Andy Oram

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Is Open Source Tolven the "Dark Horse" of Health IT Platforms?

Is there perhaps a “dark horse” in the EHR field, just poised to challenge the overhyped, slow, clumsy, and expensive leaders of the EHR heat? All the troubles with lack of interoperability and usability of proprietary EHRs have suddenly put the spotlight on what may be the EHR dark horse, the open source Tolven Platform.

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Navigating between Heavy-weight and Light-weight Standardization

Andy Oram | EMR & HIPAA | August 25, 2016

Andy Oram

FHIR is large and far-reaching but deliberately open-ended. Many details are expected tovary from country to country and industry to industry, and thus are left up to extensions that various players will design later. It is precisely in the extensions that the risk lurks of reproducing the Tower of Babel that exists in other health care standards. The reason the industry have good hopes for success this time is the unusual way in which the Argonaut project was limited in both time and scope. It was not supposed to cover the entire health field, as standards such as the International Classification of Diseases (ICD) try to do. It would instead harmonize the 90% of cases seen most often in the US. For instance, instead of specifying a standard of 10,000 codes, it might pick out the 500 that the doctor is most likely to see. 

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Navigation Between Heavy-weight and Light-weight Standardization (Part 2)

Andy Oram | EMR & HIPPA | August 26, 2016

The previous section of this article laid out the context for HL7 FHIR standard and the Argonaut project; now we can look at the current status.Tripathi portrays the Argonaut process as radically different from HL7 norms. HL7 hasestablished its leading role in health standards by following the rules of the American National Standards Institute (ANSI) in the US, and similar bodies set up in other countries where HL7 operates. These come from the pre-Internet era and emphasize ponderous, procedure-laden formalities. Meetings must be held, drafts circulated, comments explicitly reconciled, ballots taken. Historically this has ensured that large industries play fair and hear through all objections, but the process is slow and frustrates smaller actors who may have good ideas but lack the resources to participate.

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O'Reilly Report Explores Open Solutions to Health IT

Although many programmers and public interest advocates come to the concepts of free software, standards, open data, and transparent institutions out of idealism, modern businesses and governments are being driven to these same solutions out of the practical need to meet high expectations with diminishing resources. The ways in which the health care field has been incrementally adopting these paths are the subject of a new report, written by me and released by O'Reilly Media, called The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. Read More »

Open Health Round-Up For 2014: Notable Articles, Reports, And Events

Even the hidebound field of health care can undergo a lot of change over the course of one year. Key health IT trends that I saw throughout 2014 are summarized in another article. Here I'll list some of the most notable articles and reports related to open source, standards, and transparency in health. Read More »

Open mHealth Popular Standard (Part 1)

Andy Oram | EMR & EHR | December 1, 2015

If standards have not been universally adopted in the health care field, and are oftenimplemented incorrectly when adopted, the reason may simply be that good standards are hard to design. A recent study found that mobile health app developers would like to share data, but “Less progress has been made in enabling apps to connect and communicate with provider healthcare systems–a fundamental requirement for mHealth to realize its full value in healthcare management.”Open mHealth faced this challenge when they decided to provide a schema to represent the health data that app developers, research teams, and other individuals want to plug into useful applications. This article is about how they mined the health community for good design decisions and decided what necessary trade-offs to make.

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Open mHealth Popular Standard (Part 2)

Andy Oram | EMR & EHR | December 2, 2015

Normally, one wants to break information down into chunks as small as possible. Bydoing this, you allow data holders to minimize the amount of data they need to send data users, and data users are free to scrutinize individual items or combine them any way they want. But some values in health need to be chunked together. When someone requests blood pressure, both the systolic and diastolic measures should be sent. The time zone should go with the time. On the other hand, mHealth doesn’t need combinations of information that are common in medical settings. For instance, a dose may be interesting to know, but you don’t need the prescribing doctor, when the prescription was written, etc. On the other hand, some app developers have asked the prescription to include the number of refills remaining, so the app can issue reminders.

