projects being used by millions that they're just hobbyists now.
> The problem [...] everything digital [...] Who do I sue, and who has insurance, if something goes wrong?
I have heard of analog world nostalgia, but you refer to the pre-digital age as if you didn't live through it. It's easier to locate someone today than ever before.
This implies corporate sponsorship is a requirement for, as opposed to result of, a projects usefulness. That has not been the case for most valuable open source software.
GNU? Depending on how you want to treat FSF and PSF, gcc, emacs, python (are FSF/PSF/Apache corporations? Does PSF’s donations from corporations make python corporate sponsored?)
OBS and Audacity (until recently) are two off the top of my head. Plus a lot of Linux components are run solely by a couple people, and those are run my millions of programmers.
You're being downvoted but yes, this is about risk mitigation. The IT department at a health care organization has to balance matching the requirements of payers, admins and clinical staff, do so in a way that fits inside the allocated budget, and de-risk the unknowns as much as possible.
Even if the vendors are only half accurate about the solution they offer, by being paid suppliers, they are on the hook (to varying degrees). These systems are highly customized and serious headaches arise from interoperability and security. If some of that can be shifted to a vendor, it's a net positive insofar as the IT department and the compliance departments are concerned.
Some healthcare organization have invested in the technology side and become leaders in innovation but those are the exception.
The person implementing the system for the hospital is accountable. I don’t see why this is difficult because it would be the same if that person built their own product from scratch.
There’s no vendor here that they can sue if they were paying for a product and deploying that, but that’s a different situation and the hospital, frankly, won’t care about that. Who their supplier subsequently sues isn’t their problem.
Also, quite frankly, whatever fancy contract you have and whatever legal system is backing it up, if the system you're using fails, it's your problem. You can't actually shuffle around all consequences freely.
I see this so often where people pay huge amounts of money (either buying a more expensive system or buying vs building) because 'we need the support!' and then still wind up with a bad system because the quality of the product modulated by the support offered still creates problems, and being able to blame someone else doesn't actually make the problems go away.
And even in cases where the problem is 'we might get sued', the fact that you have someone else to sue is to a large extent multiplying problems because you now have two lawsuits.
This isn't a problem with open source. For many of us with startups that have low stakes (worst we can do is have no users) a lack of support is fine, we can do it ourselves and save the money.
And there's plenty of consultancies which will support OSS and give you support if you need it and be your scapegoat. Red Hat, Suse, IBM come to mind and there's many others...
You sue the developers. It’s how it works in general. So basically you’d comb the commit history for the project and name everyone in the lawsuit that you could.
It's possible that some FOSS developers have been hit with nuisance lawsuits but in general they have no contractual relationship with the users and thus no liability under US law.
> The easiest way to get MyGNUHealth is by installing the package from your favorite operating system / distribution. Many operating system distributions already ship MyGNUHealth.
I was actually curious to try this out on my phone, since they claim to support mobile devices.
If running a command-line package manager is the easiest way to install this on Android, I don't want to know what harder ways exist.
I find this is quite typical for open source projects. The community still hasn't really, truly adopted mobile. I guess it's because of the need to have some sort of entity be present in the various App Stores? But if it's possible for servers, why is this so rare to have open source projects as app store vendors?
> I guess it's because of the need to have some sort of entity be present in the various App Stores?
This, and the fees, and dealing with weird App stores' rules. On Android, we had F-Droid - an alternative store where one didn't need to deal with this. And as has been reported recently, Google is making changes that will essentially kill F-Droid.
The reason there's not much good open source stuff on phones compared to PCs is because the hardware is hostile to it. The few phones out there that aren't are the ones almost no one uses.
You seem to be living in the past. While EHRs are still primarily used from desktop PCs, all of the major ones have native mobile apps now. Clinicians appreciate being able to review patient charts and action alerts while away from a PC cart.
You're really missing the point. The EHR vendors aren't charging customers for those apps through the Apple or Google app stores so "broken economics" are irrelevant. The app stores are only a distribution mechanism and work fine for that.
