Andy Oram

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Apixio Illuminates The Pain of Recording Patient Risk Factors (Part 1)

Andy Oram | EMR & HIPPA | October 27, 2016

Many of us strain against the bonds of tradition in our workplace, harboring a secret dream that the industry could start afresh, streamlined and free of hampering traditions. But history weighs on nearly every field, including my own (publishing) and the one I cover in this blog (health care). Applying technology in such a field often involves the legerdemain of extracting new value from the imperfect records and processes with deep roots. Along these lines, when Apixio aimed machine learning and data analytics at health care, they unveiled a business model based on measuring risk more accurately so that Medicare Advantage payments to health care payers and providers reflect their patient populations more appropriately...

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A Consulting Firm Attempts a Transition to Open Source Health Software (Part 1 of 2)

Andy Oram | EMR & HIPAA | September 6, 2016

Open source is increasingly understood to be the future of software, because communities working together on shared needs can produce code that is at least as good as proprietary products, while representing user interests more effectively and interoperating without friction. But running an open source project is a complex task, and keeping a business going on it is absolutely perilous. In his 2001 book The Cathedral & the Bazaar, Eric S. Raymond listed half a dozen ways for businesses to profit on open source software, but today only one or two are visible in the field (and they differ from his list).

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A Consulting Firm Transition to Open Source Health Software

Andy Oram | EMR and HIPPA | September 7, 2016

The best hope for sustaining HLN as an open source vendor is the customization model: when an agency needs a new feature or a customized clinical decision support rule, it contracts with HLN to develop it. Naturally, the agency could contract with anyone it wants to upgrade open source software, but HLN would be the first place to look because they are familiar with software they built originally. Other popular models include offering support as a paid service, and building proprietary tools on top of the basic open source version (“open core”). The temptation to skim off the cream of the product and profit by it is so compelling that one of the most vocal stalwarts of the open source process, MariaDB (based on the popular MySQL database) recently broke radically from its tradition and announced a proprietary license for its primary distinguishing extension.

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A Mature API for an Electronic Health Record: the OpenMRS Process

Andy Oram | EMR & EHR | August 14, 2015

By some measures, OpenMRS may be the most successful of the open source EHRs, widely deployed around the world. It also has a long experience with its API, which has been developed and refined over the last several years. I talked to OpenMRS developer Wyclif Luyima recently and looked at OpenMRS’s REST API documentation to see what the API offers...

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A New Meaning for Connected Health (Part 1)

Andy Oram | EMR & HIPPA | November 3, 2016

Those of us engaged in health care think constantly about health. But at the Connected Health symposium, one is reminded that the vast majority of people don’t think much about health at all. They’re thinking about child care, about jobs, about bills, about leisure time. Health comes into the picture only through its impacts on those things. Certainly, some people who have suffered catastrophic traumas–severe accidents, cancer, or the plethora of unfortunate genetic conditions–become obsessed about health to the same extent as health professionals. These people become e-patients and do all the things they need to do regain the precious state of being they enjoyed before their illness, often clashing with the traditional medical establishment in pursuit of health...

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A New Meaning for Connected Health at 2016 Symposium (Part 2 of 4)

Andy Oram | EMR & HIPPA | November 4, 2016

Tullman’s principles of simplicity, cited in the previous section, can be applied to a wide range of health IT. For instance, AdhereTech pill bottles can notify the patient with a phone call or text message if she misses a dose. Another example of a technology that is easily integrated into everyday life is a thermometer built into a vaginal ring that a woman can insert and use without special activation. This device was mentioned by Costantini during her keynote. The device can alert a woman–and, if she wants, her partner–to when she is most fertile. Super-compact devices and fancy interfaces are not always necessary for a useful intervention. 

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An Interview with Open Source Health IT Project: LibreHealth

Andy Oram | EMR & HIPAA | December 7, 2016

LibreHealth is the largest health IT project to emerge recently, particularly in the area of free and open source software. In this video, Dr. Judy Gichoya of the LibreHealth project explains what clinicians in Africa are dealing with and what their IT needs are. Both developed and developing countries need better health IT systems to improve patient care. In the developed countries, electronic records and other health IT systems sprout complexities that reflect the health care systems in which they function...

