Algunas preguntas que respondo a menudo

Deseo que sea fácil encontrar proveedores por Especialidad, para que el paciente que busca un Pediatra lo encuentre en seguida.

No está previsto. Se puede poner la especialidad a continuación del apellido, en la función de Administrador – Usuarios. Por ejemplo, la Dra. Blanca Pérez Pediatra.
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Preguntas frecuentes – Seguro de salud

Cómo se editan los prestadores de seguro de salud ya ingresados?

Antes que nada, cada país tiene diferente sistema de salud y denominación, pero lo más común es Aseguradora de Salud. En Argentina son Obras Sociales (obligatorias para todo trabajador) o Prepagas (de afiliación voluntaria).

En Administración – Práctica – Compañías de seguro médico hay un listado editable.

Cómo se agregan más países a la opción por defecto (sólo EE.UU.)?

En Administración – Listas – Países se pueden agregar más países. Estarán disponibles en algunas opciones, como datos demográficos de paciente, Centros, etc.

Pueden asociarse las prestaciones a costos?

En la base de datos puede incorporarse un listado con prestaciones y sus precios. En países de alta inflación esto puede ser complicado, por la necesidad de ajustar los precios, pero aún así es mejor que la facturación manual.

Qué pasa con los pacientes que no tienen seguro de salud?

Necesitamos que todos tengan algún seguro, por tanto creamos una opción llamada No tiene/No sabe, para adjudicarla a los pacientes. El campo seguro no puede quedar vacío, porque excluiría al paciente de muchos listados útiles.

Se puede cobrar distinto a los pacientes, de acuerdo a la cobertura que tengan?

Sería ideal poder hacerlo, y que el sistema actualice los montos en función de la cobertura de salud que se posee. Sin embargo, aún no hemos profundizado en ese problema. Está pendiente.

Podemos cargar el nomenclador argentino en la base de datos?

El nomenclador dejó de actualizarse hace un tiempo, pero puede servir como indicador de precios de referencia. Quizá pasado a dólares.

Cual es la codificación ideal para enfermedades y prácticas?

El SNOMED es recomendado por la OMS. Es mucho más extenso que el CIE, que también se usa. Estará disponible en la próxima versión de OpenEMR.

Valor legal de la historia clínica informática

Este tema siempre surge en los ámbitos médicos sobre todo hospitalarios. En ocasiones, las posibles implicancias legales desfavorables de la informatización son una excusa para no informatizar, aunque cada vez más débil. En ocasiones el tema destaca lo inapropiado de la legislación actual, todavía varias décadas atrás de la realidad. Por ejemplo, en un reciente simposio en el Htal. Italiano, un médico de este avanzado centro pionero en Informática Médica, se quejó de que a raíz de un caso judicial, un abogado pidió incautar la historia clínica del paciente, para lo cual el juez se quería llevar un servidor completo del Centro de Datos del Hospital. Esto, sin importar el perjuicio ocasionado a las decenas de miles de pacientes cuyas historias residían en ese mismo servidor. Resultó más fácil tener siempre un backup que pretender cambiar la ley. Me gustaría saber que hubiera hecho el juez si los datos residían en un servidor ubicado en el exterior. Iba a pedir a Cancillería que haga un exhorto para que un juez extranjero envíe por correo un servidor web con un RAID de veinte discos duros? Absurdo. Continuar leyendo «Valor legal de la historia clínica informática»

Software Presupuestador para Historia Clínica Digital

Este software (PresuHisClinDig.exe) sirve para presupuestar la instalación de un sistema de historia clínica digital en una clínica tipo. Este costo es muy variable, y puede costar desde unos pocos dólares a cientos de miles.
Cada producto de software tiene su precio, y los hay desde gratuitos hasta de 200.000 dólares, cuando se destinan a un gran hospital. Los productos comerciales se cotizan en base al número de médicos que lo usarán, y a veces también de acuerdo al número de pacientes. Los productos gratuitos suelen ser demos destinados a mostrar las prestaciones de una versión paga, con más prestaciones. En el caso de OpenEMR, que es gratuito, lo que se ofrece es un servicio de soporte técnico pago. Este servicio técnico también se presupuesta en función de la cantidad de usuarios, la cantidad de registros, y otros parámetros que permiten estimar el número de consultas que deberán responderse.

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UMLS, o Sistema de Lenguaje Médico Unificado

UMLS – Guía de inicio rápido

¿Qué es el UMLS?

El UMLS, o Sistema de Lenguaje Médico Unificado, es un conjunto de archivos y software que reúne muchos vocabularios biomédicos y normas para permitir la interoperabilidad entre los sistemas informáticos. Es desarrollado por la Biblioteca Nacional de Medicina de los EE.UU.

Puede utilizar el UMLS para mejorar o desarrollar aplicaciones, tales como registros médicos electrónicos, herramientas de clasificación, diccionarios y traductores de idiomas.

El diccionario SNOMED en Español puede integrarse fácilmente al OPENEMR para uniformar la terminología médica en nuestro idioma.

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Telemedicine

Telemedicine refers to any medical action done at a distance. For some tasks this is a very easy, and does not really need the physical doctor-patient contact. Or the contact can be replaced by video cameras and touch-sensitive data gloves.