Nice to see support for Open source. I have seen selling of healthcare data, including medicare and medicaid data to private companies which sliced and diced it and sold to academic and drug research institutions via data marts. ETL jobs would run for months. The data included prescriptions, scans, visits, employee plans etc, for about ~200 millions of American patients. It is anonymized data, but still I always wondered why this was allowed.
HHS publishes clear guidelines for de-identifying healthcare data (PHI). Once it has been properly de-identified (anonymized) it is no longer subject to any special controls. I am aware that some researchers have claimed that it could be theoretically possible to re-identify certain records but so far no one has been able to do so in practice so concerns seem to be overblown.
As for Medicare, only a very limited set of data is publicly available. Larger sets are available to certain contractors and researchers but the access agreements prohibit sale to third parties. So you must have misinterpreted the content or source of the data you saw.
That federation piece is super interesting. I'm actually giving a talk in Sweden this week about machine learning/AI training in the age of data sovereignty, and my suggestion was two-fold - better and more widespread adoption of things like Homomorphic Encryption and more federated systems that can distribute access and data in sovereign systems. This is a pretty important evolution in that direction!
No offence but IshKebab is not a person I would associate with someone who knows anything about health, useable and practical software. No matter how noble their intentions are about criticizing software they’ve never used nor never attempt to use because of unfounded stigmas. Misguided indeed.
Automake, bash, emacs, gnucash, gnuhealth, coreutils, gnupg, gimp, grep, make, etc. are all great pieces of GNU software. Don’t take my word for it, here is a list of all the too-many-to-name gnu software used out in the world extensively:
I can't quite understand what is actually part of GNU Health:
> Social Medicine and Public Health
> Bioinformatics and Medical Genetics
Are these that a piece of software? scopes? Intents?
> Hospital Management (HMIS)
Ok, now this is software for sure, but what exactly does this mean? There are many things to manage within a hospital. Is this software for managing inventories? Scheduling? Personnel assignments and organizational relations? Patient flow records? And - is most of this stuff really specific to hospitals? e.g. how is this different from managing, say, a hotel?
> Laboratory Management (Occhiolino)
Again not so clear what kind of management we're talking about.
> Personal Health Record (MyGNUHealth)
Ok, this I (think I) understand.
> GNU Health embedded on Single Board devices
What exactly needs to get embedded? And - what kind of device? It could be a Raspberry Pi, that's a single-board device, right? So, just another general-purpose computer, but on ARM-based silicon. Or - it could be an, I don't know, some kind of scanner, like a portable UltraSound.
Bottom line: I'm sure it's a collection of useful software but very difficult to figure out exactly what, and how it's specific to healthcare.
Laboratory Management Systems, or LMS, is laboratory software which handles laboratory orders, retrieving results from the laboratory equipment and sending back the results to the electronic patient record (EPR). It does a lot more than that of course, but basically it's a big database handling thousands of blood tests, biopsies, tissue samples, as well as worklists for staff, in order to get diagnostics results back to the clinicians.
There was a guy on reddit a few years ago who started a dental practice with entirely open-source software and his own EHR system. Really interesting stuff, don't think anyone's posted about it here. Can't view his reddit history but he must still be using it, last commit 1 week ago.
https://www.reddit.com/r/linux/comments/p5phju/progress_repo...
https://www.reddit.com/r/linux/comments/x2mls1/update_starti...
That’s from the founder of Clear.dental, Dr. Tej Shah:
https://clear.dental/
https://gitlab.com/cleardental
https://www.linkedin.com/in/tej-shah-17829195
And the 2.0 source: https://invent.kde.org/desiotaku/cleardental
Hm they had an AMA recently going on, so I asked them some questions if they are still using it or what not (on reddit) mentioning this HN comment.
https://old.reddit.com/r/Dentistry/comments/1o3hawd/prison_d...
Surprisingly it had 100 comments but no open source questions iirc so that was a bit of surprise from what I could check.
Also Offtopic or not but its sad that you can't use reddit because you are in UK but just for the sake since I want you to see the comment, I perma-linked it and uploaded it to wayback-machine/archive.org and here's the link so that you can view what I wrote
I am going to archive the whole reddit page later for you to read as well
https://web.archive.org/web/20251011181833/https://old.reddi...
