Healthcare companies using Elixir?

My brother (family physician) and I started a direct primary care practice in South Carolina. We ended up building a lot of tools to run the practice and now sell them at https://scalpel.com/. We handle note taking, scheduling, internal/external communication, patient surveys, invoicing, online booking, and more. So there are at least two EMRs built in elixir. @darkmarmot let me know if you want to chat more about what we’re doing.

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That’s awesome! I’ll forward your kudos to Bryan Hunter! :slight_smile: He’s very interested in using Erlang clustering and/or distributed Elixir at scale.

Covid was actually the impetus for our company to move Elixir into production – as we needed something bigger and faster to implement than was typical!

I’d love to share notes on our Elixir use and talk shop!

A slightly different take on our work in one of my talks (more HL7-ish) can be found here:

By the way, The Big Elixir was by far the best conference venue I’ve experienced!

I’ll check out Eric’s talk as well, thanks!

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Nice!

Amazing to hear about using Elixir in that setting; I would love to hear more!

It’s spring break for schools here right now (so most of our team is occupied), but @tomciopp and @jc00ke and @felix-starman – maybe we could organize some kind of virtual Elixir healthcare Zoom together next week if you’re interested? (and anyone else who might want to talk about it?)

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Scalpel looks really great. Nice work. Can you shed any light on the design of the application suite? Does the application do any automatic billing based on documentation or time spent?

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Hi Everyone,

Once this is a post about Healthcare companies and saw mentioned the use of FHIR I want to share that Alissa Knight is calling out for companies to participate anonymously in her next security research project:

The new research will test current apps against the standards and recommended security practices, and will make recommendations based on the research. If you are implementing SMART apps using FHIR APIs we invite you to participate. Interested developers should contact Knight Ink directly to sign up at ak@knightinkmedia.com

I have to do a disclaimer: The sponsor of the research its the company I work for, therefore if this post I against the forum rules, I apologize in advance and please act according.

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Most of our customers are direct primary care clinics, whose billing is much simpler than the traditional fee for service model. These practices charge on a recurring monthly basis (typically ~$70-90) for direct access to a physician. They also typically offer wholesale pricing for labs, procedures, and other services. Since we operate this way we can typically charge lower prices than what people would pay out of pocket while using their insurance. We handle the recurring billing and invoicing right now, we are working on a deeper integration for insurance based billing at the moment.

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Yeah sure I’d be interested.

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Got it. Fee for service is probably going away for everyone eventually. I wish I had gotten involved in software development years ago and done something like Scalpel. I use Epic daily and it is a monster. It’s a very functional monster, but definitely not designed to make the end user happy.

BTW, my employer recently adopted the Telmediq platform for communications amongst staff across a variety of facilities. I have been very curious about the underlying technology stack because as soon as I saw it I thought “that looks like a perfect use case for Elixir!”

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I’m in!

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Definitely! If during the day, I’m free pretty much whenever. If in the evening, I’m free after 8pm EST.

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@felix-starman @jc00ke @tomciopp

Awesome! I’ll post in this thread next week and get in touch to work out a meeting time! Thanks!!

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Our team at CoverMyMeds uses Elixir most of the time. 3/4 of our team’s applications are Elixir, and we’re converting the 1/4 (Ruby) over to Elixir when it makes sense.

Looking more broadly, there’s a smattering of Elixir applications, but most teams are still building new in Ruby.

I’m also interested in a Zoom meetup, @darkmarmot !

The FHIR support in Elixir is… not great from what we’ve been able to find. Most FHIR libraries in Elixir that I’ve looked at are built to solve very specific problems that only the author has. I’d love to help build something more general!

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Awesome! I’ll reach out next week! :slight_smile:

We’ve been handling FHIR mostly “as needed” as well. I wrote a library that was built using the specs from versions 2 thru 4… and would move data to_json or to_fhir or to_map – but after doing so… discovered some issues. I had used their XML schema stuff – only to find out that it contained perhaps 90% of what’s needed. I don’t know why they bother linking it and other document types when they’re apparently incomplete. Further, Elixir’s Jason library doesn’t support roundtrip decimal precision preservation – which is required for FHIR. I ended up creating a local fork of Jason to do so after failing to get the author to support it (note: it appears that his mindset has changed and there are discussions now to support decoding strategies).

At some point, I’m hoping to go back and build an open source Elixir library for FHIR based on what they call their “structure definitions” – which are supposedly the only documents that are canon and complete. But alas, they’re an awful mess that requires mixing old data designs with new… it has to be one of the most dismal specs I’ve ever seen in terms of data definitions.

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I worked on several HL7 related projects in Argentina many years ago. The last ones were in Elixir and as a result of that I open sourced the ex_hl7 library. From what I could see in a few minutes looking at your library, the main difference is that in your library you’re apparently not providing a way to define segments. The library I created works by mapping HL7 segments to Elixir structs, for which you can define schemas. I found that to be much easier to work with than looking up fields/components by their positions/indexes in the segment.

Before this, I had also written an HL7 library for Erlang, which used NIFs to wrap an HL7 parser I had written in C.

Anyway, I haven’t been working in healthcare-related projects for a while now, but I’m happy to chat about this if you ever want to.

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That’s awesome!

How did the C parser work out? I’m looking right now at doing some parsing in Rust with Rustler (haven’t tried before, though…)

We actually did try using structs first, but my company uses HL7 data from many different sources, and a lot of it doesn’t comply with the official spec. Our business rules are usually based around the positional information of HL7, like “PV1-18” or such, since they have exceptions and whatnot everywhere.

We’re putting together a Zoom chat this Thursday at 3PM US Central – I messaged those I saw who expressed interest, but hit me up for a link if I missed you or are interested!

In the past, when I was working on EMR in Elixir, I have started project that was meant to provide structures for all FHIR, but it was abandoned when I changed a job.

We still have 1 seat available for a company wanting to participate 100% anonymously in this case study. You will get your FHIR API and Mobile App pentested for free and the data in the case study report will be 100% anonymized and will not trace back to you, just like we did in the mHealth Hacking Report - All We Let In. To participate you can contact Alissa Knight directly or if you prefer you can contact me via private message.

I wish we had a FHIR app for Alissa/y’all to knock against

For folks in general though, do people like the FHIR protobufs from Google? I liked them but we had limited use so I don’t know how true to the standard they were, and that was a while ago.

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I work at Vital Beats where we write a whole lot of elixir. Its a CE certified medical device. We perform advanced realtime analysis of ECG signals, offer cardiologists ML powered tools to make predictions and track patient’s trends, integrate with major EHR’s and medical device vendor proprietary systems etc. Been in production for approx 4 years now in multiple major heart clinics.

Mostly all elixir we write is a Phoenix apps, as part a microservice. We keep some Python around for specialized tasks, although with the advent of livebooks, kino and nx even that is moving over to Elixir. We found it scary at times (because you can’t always rely on the safety of there being a major open source package for a thing) but thats why we kept our doors open to multiple languages. Frontend is almost exclusively React & RNative. Kubernetes, aws etc.

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