Comments for Ankhos -- Clinical Oncology EMR

Comment on Guest post: Richard Orlowski, M.D. by rorlowski

rorlowski — Wed, 16 Jan 2013 20:52:32 +0000

The complaint here is about meaningless government requirements that divert physician attention and consume physician time. Internists complain that 30% of their clinical time is now spent fulfilling meaningless requirements. It is not a programming problem; it is government requirement problem. So, it is not a matter of data presentation. It is a matter of consuming limited resources (physician thought and time) with data collection requirements that do not address the main clinical problem. The requirements ripple through the medical office as different employees must take extra time at multiple stops throughout an office visit. Preparing a note for such an encounter is not a simple process and takes time. Transcription struggles to keep up with the increasing demands and transcription of notes is delayed so one physician may not have immediate access to all information.

The “bullet points” are inane data collection check points that the government uses in an accounting process to decide if the practitioner did enough “work” to justify a given charge. The bullet points are not conceived to aid in diagnosis or management.

The record is forced to serve the government and their accountants and less so the patient and physician.

Comment on Guest post: Richard Orlowski, M.D. by Mark Jones

Mark Jones — Tue, 15 Jan 2013 23:35:02 +0000

Sounds very pessimistic. Why can’t the software do both? Provide the physician with what they need to do a good job and show what was done.

I know too often when I have gone to a physician, the service I get has been shoddy, my doctor was out of town for a week, so I explain the whole issue to her substitute, only to be told when I return I need to come back for another visit so I can tell her what I told him. That’s really unacceptable, but is something that happens. Why should the payer have to pay twice?

In the code I work on we strive to present the medical personnel with what they need to do their job. And for billing we print out what is needed for billing. Computers are incredibly stupid, but they can do this, and it doesn’t take that much more to have two different presentations of the same data, much as what you get at the table in a restaurant vs the order the cook sees in the kitchen. Same data, 2 presentations.

My biggest problem is finding a “Truly Skilled Physician”.

I have a niece that has spent 20 years being misdiagnosed, 20 years of paying for specialist after specialist. Yes, she has a rare problem, but surely if the right bullet points had been in place, she could have been cured in under 20 years. Now she has to deal with what 20 years of the wrong drugs have done to her body.

Comment on Guest post: Richard Orlowski, M.D. by Joy Hester

Joy Hester — Tue, 15 Jan 2013 22:11:26 +0000

Very well said and hits the mark. It is about goverment control and not the quality of care people receive.

Comment on Meaningful use certification for 2014 by Orlowski

Orlowski — Sat, 12 Jan 2013 17:59:09 +0000

Things we will consider removing are mostly patient meta-information convenience features for planning purposes: What is the schedule for all Neulasta injections today?. This is helpful for drug ordering and employee scheduling. The answer to that question would display derivatives of more than one patient’s information at once. We will need to look closer at this.

The inconveniences come more from what we will need to *add*. For instance, we will have to click the button for “smoking status”, which is something, as an oncology clinic, we generally know. .

One click for smoking status may not sound like much, but add preferred language, race and nebulous “problem lists”, then multiply them by 2000 patients a month, and you not only end up wasting more time, but confusing an interface with ad-hoc functionality that interrupts the flow that works so well now.

Comment on Meaningful use certification for 2014 by kd4ttc

kd4ttc — Sat, 12 Jan 2013 03:47:34 +0000

You have to make it less functional to meet criteria? What did you have to remove? Why??

Comment on Python HL7 Parser Released by Open source HL7 parser « Ankhos — Clinical Oncology EMR

Open source HL7 parser « Ankhos — Clinical Oncology EMR — Wed, 31 Oct 2012 16:39:45 +0000

[...] http://ankhos.com/2012/10/31/python-hl7-parser-released/ [...]

Comment on Django polymorphism: Mixins vs Inheritance Models by atresontani

atresontani — Fri, 14 Sep 2012 04:57:37 +0000

I have another approach using proxies model and a get_proxy_class function. bit.ly/O2goO2

Comment on Django polymorphism: Mixins vs Inheritance Models by atresontanitrez

atresontanitrez — Fri, 14 Sep 2012 04:56:47 +0000

I have another approach using proxies. More detail here: bit.ly/O2goO2

Comment on Django polymorphism: Mixins vs Inheritance Models by orlowski

orlowski — Thu, 13 Sep 2012 16:46:43 +0000

Yea, looks like a drawing board problem at this point

Comment on Django polymorphism: Mixins vs Inheritance Models by Luis

Luis — Thu, 13 Sep 2012 15:35:45 +0000

Yes it helps.

Now, how about a more difficult one?

class account(models.Model):
name = models……

class accounttypeA(account):
balance = models.FLOATFIELD…

def addToBalance(self, value):
self.balance += value

class accounttypeB(account):
balance = models.CHARFIELD…….

def addToBalance(self, value):
value = do_strange_things_whith_value(value)
self.balance = value

This is were i’m stuck. Maybe i will have to review my models in order to have a good solution.

Thanks again.