Wait why is this not working wtf, Dentistry: page not found for archive wtf?
Edit: I archived the whole page as I said, here it is.
https://web.archive.org/web/20251011182126/https://old.reddi...
Hope this helps OP and maybe I will keep the archive updated for few days or give ya updates if that's something you are interested in I suppose I am not sure, just like many other things in my life.
> Can't view his reddit history as I'm in the UK
What does this mean?
It's tagged as NSFW for some reason and I can't be bothered verifying my age
just change from www.reddit.com to old.reddit.com and then it doesn't ask you to sign up.
Does this work in the UK or do they still ask you to verify?
No, but just put something like rl.bloat.cat instead of reddit.com. That'll direct to an alternative community maintained interface for Reddit that will work.
I know that alternative frontends for reddit were a huge thing which I used to use before the api fiasco
There are still some alternatives but most of them now scrape or have extreme rate limiting from what I know.
They use redlib but If I remember correctly that's similar to libreddit but patched to work without api but still, its a very finnicky solution.
Like these solutions can work but I think at that point, just use a VPN but oh boy reddit detects those VPN's from what I know.
WOW UK censorship law is really something huh, can people living in the UK somehow vote to repeal that or something?
I was thinking on the scary part of as to what if many countries can seemingly connect together these pieces to genuinely have internet authoritarianism and what if they have such eggregious fees or just even a threat of it, have a little mixture of getting sanctioned if you try to move around it but damn, this is so weird, if they really want, they can genuinely escalate this more and more to block VPN's and more and more to effectively soft-lock a person from the internet. This needs to stop. Right now. Otherwise I am scared if what if multiple countries come together to stop something like tor nodes by somehow putting them in such a law. Once tor stops, all hell can break loose on the internet, its certainly possible, I never expected this but the only thing stopping UK censorship might be hopefully their incompetence of maybe not removing VPN's or this goose chase or just the fact that this is the beginning, not the end. They are testing how much they can get away with which is increasing a lot... This really made me pessimistic actually.
The only hope is that such websites can spring up more quickly than UK can take them down but what if UK sets a dangerous precedent by suing them, its definitely possible to track them down by the UK govt.
They say on their blog that https://bloat.cat/blog/updates-may-25/ that Redlib is the most resource-hungry service. The traffic figures run into terabytes a month
Some % of these could be for bypassing the UK as well
though I suppose that not even govt. can catch them,their Opsec is genuinely really good, they use monero for the servers and etc., its fascinating to see their Opsec be so secure.
Edit: I got so curious and found out that they run some servers on senko.digital which is in fact UK based but they won't still get much (I hope) because senko.digital supports monero so their opsec is secure but if they had slipped up, it wouldn't have been hard to see them being framed as they get terabytes of data and some % of data can help loop around UK censorship evil laws and they could've tried to frame him and senko being a UK company, it isn't hard to follow that they would've complied. But they use monero and I am sure that they use a vpn as well but it was certainly fun reading their Opsec and I think that its sort of perfect, I need to learn more from it actually.
So I guess its still possible to run websites without incurring the hefty fine in UK but its certainly very hard / borderline impossible and I just hope that this UK thing / similar things in other countries doesn't get any further and gets banned/repealed otherwise the internet might die.
Edit 2: maybe I gave them too much credit since either its saying Reddit is blocking redlib as always... when I try to click on any username or it just gives a flat out nginx 502 bad error... I really gave them too much credit but it was fun learning something about opsec.
It means you can't view people's reddit profiles in the UK.
( Yes, seriously. )
Many many profiles are tagged NSFW, its' not clear why, I can't imagine the majority of those have done so deliberately, perhaps it's automatic for anyone who's posted any NSFW posts ever. ( Which includes people doing so to be funny such as someone posting a huge loss in a sports sub as NSFW. )
Recently Reddit also made it possible to private your post and comment history, which I found a surprising number of people already do too (default for new accounts maybe?), so this is about to become a very worldwide experience anyhow :)
I've been seeing a lot of profiles have their post history invisible, and thought it was a bug. I tried to search for whether or not this was possible and couldn't find it. I'm elated to hear that this is a thing, as it protects my privacy. Just enabled it (:
Only thing, shame you can only set these things in new Reddit.
