[aaavl2821]

i agree it sounds like a great tool, and epic and cerner leave huge unmet needs in terms of productivity and also cost. seems like marketing is the huge challenge

id imagine this is really for independent physicians at least in the most-near term, as the sales cycle at big hospitals is brutal, and youd have epic / cerner folks scaring the hospital admins about real / imagined security concerns.

but marketing to independent physicians is brutal. from what ive heard you need at least an inside, and sometimes field, sales force, and getting through all the marketing noise docs get is really hard. would love to hear your thoughts on how to market this more widely

edit: my post mostly concerns US physicians, but id imagine marketing challegnes would be just as big or greater for developing nations

[robertdown]

It's hard to argue marketing to giant health care systems is difficult when you go up against corporations like Epic, Cerner, or Athena Health. We simply lack the funding to do so (just thinking about Cerner's marketing budget is mind-spinning). But outside the U.S. I find that marketing is substantially easier. Many developing nations and low-resource clinics seek out ways to be financially stable with next to no funding (compared to U.S. providers). While hard to track, we estimate most of the installs are outside the U.S. helping build healthcare in areas that could never dream of a 9 figure IT install. Being a free and open-source platform is our greatest "sales pitch."

[jesdynf]

I wrote a reference implementation of OpenEMR, the "OpenEMR Full Stack", that's taking aim at facility-grade loads. It's deployed from Amazon CloudFormation, and the highlights include multi-AZ redundancy, an Elastic Beanstalk deployment fronted with a load balancer running parallel OpenEMR instances in multiple AZs, an internal Route53 domain protected with SSL between nodes, redundant document stores for patient records, and enterprise-grade backup and recovery structures all wrapped up CloudTrail and Amazon's Key Management System.

https://github.com/openemr/openemr-devops/tree/master/packag...

[toomuchtodo]

I just spoke with someone today who argued that HIPAA requires TLS termination on an instance, not the ELB. Can’t confirm or deny, as I’m in financial services, thought I’d mention it for those under such compliance/regulations.

[jesdynf]

Yeah, you won't believe the work I had to put in over it. As part of the stack creation process, I have to create a backend CA and hand certificates out to a bunch of services, and then make other services use 'em. Getting Elastic Beanstalk to use an arbitrary certificate for the backhaul is both possible and documented, but not as well I would've liked.

[toomuchtodo]

Let me know what would’ve made it easier on the AWS side and I’ll try to get it implemented with our TAM.

[jesdynf]

It was CloudFormation that made it difficult -- I had to work out exactly how to get the certificate all the way down to the load balancer's configuration details, starting from CloudFormation's interface into provisioning Elastic Beanstalk.

However, the format ELB would accept a certificate in was really frustrating, too -- I ended up having to create a Lambda function that would load a certificate file from S3 and then parse it and then return the results as a resource CFN could later refer to. If I could've simply provided an S3 URI that the CA lived in, and had the ELB load it up during initial config, I could've used many fewer layers.

The CFN syntax for actually setting those critical ELB details was also unclear, too. It took some experimentation and off-Amazon examples before I finally understood how the rule groupings worked together.

If you're curious about what the final results were, the tail-end of https://github.com/openemr/openemr-devops/blob/master/packag.... covers a lot of that ground. Thanks!

[fraidy_cat]

wow, very nice

[jesdynf]

Thanks!

[brady_m]

Yep, marketing is a real issue, since that can take up extensive resources (I am just guessing that the proprietary EMRs sink 20% or more of their resources into marketing).

Especially since US based physicians are trained that more money means better things. As you can imagine the skepticism that then results when discussing a free EMR.

Prior to a year or so ago, OpenEMR really relied on the professional support (this is basically an organic ecosystem of companies, vendors, and professionals that offer paid services to support OpenEMR) for marketing. However, the project is now taking on a more active role in marketing and is why it is listed as an item to fund in the OpenEMR Collective blog. The goal would be to get professional marketing advice and guidance.

The developing nations market is really another matter. The marketing is still important and requires resources, but is mainly focused on making OpenEMR known and accessible to these nations (for example, OpenEMR currently supports 33 languages).

And we are always looking for volunteers with (or without since we are all learning) expertise to help us in these endeavors, and anybody is free to participate in the community (hint hint).

[aaavl2821]

Thanks for the info, I'll look into the project. I really believe EMRs need to work better for docs and be more open. I know a few physician-programmers who've built their own web apps but EMR integration obviously sucks. If they can build on top of something open source and a small medical group can save money without losing functionality with an open source solution, that could garner enough donations / financial support to for ex hire an engineer

I am only a hobbyist programmer and am investing most of my spare time into learning new things, but if I ever get to the point where I felt I could add something to the open source community I'd definitely start with a project like this

[brady_m]

I'm also a hobbyist programmer with a physician day job. Volunteering for OpenEMR has been and continues to be an awesome experience. If you or your colleagues are ever interested, always feel free to contact me at brady.g.miller (at) gmail (dot) com if you have any questions or use the forums at https://community.open-emr.org/ . Note that all of us are learning at all times, and the project welcomes all skill levels.