RE: [Hardhats-members] Fwd: Text of Article from Modern Physician
we are working on an interface. -Original Message- From: A. Forrey [mailto:[EMAIL PROTECTED] Sent: Tuesday, October 19, 2004 11:15 AM To: [EMAIL PROTECTED] Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician The issue of lab data communication has largely been addressed by to sets of messaging standards: 1) Instrument Interface with lab information systems (particulalry Point-of-Care instrumentation) is address by NCCLS (1 Nov to be: Clinical and Laboratory Standards Institutue - CLSI) POCT1A 2) HL7 v2.x standards and CLSI LIS2A and LIS5A which define instrument-computer and computer-computer system data exchanges. #1 uses message formats from #2 but defines low-lvel protocols similar to LIS1A (the CLSI stds were previously ASTM E-31). The EHR locations of these data (ASTM E-1384) have been mapped to the lab standards and are being related to the newer V3 HL7 standards. VistA has an HL7 messaging module that can deal with these messaging flow how ever the CLSI POCT1A use with respect to lab data flow is in a later state of evolution. Discussions are underway with World VistA about work with the clinical lab specialty societies to address these issues in concert with society educational forums and other meetings. The lab companies below usually have this capability but use of the LOINC vocabulary (present in VistA) within healthcare enterpise business processes is an additional dimension that both lab service and lab information system Suppliers have had difficulty with. Thus this probleme area will require collbaorative work with these healthcare disciplines. On Tue, 19 Oct 2004, Nancy E. Anthracite wrote: I suspect by lab interface Kevin is referring to getting lab results back from Lab Corp, Quest and the like and entering the results directly into the EMR. Some years ago, the cost to do that was usually about $5000 collected by the EMR company and another $5000 collected by the lab for an interface for ONE lab. I don't know it that is true any longer, but I strongly suspect it is. Getting labs to make their output compliant with some standard would be a big step forward and one that I think may have to be mandated by the government sooner or later as there will be little incentive to change otherwise. Now if the VA did not do their own lab for the most part, they are big enough to force a standardized interface. On Tuesday 19 October 2004 02:22 pm, Cameron Schlehuber wrote: I think those are excellent observations! As for lab results, most lab instruments have electronic interfaces built in. (In my experience, even the oldest equipment had at least a rudimentary electronic output.) With regard to upgrading, the VA has been extremely conservative with regard to what kind of equipment the end user needs for access to VistA, as well as the server side hardware and software. Unless you're getting into diagnostic imaging, hardware (and code set license) costs will be in line with support costs (I would guess support costs over a 3 to 5 year upgrade cycle would be nearly the same as the hardware and license fees for the same time period). Having standard health data interchange standards as ubiquitous as the exchange standards banks use is critical to the VA's and the rest of the world's success at providing a cost saving HER. It's among the VHA's highest priority if not THE highest. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Kevin Toppenberg Sent: Tuesday, October 19, 2004 5:18 AM To: [EMAIL PROTECTED] Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . My office manager and I will be attending at the request of my medical group. The group had previously agreed (tenatively) to go with VistA, but they still want me to look at other alternatives. I haven't seen the actual report, but I have heard that AAFP is now strongly recommending that physicians get an EMR system. I think this will push many into buying in--perhaps for fear of liability if something happens after such a strong directive is ignored. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. For example, if labs are not obtained in a standard format that could be shared with others, then users will end up scanning the report and storing it as a graphic. This is no better than a paper chart. And while many labs probably have such an interface, I know that my hospital doesn't. And I suspect a majority of small hospitals don't (and remember that MUCH of America's health
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