I'm fairly mixed about it, personally.
Being able to inspect post and comment history allowed for finding people who are absentmindedly lying, or are otherwise intentionally and persistently abusive. I believe this was the whole original motivation about such a history being available, even.
On the flipside, it does lessen the potency of various avenues of abuse. Some people would get harassed and stalked thanks to this history feature for example, and it trivialized targeted information extraction too. It also allowed for petty censorship, i.e. some subs would auto-ban people who commented in various other subs.
One might also criticize it for being a minor bandaid over a gaping hole. Your username and user avatar you still carry across subs and are not autogenerated. This means that with sufficiently wide scraping, your posts are still perfectly correlatable, collectable, and subscribeable. Within subs, the same applies to your user flair. This has benefits, i.e. it allows you to block users who you identify as inherently malicious, but it also means that all the aforementioned benefits apply only in limited ways.
Trust requires the sharing of information, privacy requires the obfuscation of information - and so I think these concerns run contrary to each other, resulting in the many solutions of the world not committing fully to either, as they are extreme and unrealistic positions in isolation. Difficult world.
As I said it on the OP's comment but I will type it here as well, sorry if it counts as spam but
just change from www.reddit.com to old.reddit.com and then it doesn't ask you to sign up. (atleast this works in my country)
Does this work in the UK or do they still ask you to verify?
It does not work for me in the UK.
Heath centers pay unreal amounts of money for these kinds of commercial products, but in my experience the health centers themselves have very few technical resources. So the real "value" being delivered by the commercial software providers is often the setup, support, and hand-holding provided to customers who pay the crazy amounts.
I imagine there will be a niche but high-paid market integrating these GNUHealth products with existing commercial systems, and ongoing opportunities in supporting health centers using the software with planning, upgrades, and lots of phone & email support.
I could certainly imagine NHS England looking at this and creating something that hospitals and GPs could deploy
I'd love it if my government created a civil reserve for technology workers. Let me volunteer every weekend to help fix infrastructure so I don't have to give up my existing job.
If it was a volunteer effort without ulterior motives, it would be beneficial to society, but ultimately who is on call? Who pushes for hard, but beneficial changes that might not have immediate obvious value? Who accepts risk or responsibility.
Ultimately that’s the point of the market. Incentivize people to take risks for rewards. Allow others to improve on proven models for lower costs. Unfortunately, government does not have any risk/reward or other market pressures.
It's pretty common for traditional organised volunteer services to have "on call" aspects.
Think of like volunteer firefighters, The Samaritans, St John Ambulance, the UK lifeguards and lifeboats (RNLI). Such organisations do usually have full time paid staff too, but the bulk of the front line work is part time volunteer.
Sadly, very sadly, I cannot imagine it. I have seen the inside of NHS IT.
In the US, the Veteran's Administration wrote their own EHR (Vista) which was released as public domain. They've been trying (and mostly failing) to migrate to a commercial EHR for the last seven or eight years.
VistA has some great functionality and end users generally like it, but unfortunately the underlying platform and developer tooling is hopelessly outdated. It's approaching a technical dead end and there's no practical way to keep it moving forward unless someone steps forward with the funding and resources for a major refactoring / rewrite engineering effort.
https://worldvista.org/
Vista is ancient, and it's written in MUMPS, an evil twin of COBOL.
No, MUMPS (or M) is a remote descendant of JOSS, an interactive language of the 1950s. JOSS has all sorts of variants (DEC's FOCAL language of the 1960s was a dialect), but I think MUMPS is the only living one. MUMPS code is mostly unreadable, as the commands can be, and often are, abbreviated to the first letter. As a result, it looks a lot like line noise.
Regardless of its many warts, Cobol cannot be accused of being unreadable. Verbose, yes.
MUMPS was originally developed in the 1960s for use on minicomputers that had maybe 64KB RAM. At the time it was a lot more important to keep code size small, hence the single letter commands. Readability wasn't a concern then but it sure looks like a mess today.
> Regardless of its many warts, Cobol cannot be accused of being unreadable. Verbose, yes.
