Archivo de la categoría: General Issues

General health-related or Internet-related issues.

Instalación de OpenEMR en clínica de 60 camas

Hemos instalado OpenEMR en una clínica mediana, en la provincia de Chubut, Argentina, en setiembre de 2016. Hasta ahora, 7 meses más tarde, hay 100 usuarios registrados y casi 10.000 pacientes. No hubo inconvenientes hasta ahora.
La administración nos solicitó algunos informes, más allá de los programados en el Sistema. Por ejemplo, un listado de pacientes sin seguro médico. Lo resolvimos con un query de MySQL a medida.
Se implementó un formulario para ginecología con algunas preguntas estándar. Nos pidieron verificación de número de DNI único, exigencia de TE y algunos otros requisitos para el alta de nuevos pacientes.
Incorporamos un listado de códigos diagnósticos CIE10, en español.
El apoyo a los usuarios se realiza a través de un administrador local. Para acceder al servidor Windows con Xampp, utilizamos Remote Desktop de Windows.
Se completó también el diccionario inglés/castellano.
Consulte por sus necesidades específicas. Realizamos instalación en servidor propio o en la nube. Hacemos programación a medida, capacitación, soporte permanente y servicios relacionados.

Historia clinica digital unificada para Argentina

Veo en Facebook la iniciativa de Alejandro Abraham para que el país adopte la Historia Clinica Digital, y desde ya adhiero.

Acerca de la Ley 26.529:

La Ley 26.529 que regula los derechos del paciente, en cuanto a la autonomía de la voluntad, la información y la documentación clínica, especifica ciertas pautas que debe cumplir una historia clínica.

Entre estas pautas, se encuentra la confidencialidad de la información entre el médico y el paciente, y todo profesional de la salud que pueda tener acceso a la misma.

Uno de sus artículos, el artículo 14, especifica que el paciente es el titular de la historia clínica y que a su simple requerimiento debe suministrarse una copia de la misma.

Pero a su vez, el artículo 17, indica la unicidad de las historias clínicas por establecimiento. Es decir, cada establecimiento de salud, debe llevar una historia clínica particular, completamente aislada de cualquier otra institución.

Son relevantes en la Ley 26.529, los artículos 2 (incisos C y D), artículo 13, artículo 14, artículo 17 y artículo 18.

Agrego que todos los profesionales de la salud perdemos mucho tiempo y esfuerzo tratando de entender los escritos a mano de colegas en todo tipo de documentos clínicos, lo cual ocasiona dilaciones y errores a veces graves.

Y como sigue siendo obligatorio que las recetas o prescripciones sean MANUSCRITAS, el responsable es el mismo Estado y su adherencia a legislación arcaica.

Costo de implementación del sistema de historia clínica digital

En general respondemos a esta pregunta de modo personalizado, ya que existen muchas variables a tener en cuenta.

– tienen una red? De cuántas computadoras?
(más máquinas, más costo)
– tienen servidor? De qué tipo? Windows o Linux?
En principio, Linux tiene todos los componentes necesarios, en Windows deben instalarse adicionales.
– tienen conexión a Internet con IP fija?
Si hay IP variable, hay que instalar componentes adicionales para tener un dominio web de acceso al sistema.
– ya tienen Uds. página web? Cual es? Está alojada en vuestro servidor?
Ayuda a configurar el acceso web al sistema.
– ya tienen algún sistema para datos de pacientes?
Puede ser necesaria una migración de datos.
– piensan cargar datos de estudios bioquímicos o radiografías?
Es útil, pero puede ser más complejo.
– tienen definidas las necesidades de una historia clínica digital ? O usamos las convencionales?
Hay muchas alternativas de configuración que pueden aprovecharse.
– Dónde están ubicados?
Nosotros en Buenos Aires, con asociados en Uruguay, Honduras y Colombia.

Preguntamos primero que nada si el cliente desea instalarlo en su servidor, o si desea utilizar nuestro servicio remoto, en la web o en la “nube”. De la primera manera se tiene más control sobre el sistema, y se obtiene un poco más velocidad de respuesta. Por la diversidad de servidores, routers y redes, el costo es alto al principio, pero luego muy bajo para realizar el mantenimiento. Con nuestro servidor en la nube es al revés: baja la instalación, y un poco más costoso el mantenimiento.

También debe analizarse el espacio en disco que requerirá el cliente, en función de cantidad de pacientes y si habrá necesidad de guardar documentos y radiografías en el servidor.

En función de la cantidad y calidad de datos, podrá ser necesario realizar un backup (copia de seguridad) con distinta frecuencia: diaria, semanal, quincenal. Esto también tiene un pequeño costo por exigir actividad de un operador o del servidor automatizado.

Sugerimos realizar un presupuesto preliminar en nuestro presupuestador online de sistema de historia clínica digital.

Psychological Testing and Treatment

To this proposal, the 3 medical businesses described above apply: Online EMR, Telemedicine, Marketing and Marketplaces.

Psychology is a discipline that can greatly benefit from the Internet, because there is no strict need for physical contact between patient and doctor. Of course, something is lost when human proximity is replaced by a webcam. There are a number of clues from the environment, body language and details that help the psychologist to make a diagnosis. But psychological tests are objective and can be easily implemented and carried out online. The advantage of offering Web Psycho Testing is to centralize the tests, to assure uniformity, and to be able to chain the tests according to the results and following a predetermined algorithm, thus automating most of the diagnostic process.
Sigue leyendo

Opportunities for Pharmaceutical Companies

The 5 previous proposals have many advertising and sponsorship places for drug companies. Doctors who are active online are likely to be more influential and see more patients that those who are hiding in their offices, and pharm sales reps need to identify them and see them, virtually or physically.