Kevin, Kevin Toppenberg wrote: --- Bill Walton [EMAIL PROTECTED] wrote: [snip] The costs for the EMR systems I've looked at recently (GE, A4, NextGen, and Misys) are in the $30-60K per physician range. It's a little dangerous, IMO, if you're going to use numbers like this to be specific WRT what size practice you're talking about. It's important not to set yourself up for strawman arguments against your case. Good point. I guess I forgot the difference between per group and per doctor expense. But actually, the numbers you give are worse. We have 15 doctors in our group, so my part of $150k would be less than $30k. But both are still FAR MORE than I am interested in paying. I'd be very interested in hearing more about the quote you got. $10K / Doc is way less than anything I've seen for systems from top-tier vendors. I'll be happy to share the quotes I got last year. This may or may not be the right place for that exchange. If you're willing to have it but prefer to do it offline, that suits me fine. /snip/ Well, in my mind the HIPAA think is entirely out of hand. I have personally been told at two different medical institutions that a patient (my father) was not allowed to view the medical chart because of HIPAA issues. In far too many minds, HIPAA means a steel wall around information, and only the privilaged few can get through. /snip/ This is outrageous. HIPAA's intent was to establish the patient's right, UNDER LAW, to view their medical records, and to have explicit control over who *else* can view that record. There are exceptions to that, but unless your father is under someone else's legal guardianship or is in a criminal institution, your father has legal recourse if he wants to pursue it. Best regards, Bill --- This SF.net email is sponsored by: IT Product Guide on ITManagersJournal Use IT products in your business? Tell us what you think of them. Give us Your Opinions, Get Free ThinkGeek Gift Certificates! Click to find out more http://productguide.itmanagersjournal.com/guidepromo.tmpl ___ Hardhats-members mailing list [EMAIL PROTECTED] https://lists.sourceforge.net/lists/listinfo/hardhats-members
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
if an Oklahoma gold rush mentality develops to get an EMR, and say a salesman's batting average rises to one hit for every three times up to bat, as opposed to one hit in 10, but while physicians are much more receptive to the idea of buying an EMR today than just four years ago, price is still the No. 1 barrier to EMR purchase, as cited by the recent MGMA survey and the Modern Physician IT survey last year. The AMA says there is no direct number of patient care physicians to multiply these percentages against, because they are for a sample, not a total count, but that said, there are about 514,016 docs in what the AMA calls office-based physicians in patient care,which is not exactly the same as patient care physicians, I'm told, but it is probably close enough for handgrenades and this estimate. So, doing the math, that's 171,167 in solo practice, 57,570 in dual-practice, 43,691 in trio-practice, and 272,428 in those three combined. That's the market that's being underserved right now and where EMR penetration rates are lowest (10%) according to the latest MGMA survey. Joseph Conn Online Editor Modern Physician ModernPhysician.com Modern Physician STAT Heatlh IT Strategist 312-649-5395 [EMAIL PROTECTED] Check out the NEW ModernPhysician.com, and register now for MP Stat and MP Point of Care [EMAIL PROTECTED] 10/15/04 01:07PM May I suggest shifting the frame of reference to the global context which is where open source really matters. In this context the numbers of potential adopters for VistA, whether for clinics or hospitals becomes staggering. Not one of any of the current vendors of any system has the capacity or business model to ramp up the way a well designed open source application with an effective community behind it can. VistA is a classic example of a disruptive technology...stay tuned we are just at the beginning of the ride. Joseph On Fri, 2004-10-15 at 17:03, Michael Ginsburg wrote: Bill, Let's not confuse ourselves. As far as I know, there are no commercial vendors planning to release their products as Open Source or to put them in the public domain. If I'm wrong, please let us know! If I'm right, than the VistA community, regardless of the actual number, is larger than a non-existent (fill in the blank) community. So worrying about something that doesn't exist isn't going to help us. Having said that, the size of the VistA community will be important as we move forward. It's the law of Small Numbers. 1% market penetration is 4000! That's a lot of potential customers for any business. These are customers that will need help implementing their systems, training their users and fixing problems when they arise. They will also be constantly demanding upgrades and improvements. Figuring out how to provide all that to the same standard set by the best non-VistA vendors is the challenge for the VistA community. And I say community because references and credibility are the keys to product acceptance. If a VistA site crashes and burns it will reflect badly and impede the efforts of everyone. You are right, the community needs to get serious. As for documentation, I can assure you that VistA-Office EHR will be a high quality product in all respects, including good documentation. As for M, I see that as being a big plus since it's the only technology that I know of that is purpose-built to handle medical information. But that's just my opinion. Mike [EMAIL PROTECTED] 10/15/2004 4:17:15 PM Hi Michael, - Original Message - From: Michael Ginsburg To: [EMAIL PROTECTED] Sent: Friday, October 15, 2004 1:18 PM Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician In my opinion, (and, as always, I speak only for myself) I would agree that in a head to head competition with Open Logician that VistA-Office EHR would lose. That is if all you were comparing was functionality. As a system for the physician's office, Logician is a more mature offering, no question. VistA-Office EHR is only in the embryonic stage. However, if you were to compare them in open source market and all that implies and entails, VistA-Office EHR would be the clear winner. To the best of my knowledge, Logician does not have a rabid (and I mean that only in the nicest sense!), international community of developers or an organized community of cooperating vendors who can supply professional services, with all working in concert to promote, support and enhance the application. This community you speak of... how big is it exactly? Compared to the one the exists
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
That makes a lot of sense and is one of the potential ROI's for an EHR that has been overlooked. Will they offer a discount for physicians that use EHR's? Are there circumstances under which they would consider offering a discount? [EMAIL PROTECTED] 10/19/2004 12:10:20 PM Well, the company is State Volunteer Mutual InsuraceCompany, and it is physician run an owned. They haveregular education programs with the idea of promotinggood practice patterns to AVOID malpractice cases inthe first place.I guess they believe that an EMR will reducemalpractice events.Kevin--- Michael Ginsburg [EMAIL PROTECTED] wrote: Kevin, I am most interested in your first sentence. Why is your medical malpractice company hosting the conference? Mike [EMAIL PROTECTED] 10/19/2004 8:17:45 AM Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . My office manager and I will be attending at the request of my medical group. The group had previously agreed (tenatively) to go with VistA, but they still want me to look at other alternatives. I haven't seen the actual report, but I have heard that AAFP is now "strongly recommending" that physicians get an EMR system. I think this will push many into buying in--perhaps for fear of liability if something happens after such a strong directive is ignored. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. For example, if labs are not obtained in a standard format that could be shared with others, then users will end up scanning the report and storing it as a graphic. This is no better than a paper chart. And while many labs probably have such an interface, I know that my hospital doesn't. And I suspect a majority of small hospitals don't (and remember that MUCH of America's health care is given by small practices working with small hospitals). So after AAFP and other organizations push doctors into coughing up the $100-200k needed to get a new system up and running, will patient care be better? I'm not convinced it will. I have heard that thought leaders feel that a good EMR could achieve a 20% reduction in health care expendatures. But unless my EMR will somehow let me instantly access a lab/study ordered by another physician in another city, I don't see how this could happen. And now system I have seen addresses this issue. With HIPPA nervousness abounding, no one will release records without a written signature from a patient, and I not heard of any quicker electronic solution to this problem. I keep a relatively well organized paper chart with tabs etc. It is fast and complete. It easily stores the carbon copies of scripts that I write, letters that patients write me, copies of their advance directives etc etc. All these things would have to be scanned in an EMR, and then possibly lost in a shuffle of filenames (i.e. "image1462"). My charts are portable: they can travel in the car with me, or I can take them to the hospital when admitting a patient. They're flexible: I could have a visit in a patient's home if required (i.e. I don't have to have a computer station set up.) They're "hi-res": Most computer screens have to magnify the image so that a scanned image is readable. Thus a full scanned page often won't fit on a screen and still be legible. So you have to scroll around. Paper doesn't have this problem. As one who has put in a significant amount of time working with VistA, I don't want to sound like a Luddite anti-technologist. But I am seriously concerned that physicians are being pushed into making a sudden technology change away from a system that has withstood the test of time. I'm also concerned about a "lock-in" issue. I suspect that none of us use the same word processor that we did 10 years ago, but rather technology has progressed and we regularly purchase the latest and greatest. But will physicians be willing to purchase system after system the way we do computers now? I doubt it. If our group buys a non-VistA EMR, I imagine we will keep it at least 10 years. We'll be locked into 2004 technology until 2014. (Our current system is 1980's technology) So what do I think the solution is to all this? Well, VistA goes a long way. First, it is easily conceivable that VistA could be established in an office for ~$10-20k, one-tenth the cost of a commercial system. (And my goal is to make the cost much less than this). This will make it much less painful for small practices, and still quite attractive for vendors (multiply the "272,428 practices" below by $10,000 makes for a nice retirement plan.) And if we have a critical mass of physicians on the same system, we have more chance of interoperability. So in summary, I support getting EMRs