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Apervita Creates Health Analytics for the Millions

Andy Oram | EMR & EHR | January 9, 2015

I have often advocated for better integration of analytics into everyday medical practice, and I found a company called Apervita (originally named Pervasive Health) that jumps off in the right direction.

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API Infrastructure Importance When Providing a Health Service

Andy Oram | EMR & EHR | May 2, 2016

In my ongoing review of application programming interfaces (APIs) as a technical solution for offering rich and flexible services in health care, I recently ran into two companies who showed as much enthusiasm for their internal technologies behind the APIs as for the APIs themselves. APIs are no longer a novelty in health services, as they were just five years ago. As the field gets crowded, maintenance and performance take on more critical roles in offering a successful business–so let’s see how Orion Health and Mana Health back up their very different offerings...

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Apixio Illuminates The Pain of Recording Patient Risk Factors (Part 2)

Andy Oram | EMR & HIPPA | October 28, 2016

The previous section of this article introduced Apixio’s analytics for payers in the Medicare Advantage program. Now we’ll step through how Apixio extracts relevant diagnostic data. Providers usually submit SOAP notes to the Apixio web site in the form of PDFs. This comes to me as a surprise, after hearing about the extravagant efforts that have gone into new CCDs and other formats such as the Blue Button project launched by the VA. Normally provided in an XML format, these documents claim to adhere to standards and offer a relatively gentle face to a computer program. In contrast, a PDF is one of the most challenging formats to parse: words and other characters are reduced to graphical symbols, while layout bears little relation to the human meaning of the data...

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Burgess Bill Addresses Interoperability, the Leading Health IT Issue in the US

Health care reformers around the country should be jumping up to thank Representative Michael C. Burgess (R-Texas), an MD who is working with his staff to write a bill to promote Health IT interoperability. Readers of Open Health News probably know that interoperability--in simple terms, the ability of any authorized user to read a medical record from any source--has emerged as one of the two top burning issues of health IT, the other one being the lack of usability of proprietary/lock-in electronic health records (EHRs).

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Communities Help Open Source EHRs Thrive (Part 1 of 3: Justification)

Andy Oram | EMR & EHR | December 2, 2014

The next two articles in this series will examine various open source projects in the health IT space that have developed vibrant communities. But before we can appreciate the importance of those efforts, we need to understand why community is central to growth. That is the subject of this article...

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Doctors and Disaster Relief: Technology and Data for HealthTap

Andy Oram | EMR & EHR | February 2, 2016

In November 2015, when Tamil areas of southwestern India suffered from serious monsoon-related flooding that killed hundreds and caused the major city Chennai to essentially shut down for a week, local residents asked for help from an unusual source: HealthTap, the online service that offers medical advice and concierge care. This article explains the unique technical and organizational resources HealthTap offered, making it a valuable source of information for anyone in the disaster area with a cell phone or Internet access. At the end I will ask: what can public health institutions do to replicate HealthTap’s success in aiding the people of Chennai?

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Epic and Other EHR Vendors Caught in Dilemmas by APIs (Part 1 of 2)

Andy Oram | EMR and HIPAA | March 15, 2017

The HITECH act of 2009 (part of the American Recovery and Reinvestment Act) gave an unprecedented boost to an obscure corner of the IT industry that produced electronic health records. For the next eight years they were given the opportunity to bring health care into the 21st century and implement common-sense reforms in data sharing and analytics. They largely squandered this opportunity, amassing hundreds of millions of dollars while watching health care costs ascend into the stratosphere, and preening themselves over modest improvements in their poorly functioning systems...

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Epic and Other EHR Vendors Caught in Dilemmas by APIs (Part 2 of 2)

Andy Oram | EMR and HIPAA | March 16, 2017

The first section of this article reported some news about Epic’s Orchard, a new attempt to provide an “app store” for health care. In this section we look over the role of APIs as seen by EHR vendors such as Epic. Dr. Travis Good, with whom I spoke for this article, pointed out that EHRs glom together two distinct functions: a canonical, trusted store for patient data and an interface that becomes a key part of the clinician workflow. They are being challenged in both these areas, for different reasons...

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