 

For instance, interpreting EKG, EEG or X Ray images is often done with the hard data alone. Actually, starting a marketplace for those interpretations could be a still virgin starting point. With Medicine going more and more the way of biochemical, electrical or other physical tests, there are always more data to be analyzed. Some of those data can be very complex, like the EEG, and benefit for computer treatment for signal improvement and processing. I am currently advisor in a project for Computerized Polygraph testing for the Federal Police in my country.  Images provided by X Ray, Tomography, Photography, Microscopy or Sonography can also be computer-enhanced, compared and stored, before expert interpretation, all of which can be done remotely. This opens the field of

Telemedicine for almost every medical specialty.

 

The few exceptions are those practices where direct contact is required, like taking samples, feeling, smelling or operating. And still, some of them can be left to nurses, technicians or beginning physicians, with remote supervision by experienced professionals.

 

We are only scratching the surface of the immense, fast-growing medical information market

 

Developing software able to analyze instrumental data is another form of Telemedicine that already started to grow.

 

Health has always been a conservative area, doctors are known to be anti-computing technology, and lawyers are anxiously waiting to take action against every little mistake or data glitch. But still, there is a lot do in this area, with enormous potential for growth and wealth.

 

 

Personal View

 

I took part in a successful project where overweight patients were followed by phone, to ensure they took the medication, followed the diet and lost weight. The phone calls really helped them to comply.

I cannot wait for Telemedicine to mature and allow me to work from home and collect as if I was in a fancy American clinic.

Health eBizz Proposals

 

While generating e-businesses I explored all of the sites that match Entrepreneurs (inventors, web business developers, small business owners) with Investors. There are many, and none of them was of any use for me. However, they have a place in the e-economy and some of them eventually produce transactions. There are a lot of unwanted consequences of entering a project in those sites, including registration fees, spam, fake offerings of capital with a small fee required in advance, fancy services for the entrepreneur like courses and business plan assistance, fake degrees and the like. Once the project gets funded, or when the entrepreneur gives up and stops paying a fee, the project disappears from the site. It would be nice to be able to track the projects for at least 2 years, let several small investors join forces to start a project, see it evolve and measure the success rate of those matching sites. The projects alive in the system could benefit from the distributed knowledge coming from the Problem Solver Marketplace and the Futurologist Arena, two proposals described elsewhere in this book.

 

Investing in a Net project seems to be a all/nothing operation. Of course, nobody expects that a real-life investor will fork 10,000 or more without a lot of expensive research, due diligence requirements, planning and contracts. However, 500 investors could be ready to contribute $20 to a promising project with decent guaranties, achieving the same result in a very short time.

 

This Virtual Shares business needs to be developed to help finance this site and its probable spin-offs. The first step in acquiring shares is to vote (for or against) the proposals in the News Aggregator system located at www.netocios.com. The votes will help other readers to estimate the value of the proposed business.

 

I am sure there will be many readers interested in betting a few dollars in some of these health proposals, but without the obligations arising from a formal partnership.

 

In order to issue shares, most countries have detailed and cumbersome legislation and requirements. For that reason, we keep all the matter within virtual boundaries, meaning that the shares traded here are in no way real. Any transaction arising from investors willing to partner with the author in the development of e-businesses will have to be treated separately, with specific contracts and documents.

Imagine a Reality Show where the participants are entrepreneurs carrying online projects.

 

In the meantime, contributions are treated as donations, and create a moral compromise on our part of further retribution. Moral compromises, I hope, are not enforceable, taxable or likely to create legal trouble. Virtual or moral shares offered in this site are payable as donations to my Paypal address.

 

The Reality Show structure is also an appealing alternative. Imagine a Reality Show where the participants are entrepreneurs carrying online projects. Being public is the price to pay for contributions from viewers and sponsors. Online popularity, traffic and sales are measures of success, and increase chances of participants to climb to the next level. This proposal for a Reality Show is so neat that can be even ported to TV…

 

Some businesses have, or can easily have, an associated domain name. We can register those domains to the name of the best bidder in an eBay.com auction. That provides an initial association between parties with a solid guaranty. A written compromise of keeping the new business within that domain and providing consulting can be a second step.

 

An alternative way to offer virtual shares for Internet businesses is to create a special Domain Register that allows combined registrations, by more than one party. Since all the parties would be needed to transfer the domain, this creates a control mechanism for those domain-based businesses with 2 or more owners. It is the equivalent of business bank accounts that require two signatures on every check. This should be a separate business proposal, but I leave it here for now.

 

Most business can be divided in parts, based on geographic boundaries, on items or type of clients. A contract can grant the rights of exploitation of that part of the business to an early contributor.

 

Another way to implement the virtual shares system is to base the business and website in a permissive country, like the Cayman or Bahamas Islands.

 

If the model turns to be successful, it can be sold to other websites offering business to the public. If most people enjoy picking up winners for a football match or a horse race, why they would not enjoy picking up winners for a business project?

 

 

Personal View

I like the Reality Show on Tv, why not? I sent the idea to a local producer but got no answer. Mr. Trump has the Apprentice show which is close but not exactly the idea. American Inventor is more like it, but they have no continuity and there is little chance for the audience to participate. I could focus on Entrepreneurs at large, or Netpreneurs alone.

I will receive all kinds of objections to my shares project from corporate attorneys. However, there must be a loophole. Venture Capital is fully developed as science and business in the 1st World, but hardly existent in developing countries. So, Virtual Shares are a way for us South American entrepreneurs from to raise seed capital from the Web.