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
Well, the company is State Volunteer Mutual Insurace Company, and it is physician run an owned. They have regular education programs with the idea of promoting good practice patterns to AVOID malpractice cases in the first place. I guess they believe that an EMR will reduce malpractice events. Kevin --- Michael Ginsburg [EMAIL PROTECTED] wrote: Kevin, I am most interested in your first sentence. Why is your medical malpractice company hosting the conference? Mike [EMAIL PROTECTED] 10/19/2004 8:17:45 AM Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . My office manager and I will be attending at the request of my medical group. The group had previously agreed (tenatively) to go with VistA, but they still want me to look at other alternatives. I haven't seen the actual report, but I have heard that AAFP is now strongly recommending that physicians get an EMR system. I think this will push many into buying in--perhaps for fear of liability if something happens after such a strong directive is ignored. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. For example, if labs are not obtained in a standard format that could be shared with others, then users will end up scanning the report and storing it as a graphic. This is no better than a paper chart. And while many labs probably have such an interface, I know that my hospital doesn't. And I suspect a majority of small hospitals don't (and remember that MUCH of America's health care is given by small practices working with small hospitals). So after AAFP and other organizations push doctors into coughing up the $100-200k needed to get a new system up and running, will patient care be better? I'm not convinced it will. I have heard that thought leaders feel that a good EMR could achieve a 20% reduction in health care expendatures. But unless my EMR will somehow let me instantly access a lab/study ordered by another physician in another city, I don't see how this could happen. And now system I have seen addresses this issue. With HIPPA nervousness abounding, no one will release records without a written signature from a patient, and I not heard of any quicker electronic solution to this problem. I keep a relatively well organized paper chart with tabs etc. It is fast and complete. It easily stores the carbon copies of scripts that I write, letters that patients write me, copies of their advance directives etc etc. All these things would have to be scanned in an EMR, and then possibly lost in a shuffle of filenames (i.e. image1462). My charts are portable: they can travel in the car with me, or I can take them to the hospital when admitting a patient. They're flexible: I could have a visit in a patient's home if required (i.e. I don't have to have a computer station set up.) They're hi-res: Most computer screens have to magnify the image so that a scanned image is readable. Thus a full scanned page often won't fit on a screen and still be legible. So you have to scroll around. Paper doesn't have this problem. As one who has put in a significant amount of time working with VistA, I don't want to sound like a Luddite anti-technologist. But I am seriously concerned that physicians are being pushed into making a sudden technology change away from a system that has withstood the test of time. I'm also concerned about a lock-in issue. I suspect that none of us use the same word processor that we did 10 years ago, but rather technology has progressed and we regularly purchase the latest and greatest. But will physicians be willing to purchase system after system the way we do computers now? I doubt it. If our group buys a non-VistA EMR, I imagine we will keep it at least 10 years. We'll be locked into 2004 technology until 2014. (Our current system is 1980's technology) So what do I think the solution is to all this? Well, VistA goes a long way. First, it is easily conceivable that VistA could be established in an office for ~$10-20k, one-tenth the cost of a commercial system. (And my goal is to make the cost much less than this). This will make it much less painful for small practices, and still quite attractive for vendors (multiply the 272,428 practices below by $10,000 makes for a nice retirement plan.) And if we have a critical mass of physicians on the same system, we have more chance of interoperability. So in summary, I support getting EMRs into physicians offices, but I think we need to have realistic goals. We need to provide inexpensive