When a product is being discussed in a forum, the “virtual reps” can intervene defending the drug from attacks. Although it is not correct, they can do so anonymously or without identifying themselves as company members.
Sigue leyendo

Traceable Medicine

This bizz takes elements of several others described here.

 

Medicine has always been defined as part art, part science. Art resists definition and can not be traced, while science is the opposite. As a part-time practicing doctor, I know that Medical care is far from being exact science and the doctor-patient interaction is hardly traceable. We doctors enjoy certain impunity from the fact that not everything we do and advice is recorded, and our errors most of the times, get covered with dirt… Even those facts that get written can be left in paper or in electronic format that is not integrated in larger databases.

 

For instance, let’s compare several parts of patient-doctor interaction, in the old and modern ways of doing medicine:

 

 

Standard-traditional-Old Way

Connected-traceable-telework-New Way

Patient selects Doctor

Word of mouth

Advertising

Managed care org. decides

Whoever is available

Verifiable CV

Knowledge Marketplace

Doctor selects patient

Clinicians accept everyone

Specialists accept patients broadly within their specialty

 

Doctors search for patients in knowledge (medical service) marketplaces, which assure they stay within their proven abilities.

Initial interview

Spoken

Spoken + Audio record + full data entry in EMR. Telemedicine.

Medical Records

Paper or single PC

Electronic Medical Record  (EMR) in a Database

Data collection

Analogical forms (paper, X Ray film, thermo sensitive paper)

Digital forms integrated into the EMR

Medical decisions

Doctor’ call. Hunch. Coin toss. Infrequently, second medical opinion sought. Many times, from a friend or the first doctor who walks around.

Software assisted. Expert systems. Knowledge Marketplace. Telemedicine. Online qualification system for medical acts.

Outcome

Hopefully, everything Ok. Doctor performance is approximately estimated by those few that happen to know the case.

Permanently monitored by the Online Qualification System for Medical Acts.

 

 

Special examples of Traceable Medicine are clinical trials. When companies need to test new products or treatments define tests with extreme control of every variable, write strict protocols and appoint experts that ensure compliance. Everything is traceable. The results are solid enough to allow researchers to extract valid conclusions of general value.

 

Traceable Medicine will push health care away from art and into science. The result will be a less human patient-doctor relationship, but without doubt, success rates will be better and costs lower.

 

The “Online Qualification System for Medical Acts” does not exist and is a business by itself. It requires the EMR, for every participant being able to check patient data. Let’s show some properties:

 

  • can be complemented by Verifiable CVs, because the ratings that doctors obtain in this system can be added (if good…) to their CVs.

 

  • would be a useful Medical Marketing tool for the service providers in the Medical Knowledge Marketplace, because those with a good record can be trusted and sell themselves better.

 

  • will add credibility for those who participate in the Medical Social Networks.

 

  • will be able to run Contests (with many marketing opportunities). Of course, the patient will stay anonymous.

 

  • will be able to provide Certifications (a new business)

 

  • instead of passing tests, obtaining certifications and solving quizzes for free or paying a fee, Doctors will do it and at the same time, get paid for their work

 

  • large amounts of valuable data will be available for Public Health and Epidemiology technicians and experts, which will greatly improve Health Care in general.

 

 

Personal View

I envision huge resistance from doctors to accept traceable medicine. They still fiercely resist using PCs to keep appointments and data. And the pen and paper generation still rules over the young and connected.

We doctors enjoy certain impunity from the fact that not everything we do and advice is recorded, and our errors most of the times, get covered with dirt

Privacy concerns over EMR systems

I was researching EMRs for a Congress presentation, as I mentioned before, and the privacy concerns were among the top issues for both doctors and medical administrators.
It is known that Google and Microsoft are making progress with their products, expecting everyone to have online EMRs in short time. It caused me a little trouble to try them, because they are only available in the USA, and I had to browse them with a proxy.
It is known that Microsoft has a very limited online EMR, HealthVault, but they purchased Amalga, a top-level EMR solution and they are trying it in several US hospitals. Amalga comes from “amalgamate”, or unite, because it unites several sources of medical information about a single patient.
Google Health has also a limited version online, but they are working on a full solution. The question is about the future free EMR from Google. Will it have Adsense ads?
How will anyone feel checking his own EMR on Google and finding ads related to his condition? It will be ok if the guy is diabetic and finds ads about insulin syringes. But what if he has terminal cancer and finds ads about coffins and private cemeteries?
Sorry for being blunt. It just came first to my mind.
free EMR by Goog

Working in the intersection of Medicine and Internet

I conceive the near future of medical care as a connected, distributed space where only a few persons have direct contact with the patient, and a number of consultants examine the relevant data and make recommendations. The eHealth paradigm will make medicine ultra-specialized, a bit de-personalized, fast and cheap.

The current e-business models are taking a while to enter the very conservative health field, but they will enter for good, with great impact and making big bucks for the pioneers. (us). For instance: 

– Telemarkets, where the patient demands service offers from all the possible providers;
– Auctions, where medical services/hours are sold to the best buyer:
– Social Networks, where doctors and consultants are qualified by colleagues, online, worldwide
– Expert Systems
– Advertising following the PPC and related models, using the doctor-specific channels to allow pharmaceutical ethical advertising.

Sergio 2007