Hence the "evil twin" comment :)
For context, many (most?) other EHRs are too, though they call it M now so it sounds less disease-ridden.
I wonder what would happen if EU harmonized the legislation so that the EU states could go together and develop an OSS journaling system. The amount of money saved would be astronomical.
Spending money is what drives the economy. No diverse expensive healthcare software means thousands of employees don't get paid and don't spend earned money within the economy.
When a measure becomes a target, it ceases to be a good measure. Goodhart's law.
That's broken window fallacy.
"Broken windows" is not a fallacy. The common belief that it's a fallacy is a fallacy.
"Broken windows" indeed can stimulate the economy and improve the lives of people. But not _always_.
I think you're right. At the end of the day it just makes healthcare more costly without real benefit.
A good primer from Acquired https://www.acquired.fm/episodes/epic-systems-mychart
Seems like a wonderful win/win opportunity to have the software be FOSS but enable small businesses to provide hosting/support/customization.
The biggest win of all is if we had an open/extensible/maintainable data exchange format so that we could eliminate the need for paperwork. How many times must we fill out the same information, and then require the providers to keyboard it in?
There are in fact multiple data exchange formats published by standards development organizations including HL7 (V2 Messaging, CDA, FHIR), DirectTrust, NCPDP, DICOM, and X12. Some such as HL7 and DirectTrust are very open, others may require a paid licensing agreement. Usage of some of those standards is mandated by CMS interoperability regulations and/or ASTP (ONC) Health IT Certification requirements.
Beyond the wire formats, in order to eliminate the need for paperwork provider organizations also have to participate in data exchange networks. These include TEFCA, Carequality, eHealth Exchange, and some smaller regional HIEs. It all works fairly well when used correctly but many provider organizations continue to waste administrative effort and abuse their patients by failing to take advantage of the available technology. Like in many cases the necessary functionality is already built in to their EHR/PMS software but they simply don't turn it on or train their users.
Wasn't that in fact apropriated, launched and funded in the US under the Obama administration?
You are perhaps thinking of the HITECH Act of 2009? The Obama administration didn't directly fund any open-source healthcare software. There were billions in federal grant funding available to provider organizations to purchase EHR software that met certification criteria for a certain level of interoperability and clinical functionality. This really accelerated the growth of commercial EHR vendors like Epic, as well as some smaller vendors that used FOSS within their offerings.
https://www.hipaajournal.com/hitech-act-meaningful-use/
I recall various tech/data initiatives during that admin and my search came up with this: https://www.cms.gov/newsroom/press-releases/hhs-announces-ne...
I don't work in healthcare but I do use their services and every intake interaction is the same paperwork dance, so it doesn't seem to have impacted providers themselves.
There's another element that needs address as well, which is the controlled dissemination of one's medical history. It should be easy peasy technology wise, with the only blockers being political/entrenched players sabotaging it.
https://xkcd.com/927
From what I have seen, the only people seriously using systems like these are in emerging markets or developing countries.
No… hospitals use EHR to maximize billing. That is the value.
Private practices are generally shrinking in number, so there IS NO EHR that is growing in the long term to serve them, so there CANNOT BE a trend where hospitals are exceptional, their IT buying trends are the NORM and their purpose is to code for billing. It is NOT about having or not having IT resources strictly speaking.
Typing in ALL CAPS does not make your argument stronger, this isn't Truth Social.
> hospitals use EHR to maximize billing
As a person who has worked extensively with hospitals and CHCs helping them integrate technology, this is false.
EHR is being used because it's required - both by payors and regulation/law. I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
I dunno, QuadraMed that was used by at least NYC H&H for years before their imperiled transition to Epic prominently displayed “Revenue Cycle Management” on the splash screen of its decrepit provider facing frontend.
Both of you are overstating your cases. That said, it’s hard to overstate how heavily charge capture and billing are prioritized to the detriment of other aspects.
> I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
There were major EHR deployments in the 80s through early 00s, before most government mandates. Surely later mandates were an incentive This reflects a lack of tenure.
> There were major EHR deployments in the 80s through early 00s, before most government mandates.
Examples?