RE: [Hardhats-members] Fwd: Text of Article from Modern Physician
I think those are excellent observations! As for lab results, most lab instruments have electronic interfaces built in. (In my experience, even the oldest equipment had at least a rudimentary electronic output.) With regard to upgrading, the VA has been extremely conservative with regard to what kind of equipment the end user needs for access to VistA, as well as the server side hardware and software. Unless you're getting into diagnostic imaging, hardware (and code set license) costs will be in line with support costs (I would guess support costs over a 3 to 5 year upgrade cycle would be nearly the same as the hardware and license fees for the same time period). Having standard health data interchange standards as ubiquitous as the exchange standards banks use is critical to the VA's and the rest of the world's success at providing a cost saving HER. It's among the VHA's highest priority if not THE highest. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Kevin Toppenberg Sent: Tuesday, October 19, 2004 5:18 AM To: [EMAIL PROTECTED] Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . My office manager and I will be attending at the request of my medical group. The group had previously agreed (tenatively) to go with VistA, but they still want me to look at other alternatives. I haven't seen the actual report, but I have heard that AAFP is now strongly recommending that physicians get an EMR system. I think this will push many into buying in--perhaps for fear of liability if something happens after such a strong directive is ignored. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. For example, if labs are not obtained in a standard format that could be shared with others, then users will end up scanning the report and storing it as a graphic. This is no better than a paper chart. And while many labs probably have such an interface, I know that my hospital doesn't. And I suspect a majority of small hospitals don't (and remember that MUCH of America's health care is given by small practices working with small hospitals). So after AAFP and other organizations push doctors into coughing up the $100-200k needed to get a new system up and running, will patient care be better? I'm not convinced it will. I have heard that thought leaders feel that a good EMR could achieve a 20% reduction in health care expendatures. But unless my EMR will somehow let me instantly access a lab/study ordered by another physician in another city, I don't see how this could happen. And now system I have seen addresses this issue. With HIPPA nervousness abounding, no one will release records without a written signature from a patient, and I not heard of any quicker electronic solution to this problem. I keep a relatively well organized paper chart with tabs etc. It is fast and complete. It easily stores the carbon copies of scripts that I write, letters that patients write me, copies of their advance directives etc etc. All these things would have to be scanned in an EMR, and then possibly lost in a shuffle of filenames (i.e. image1462). My charts are portable: they can travel in the car with me, or I can take them to the hospital when admitting a patient. They're flexible: I could have a visit in a patient's home if required (i.e. I don't have to have a computer station set up.) They're hi-res: Most computer screens have to magnify the image so that a scanned image is readable. Thus a full scanned page often won't fit on a screen and still be legible. So you have to scroll around. Paper doesn't have this problem. As one who has put in a significant amount of time working with VistA, I don't want to sound like a Luddite anti-technologist. But I am seriously concerned that physicians are being pushed into making a sudden technology change away from a system that has withstood the test of time. I'm also concerned about a lock-in issue. I suspect that none of us use the same word processor that we did 10 years ago, but rather technology has progressed and we regularly purchase the latest and greatest. But will physicians be willing to purchase system after system the way we do computers now? I doubt it. If our group buys a non-VistA EMR, I imagine we will keep it at least 10 years. We'll be locked into 2004 technology until 2014. (Our current system is 1980's technology) So what do I think the solution is to all this? Well, VistA goes a long way. First, it is easily conceivable that VistA could be established in an office for ~$10-20k, one-tenth the cost
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
