I have concerns, and frankly a small amount of shock as to the content in the current development tip.
Provider types have been added to the user configurations. The only types (and a long disassociated batch they are, yet lacking in many ways) are physicians. What about the long list of nursing, PA, and therapist types? What is the intended use of this list anyway? Is it for reporting only? If so, is there no need for MU relevant types such as ARNP’s?
Religion has been forced upon us. First, I find no reporting requirements for such. If someone wants a list of theological standpoints in their system to ensure the correct treatment of their patients, they can add this. I have not noticed any ICD-10 code sections currently addressing Voodoo curses. Where, pray tell, did this come from and WHY? I suggest an optional external data load for those interested in adding theological factors into their evidence-based medicine. We already have DNR options etc… I can understand expanding this to include hematology/transfusions, dietary restrictions, and even an “end of life care” module or global that allows the patient’s visitor list to identify their particular Shaman, Priest etc… for visitation purposes and emergency contact requirements. There are something like 62,000 belief systems out there, even without adding Saganisim. Carl’s philosophy was not listed. I am offended.
There are a handful of etheno-racial groups delineated in the MU requirements…sort of. What is, and where the heck did this massive list of database plugging poo come from? What is the purpose of this? “Race” does not exist. There are more ‘ethnicities’ than religions. This junk is of no practical use whatsoever. Where are the haplogroup multi-select drop-downs? Why isn’t Hillbilly, Conch, or Cajun listed? I am offended.
Please stop pushing >obviously< single-vendor content to the public project. UK footballers and the Zen Homeopathy Club of Madison Wisconson can use a MODULE.
Art Eaton, High Priest of the Spaghetti Monster Fan Club, Vermicelli Branch.
Art, what a revolt, or almost and still your intentions are to make things better. … Why not have a check on Languages. Could keep you bussy for years. Luckily enough there is something like sorting order and careful delete options, to make things more personal. Hope the creators of Race, Religions, Language and Entnicity etc. are not offended.
Professional Types
Back in the old days when we were physicans, before we were re-designated as providers; Medicare generally had lower fee schedules for non-physicians. When we became providers, the pay scale narrowed over the years.
With the advent of Meaningful Use, certain professions were allowed/required to participate. A nurse practitioner or a psychologist is not considered an eligible professional in the Medicare program, so (s)he was spared this intrusion.
Religious Affiliation
Religion does not enter in our care of patients except during small talk. It is revelant, however, to have it on the face sheet of a hospital admission because it would be inappropriate to have a Catholic priest administer Extreme Unction or provide pastoral counseling to a Jewish patient.
Race/Ethnicity & Other Demographic Data
Our federal government has been in charge of the census as stipulated by Article I, Section 2 of the Constitution. Meaningful Use is merely an extension of Big Data gathering since 1790; albeit hendiatris citius, altius, fortius.
Big Data is all the rage; NSA, Facebook, Google & Windows 10. ONC-HIT is on the same bandwagon because CMS seems to think Big Data is the magic bullet for the Medicare funding problem.
All of us, physicians & non-physicians alike, are not too crazy about the tunes; but we don’t control the purse strings.
ONC-HIT probably has little experience caring for patients. If any of them worked in an actual medical office, they would realize nonsense greatly outweighs sense in their mandates.
A patient suggested that more directives justify the existence of ONC-HIT. If ONC-HIT left us alone, Congress may not fund them next year (delicious thought!). So, more output, even if nonsensical, is vital to those folks.
Art,
The current code and deployment model is to dump everything in the bucket “to make it easy to install”. I don’t agree with that model myself, but it’s what the current community seems to be OK wtih.
I would prefer an approach that uses a core base system and the common data required and loadable modules in their own repositories, based on speciality (or need). But … we are a long way from that.
I am not seeing anything at all that involves any federal mandate that would be supported by any portion of this. It is not the ethnicity category list that is required (which does not even have a designation for middle eastern origin), and there is, nowhere, a requirement for a huge list of theological factions.
I see no involvemevInvolvement with congress, onc, abc or cbs in this. It appears to just be some stuff integrated into the main project. Maybe tony is right, and the dev tip is just a dump…so where is the release candidate build?
Feel free to read through the posts in above tracker item to see the massive scale of that code and the features it brings in. Note the two items you bring up were simply drops in the bucket in comparison to the code/features brought in by the code, so the amount of thought that went into them was rather minimal. Note the code reviews were open, but I was the only one whom reviewed the code.
After a nanosecond or two of thought, I felt the ethnicity stuff was fine because all the “fluff” items on the list are not active (note ZH added a feature to allow making list items inactive to support this) and the items are codified for reporting; so, by default they are not used, but the user can use the item(s) if they make them active.
After a nanosecond or two of thought, I felt the religion was fine because the choices were codified and a user can simply turn it off. As fsgl pointed out, my clinical brain also thought this could have use for end of life issues. You have brought up an issue in a recent bug tracker item regarding the mechanism of bringing in new layout items(such as the Religion item) here though that we do need to deal with: https://sourceforge.net/p/openemr/bugs/403/
This is a good example of one of the negative impacts of MU2. Although the above two items were not required for MU2, the sheer mass of everything else that needs to come in brings in some possibly unwanted passengers.
It’s good to be idealistic & practice our craft as it was taught at university.
Because this is an open source project, “orthopraxy” cannot be imposed upon contributors; unless the “Lord High Executioner” wants to do everything himself. Messiness is here to stay.
ONC-HIT’s directives are compounding the untidiness. If nothing else, the breadth of their demands & the time constraints introduce gobs of entropy.
Rather than worrying about the codebase confusion, I’m deeply concerned about the implications of e-CQM’s, wherein the privacy of all Americans will be violated.
I seriously doubt that my colleagues will obtain patient consent prior to sending PHI to the PQRS portal & I cannot imagine patients consenting in the first place.
If the quality of security at the PQRS portal is comparable to that of the Office of Personnel Management’s server (21.5 million records compromised), it is with certainty that groups like Black Vine will hack our collective PHI (yours, mine & all 320 million of us).
We should be so lucky to deal only with small potatoes like entropy gobs.
At Mass Catholics pray for special intentions. Mine would be defunding of ONC-HIT.
Yes, I have some reading to to here, but it remains that …this stuff it totally out of the context of ONC. Period. ONC is not to blame in any way. The proper statement is that we are going to be messy.