> EHR is being used because it's required - both by payors and regulation/law. I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
Your argument fails in cases where hospitals switch from bespoke EHRs to use one large EHR that has better revenue features. This is quite trivially discovered if one follows the news of large hospital chains who have moved to Epic recently.
> This is quite trivially discovered if one follows the news of large hospital chains who have moved to Epic recently.
Epic is one of the few providers who can meet a larger organization's overall needs
The competitors, like eClinicalWorks, are a shadow in comparison
No doubt companies increase revenue with more efficient capture of services, costs, labor factors, etc, but I've actually been in the room with people from Epic and have heard the sales presentation. I'm betting I have a decent grasp on both what they're selling and what the buyers are asking for.
Revenue cycle issues are important but not the only factor. It's simply no longer economically feasible for provider organizations to maintain bespoke EHRs. The costs have gone up too much. They can't afford to pay developers to build and maintain all of the functionality now required due to federal interoperability rules compliance and escalating user expectations.
> They can't afford to pay developers to build and maintain all of the functionality now required due to federal interoperability rules
Yep, and more and more payors - government and private - are demanding systems that are both interoperable and audiable
Internal, bespoke systems are notoriously nightmarish for auditing
The problem open-source, and social media, and everything digital, has never overcome is accountability. Who do I sue, and who has insurance, if something goes wrong?
Combine that with most small businesses having more money than time (just pay Gmail, don’t spend the required amount of time to self host), and open-source is stuck at being hobbyists if there is no corporate sponsorship.
> Who do I sue, and who has insurance, if something goes wrong?
You sue the Red Hat-like support company with whom you ostensibly signed a contract.
If your question is who does the Red Hat-like support company sue if they want accountability for the code they are leveraging, I guess I don't understand the question or its relevance. E.g., with regard to proprietary code, who does Microsoft microsoft when Microsoft microsofts Microsoft? (Fun to write, but I don't think that sentence really makes sense.)
Do you think a small mom-and-pop dentist can win a lawsuit against Google?
There's absolutely no way that dentist will have a well-negotiated contract with SLA's and damage compensation with Google. The extent of their business relationship is that the dentist clicked a checkbox and put in their credit card details. Google does not even know they exist.
If Gmail loses all your email and accidentally kills your entire business, the absolute best outcome is a refund of your $10/month business subscription fee. The idea that they could in any way be held responsible is ludicrous.
> The problem open-source [...] has never overcome is accountability.
There are lots of organizations that provide a throat-to-choke-as-a-service, e.g. Red Hat.
> just pay Gmail, don’t spend the required amount of time to self host
Are you seriously suggesting a business put their contacts in the hands of Google, who has reportedly been totally capricious with account actions in the past and is notoriously difficult to contact when problems arise?
> and open-source is stuck at being hobbyists if there is no corporate sponsorship
Corpo sponsorship required for success? I guess I better tell all the open-source projects being used by millions that they're just hobbyists now.
> The problem [...] everything digital [...] Who do I sue, and who has insurance, if something goes wrong?
I have heard of analog world nostalgia, but you refer to the pre-digital age as if you didn't live through it. It's easier to locate someone today than ever before.
Can you name one open-source project "used by millions" that does not have corporate sponsorship?
This implies corporate sponsorship is a requirement for, as opposed to result of, a projects usefulness. That has not been the case for most valuable open source software.
Who sponsors curl?
GNU? Depending on how you want to treat FSF and PSF, gcc, emacs, python (are FSF/PSF/Apache corporations? Does PSF’s donations from corporations make python corporate sponsored?)
Never heard of Monero?
Keepass only allows donations, with no benefits for corporate vs. personal sponsors
GIMP is one of the most widely known & its sponsors only lists a few companies as hardware donors
VLC anyone?
OBS and Audacity (until recently) are two off the top of my head. Plus a lot of Linux components are run solely by a couple people, and those are run my millions of programmers.
I'd say if you take software that doesn't cost you anything, either
(1) you carry the risk or
(2) find someone that operates the software for you (on premise or SaaS) and they may also carry the risk for the premium you pay them.
