One of the hurdles of EMR systems is that there is a pretty significant minimum viable product due to various standards that can't be ignored. Thankfully, this space is far more open now than it used to be; HL7 for example used to require payment just to see the standards. Pretty much everything you would need access to (HL7, CCDA, SNOMED, LOINC, ICD-10, etc) is freely available now!
Generally just having an EMR system is not enough; you also need practice management, scheduling, billing, insurance claims, etc. Interoperability between separate software for these things is... tenuous at best, though some practices do manage to handle it, it can be very fragile. Hence integrated solutions are pretty much the best way to go, and also prevent disruption from competitors which may be better in one space but not another, since it's so hard to get them to talk to each other well.
> Pretty much everything you would need access to (HL7, CCDA, SNOMED, LOINC, ICD-10, etc) is freely available now!
The AMA’s CPT-4, incorporated as a component of HCPCS, is not free, and is the mandated code set for most professional procedure coding.
And while otherwise that may be true for most of what you need for core EMR functionality, everyone wants EMR and billing/insurance transaction handling to be modules of the same core system (because you are going to need both, and they need to interface smoothly to avoid a whole lot of operational friction), and most of the mandatory billing/insurance standards are decidedly not gratis; older versions of at least the X-12 standards in this space were subsidized by CMS and available for free, but that hasn't been the case for the versions required since 2010. And that's just basic transaction standards, a lot of the code set standards are also proprietary.
(In addition to not being free, the standards in this space are exceptionally poorly written, ambiguous, self-contradictory, and incorporate vast quantities of external material, often also not free, by reference—and often not hyperlinks, but “here is the name of the document and the postal address from which you can contact the entity from which you can order it.”)
I think what would help us the most is not writing software, but instead explaining the requirements in detail (like a specification). There are many people looking for a nice self-contained FOSS project to work on, but many don't know where to look and joining an existing codebase might be too daunting.
There will be an Uber of this space, someone who says "I understand the problems these laws are trying to solve, unfortunately they are a kludge and we can solve them much better with better technology". So complying with all these standards will be a second priority done for backwards compat for the person who comes in and disrupts this space.
Yeah its a total mess, most health systems I work with have 30-50 different vendors all with some various forms of integration with the EMR... It's always a mess, with no end in sights.
Generally just having an EMR system is not enough; you also need practice management, scheduling, billing, insurance claims, etc. Interoperability between separate software for these things is... tenuous at best, though some practices do manage to handle it, it can be very fragile. Hence integrated solutions are pretty much the best way to go, and also prevent disruption from competitors which may be better in one space but not another, since it's so hard to get them to talk to each other well.