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Comment by Gatsky | Hacker News Reader

What if there was an open source EMR? *nix backend with browser interface. The huge amount of money saved could pay for support, customisation and implementation. Perhaps I’m being naive, but a system where the institution has more ownership would go down well I think. We are about to get an Epic EMR and all the clinical staff are basically expecting a catastrophe.

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The VA's old system (VistA) is that open source solution - but other hospitals didn't want to use or buy it.

I think the EMR industry is driven more by safety, liability, and revenue for hospitals (in that order) than by patient/physician desired features or security.

It's also difficult to build tooling that interconnects across all of the medical specialties - and with the amount of customization that some providers want.

Hey thanks, I hadn't heard about it [1]. Apparently VistA has the highest user satisfaction of any EHR! Sounds like what is missing is the equivalent of Red Hat, which can support and implement the product, although implementation would be much more involved.

[1] https://en.wikipedia.org/wiki/VistA

You could look at this from a couple of angles. From the healthcare business side, it's controlling costs, plus either regulatory compliance or revenue support (e.g., through provider lock-in). From the tech side, it's whether something developed 'in house' can be 'sold' to the private market: the economics about government institutions 'crowding out' private ventures argues that publicly funded innovations should not deny private profit opportunities. In the public sector this is controlled with ethics regulations that prevent organizations (and individuals) from benefiting from that effort: they legally cannot market or sell that work _at all_. With an open-source system, it's (business) risk management and (provider) lock-in concerns. Proprietary systems are used to satisfy both. Safety risks arising from cybersecurity concerns are almost always chained to something already managed by existing processes with an insurer at the end of the line.

Is VistA usable by sole practitioners?

Like GNU Health?

- https://www.gnuhealth.org/#/download/projects

- https://savannah.gnu.org/projects/health

- https://en.wikibooks.org/wiki/GNU_Health

Can't tell if it's any good, though I hear it's been used in some medical facilities around the world.

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