You're being downvoted but yes, this is about risk mitigation. The IT department at a health care organization has to balance matching the requirements of payers, admins and clinical staff, do so in a way that fits inside the allocated budget, and de-risk the unknowns as much as possible.
Even if the vendors are only half accurate about the solution they offer, by being paid suppliers, they are on the hook (to varying degrees). These systems are highly customized and serious headaches arise from interoperability and security. If some of that can be shifted to a vendor, it's a net positive insofar as the IT department and the compliance departments are concerned.
Some healthcare organization have invested in the technology side and become leaders in innovation but those are the exception.
The person implementing the system for the hospital is accountable. I don’t see why this is difficult because it would be the same if that person built their own product from scratch.
There’s no vendor here that they can sue if they were paying for a product and deploying that, but that’s a different situation and the hospital, frankly, won’t care about that. Who their supplier subsequently sues isn’t their problem.
Also, quite frankly, whatever fancy contract you have and whatever legal system is backing it up, if the system you're using fails, it's your problem. You can't actually shuffle around all consequences freely.
I see this so often where people pay huge amounts of money (either buying a more expensive system or buying vs building) because 'we need the support!' and then still wind up with a bad system because the quality of the product modulated by the support offered still creates problems, and being able to blame someone else doesn't actually make the problems go away.
And even in cases where the problem is 'we might get sued', the fact that you have someone else to sue is to a large extent multiplying problems because you now have two lawsuits.
This isn't a problem with open source. For many of us with startups that have low stakes (worst we can do is have no users) a lack of support is fine, we can do it ourselves and save the money.
And there's plenty of consultancies which will support OSS and give you support if you need it and be your scapegoat. Red Hat, Suse, IBM come to mind and there's many others...
You sue the developers. It’s how it works in general. So basically you’d comb the commit history for the project and name everyone in the lawsuit that you could.
It's possible that some FOSS developers have been hit with nuisance lawsuits but in general they have no contractual relationship with the users and thus no liability under US law.
Here is the link I was looking for. Took me about three clicks to get there so wanted to save you guys the trouble
https://codeberg.org/gnuhealth
> The easiest way to get MyGNUHealth is by installing the package from your favorite operating system / distribution. Many operating system distributions already ship MyGNUHealth.
I was actually curious to try this out on my phone, since they claim to support mobile devices.
If running a command-line package manager is the easiest way to install this on Android, I don't want to know what harder ways exist.
I find this is quite typical for open source projects. The community still hasn't really, truly adopted mobile. I guess it's because of the need to have some sort of entity be present in the various App Stores? But if it's possible for servers, why is this so rare to have open source projects as app store vendors?
> I guess it's because of the need to have some sort of entity be present in the various App Stores?
This, and the fees, and dealing with weird App stores' rules. On Android, we had F-Droid - an alternative store where one didn't need to deal with this. And as has been reported recently, Google is making changes that will essentially kill F-Droid.
The reason there's not much good open source stuff on phones compared to PCs is because the hardware is hostile to it. The few phones out there that aren't are the ones almost no one uses.
This is meant to be used in hospitals. Where I live no hospital personal uses phones to manage healthcare data. They have PCs.
MyGNU Health looks to be along the lines of Apple Health and is intended to be used by consumers to monitor vitals and track statistics.
It makes sense to own your own medical data rather than handing it over to big tech/FAANG.
Also to manage it on a device that is not owned by big tech/FAANG
I’d never put my health data on an iPhone or Googlized phone.
You seem to be living in the past. While EHRs are still primarily used from desktop PCs, all of the major ones have native mobile apps now. Clinicians appreciate being able to review patient charts and action alerts while away from a PC cart.
Better to make it a web app, so you don't have to mess with Apple or Google's broken economics.
You're really missing the point. The EHR vendors aren't charging customers for those apps through the Apple or Google app stores so "broken economics" are irrelevant. The app stores are only a distribution mechanism and work fine for that.
So I couldn't find this on their site and too little time to trawl through their events page. Is this being used in production anywhere?
Nice to see support for Open source. I have seen selling of healthcare data, including medicare and medicaid data to private companies which sliced and diced it and sold to academic and drug research institutions via data marts. ETL jobs would run for months. The data included prescriptions, scans, visits, employee plans etc, for about ~200 millions of American patients. It is anonymized data, but still I always wondered why this was allowed.