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Open mHealth Popular Standard (Part 3)

Andy Oram | EMR & EHR | December 3, 2015

The first section of this article introduced the common schemas for mobile healthdesigned by Open mHealth, and the second section covered the first two design principles driving their schemas. We’ll finish off the design principles in this section. Here, the ideal is to get accurate measurements to the precision needed by users and researchers. But many devices are known to give fuzzy results, or results that are internally consistent but out of line with absolute measurements. The goal adopted by Open mHealth is to firm up the things that are simple to get right and also critical to accuracy, such as units of measurement discussed earlier. They also require care in reporting the time interval that a measurement covers: day, week, month. There’s no excuse if you add up the walks recorded for the day and the sum doesn’t match the total steps that the device reports for that day...

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Open Source EHRs: Will They Support Clinical Data Needs of the Future? (Part 1 of 2)

Andy Oram | EMR & EHR | November 10, 2014

Open source software missed out on making a major advance into health care when it was bypassed during hospitals’ recent stampede toward electronic health records, triggered over the past few years by Meaningful Use incentives...As Meaningful Use ramps down and clinicians have to look for value in EHRs, can the open source options provide what they need?

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Open Source EHRs: Will They Support Clinical Data Needs of the Future? (Part 2 of 2)

Andy Oram | EMR & EHR | November 18, 2014

The first part of this article provided a view of the current data needs in health care and asked whether open source electronic health records could solve those needs. I’ll pick up here with a look at how some open source products deal with the two main requirements I identified: interoperability and analytics. Interoperability, in health care as in other areas of software, is supported better by open source products than by proprietary ones. Read More »

Open Source in the Worldwide COVID-19 Response

February marks the celebration of creation of the Open Source Initiative (OSI) in 1998. OSI created the standard definition of the term Open Source that helped guide many of LPI's initiatives today. Through the past year, open source provided many opportunities to organizations to continue to work, implement their projects, and continue reaching out to communities. Here are just a few examples of how open source provides opportunities through the face of COVID-19. The COVID-19 crisis brought out all the creativity of the open source movement. In every area of innovation--open source software, open data, open collaboration, and even open equipment--companies and research institutes have addressed medical and public health needs quickly. This article highlights some of the initiatives in each area.

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Open Source Libraries for Health Analytics

Andy Oram | EMR & HIPAA | December 19, 2016

According to Health Catalyst’s Director of Data Science Levi Thatcher, the main author of the project, these tools are tried and tested. Many of them are based on popular free software libraries in the general machine learning space: he mentions in particular the Python Scikit-learn library and the R language’s caret and and data.table libraries. The contribution of Health Catalyst is to build on these general tools to produce libraries tailored for the needs of health care facilities, with their unique populations, workflows, and billing needs. The company has used the libraries to deploy models related to operational, financial, and clinical questions. Eventually, Thatcher says, most of Health Catalyst’s applications will use predictive analytics based on healthcare.ai, and now other programmers can too...

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Patient-Centered Security Program

Andy Oram | EMR & HIPPA | August 29, 2016

Andy OramThe HIMSS report certainly appears comprehensive to a traditional security professional.They ask about important things–encryption, multi-factor authentication, intrusion detection, audits–and warn the industry of breaches caused by skimping on such things. But before we spend several billion dollars patching the existing system, let’s step back and ask what our priorities are. It’s a long-held tenet of the security field that the most common source of breaches is internal: employees who were malicious themselves, or who mistakenly let intruders in through phishing attacks or other exploits. That’s why (you might notice) I don’t use the term “cybersecurity” in this article, even though it’s part of the title of the HIMSS report.

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Pharmaceutical and Biomedical Research using Agile Software

Andy Oram | EMR & EHR | January 18, 2016

Medical research should not be in a crisis. More people than ever before want its products, and have the money to pay for them. More people than ever want to work in the field as well, and they’re uncannily brilliant and creative. It should be a golden era. So the myriad of problems faced by this industry–sources of revenue slipping away from pharma companies, a shift of investment away from cutting-edge biomedical firms, prices of new drugs going through the roof–must lie with the development processes used in the industry...

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popHealth App Challenge Launched by ONC and Health 2.0

We should be seeing major improvements to the open source popHealth reporting tool as a result of a Challenge Award just announced by the Office of the National Coordinator for Health Information Technology (ONC) and Health 2.0. It is hoped that the awards will  motivate developers to create innovative applications that will enhance the open source tool beyond its current capabilities. The hope is that the challenge will generate new methods of leveraging the program’s current reporting functions and open source framework to help providers better understanding and care for patient populations...

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