HHS publishes clear guidelines for de-identifying healthcare data (PHI). Once it has been properly de-identified (anonymized) it is no longer subject to any special controls. I am aware that some researchers have claimed that it could be theoretically possible to re-identify certain records but so far no one has been able to do so in practice so concerns seem to be overblown.
https://www.hhs.gov/hipaa/for-professionals/special-topics/d...
As for Medicare, only a very limited set of data is publicly available. Larger sets are available to certain contractors and researchers but the access agreements prohibit sale to third parties. So you must have misinterpreted the content or source of the data you saw.
https://www.cms.gov/data-research/cms-data/types-data-files
https://ghdx.healthdata.org/record/united-states-marketscan-...
It shows some medicare data as owned by a private company.
That doesn't look like Medicare data. It comes from Medicare Supplement health plans offered by commercial payers (not a government program).
That federation piece is super interesting. I'm actually giving a talk in Sweden this week about machine learning/AI training in the age of data sovereignty, and my suggestion was two-fold - better and more widespread adoption of things like Homomorphic Encryption and more federated systems that can distribute access and data in sovereign systems. This is a pretty important evolution in that direction!
I'm extremely interested in this topic. Would you be able to share your presentation?
Text is too dark for my old eyes.
This is really cool to see. I've been on the lookout for software like this ever since reading "Why Doctor's Hate Their Computers" in the New Yorker: https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha....
HN discussions:
https://news.ycombinator.com/item?id=24336039
https://news.ycombinator.com/item?id=18381969
I wonder how feasible it would be to replace the current software in practice?
crazy to think that with this you could run the better part of a hospital with...
..but then again there is open source ERP, too!
No offence but GNU is not an organisation I would associate with health, usability and practical software. Noble effort no doubt. Misguided perhaps.
No offence but IshKebab is not a person I would associate with someone who knows anything about health, useable and practical software. No matter how noble their intentions are about criticizing software they’ve never used nor never attempt to use because of unfounded stigmas. Misguided indeed.
Automake, bash, emacs, gnucash, gnuhealth, coreutils, gnupg, gimp, grep, make, etc. are all great pieces of GNU software. Don’t take my word for it, here is a list of all the too-many-to-name gnu software used out in the world extensively:
https://www.gnu.org/manual/blurbs.html
I can't quite understand what is actually part of GNU Health:
> Social Medicine and Public Health
> Bioinformatics and Medical Genetics
Are these that a piece of software? scopes? Intents?
> Hospital Management (HMIS)
Ok, now this is software for sure, but what exactly does this mean? There are many things to manage within a hospital. Is this software for managing inventories? Scheduling? Personnel assignments and organizational relations? Patient flow records? And - is most of this stuff really specific to hospitals? e.g. how is this different from managing, say, a hotel?
> Laboratory Management (Occhiolino)
Again not so clear what kind of management we're talking about.
> Personal Health Record (MyGNUHealth)
Ok, this I (think I) understand.
> GNU Health embedded on Single Board devices
What exactly needs to get embedded? And - what kind of device? It could be a Raspberry Pi, that's a single-board device, right? So, just another general-purpose computer, but on ARM-based silicon. Or - it could be an, I don't know, some kind of scanner, like a portable UltraSound.
Bottom line: I'm sure it's a collection of useful software but very difficult to figure out exactly what, and how it's specific to healthcare.
I work in healthcare IT and all of these have very specific meanings, and it’s very clear to the intended audience what these all are.
The terms are also clarified later on that same home page ...
All of these terms are well understood if you work in a hospital. Even a technician could probably guess at the ones they don't work with directly.
> Laboratory Management (Occhiolino)
Laboratory Management Systems, or LMS, is laboratory software which handles laboratory orders, retrieving results from the laboratory equipment and sending back the results to the electronic patient record (EPR). It does a lot more than that of course, but basically it's a big database handling thousands of blood tests, biopsies, tissue samples, as well as worklists for staff, in order to get diagnostics results back to the clinicians.