Kevin, Nice post. Comments / support in-line below. Kevin Toppenberg wrote: Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . I hope you'll let us know what they say their reason is. More on this below. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. I absolutely agree. But while I think your example of lab data interchange is a good / valid one, I believe there are even stronger reasons for the interoperability requirement. /snip/ So after AAFP and other organizations push doctors into coughing up the $100-200k needed to get a new system up and running, The costs for the EMR systems I've looked at recently (GE, A4, NextGen, and Misys) are in the $30-60K per physician range. It's a little dangerous, IMO, if you're going to use numbers like this to be specific WRT what size practice you're talking about. It's important not to set yourself up for strawman arguments against your case. will patient care be better? I'm not convinced it will. EMR's have very little to do with improving patient care per se. They are mostly touted in an error-avoidance setting. I have heard that thought leaders feel that a good EMR could achieve a 20% reduction in health care expendatures. These numbers are nonsense as they relate to community-based physicians. They come from institutional settings where, for example, there are entire groups of employees devoted to nothing but record retrieval, *large* amounts of room devoted to paper record storage that can be converted to revenue-producing uses, etc. In the seven practices I worked for last year, not one of them predicted that they would be able to reduce staffing levels or convert space to revenue producing uses. In fact, given that servers couldn't realistically be kept out in the open like the file cabinets, some worried whether adopting an EMR system might have the opposite effect. None of this, of course, dissuades the evangalists. But unless my EMR will somehow let me instantly access a lab/study ordered by another physician in another city, I don't see how this could happen. How often does this happen? And how much money does it save each time? 20% is a big number if we're talking about reductions in the average. This example won't get it anywhere close. And now system I have seen addresses this issue. You're right about this. Some of the major vendors do have a product offering that will allow you to exchange data between installations of their own systems under a very limited set of circumstances. It tends to be an expensive option though, based on what I saw last year. With HIPPA nervousness abounding, no one will release records without a written signature from a patient, and I not heard of any quicker electronic solution to this problem. This is another one of those circumstances where I'd recommend you use this argument with caution. HIPAA definitely allows the circumstance you outlined above. But you're right, the legal vultures have created such an environment of fear, uncertainty, and doubt that many physicians are reluctant to even do what the law, including the preamble, clearly says they can do. I keep a relatively well organized paper chart with tabs etc. It is fast and complete. It easily stores the carbon copies of scripts that I write, letters that patients write me, copies of their advance directives etc etc. All these things would have to be scanned in an EMR, and then possibly lost in a shuffle of filenames (i.e. image1462). My charts are portable: they can travel in the car with me, or I can take them to the hospital when admitting a patient. They're flexible: I could have a visit in a patient's home if required (i.e. I don't have to have a computer station set up.) They're hi-res: Most computer screens have to magnify the image so that a scanned image is readable. Thus a full scanned page often won't fit on a screen and still be legible. So you have to scroll around. Paper doesn't have this problem. You're right about these technical issues too. As one who has put in a significant amount of time working with VistA, I don't want to sound like a Luddite anti-technologist. But I am seriously concerned that physicians are being pushed into making a sudden technology change away from a system that has withstood the test of time. In my mind, there's only one reason for community-based physicians to an EMR system: ROI. That could take several forms. 1) getting paid faster for services rendered 2) getting paid more for services rendered (CMS is actually talking about this) 3) reduced expenses (As discussed above, the typical
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
I'll check when I attend the conference. If I find anything out, I'll post here.. Kevin --- Michael Ginsburg [EMAIL PROTECTED] wrote: That makes a lot of sense and is one of the potential ROI's for an EHR that has been overlooked. Will they offer a discount for physicians that use EHR's? Are there circumstances under which they would consider offering a discount? [EMAIL PROTECTED] 10/19/2004 12:10:20 PM Well, the company is State Volunteer Mutual Insurace Company, and it is physician run an owned. They have regular education programs with the idea of promoting good practice patterns to AVOID malpractice cases in the first place. I guess they believe that an EMR will reduce malpractice events. Kevin --- Michael Ginsburg [EMAIL PROTECTED] wrote: Kevin, I am most interested in your first sentence. Why is your medical malpractice company hosting the conference? Mike [EMAIL PROTECTED] 10/19/2004 8:17:45 AM Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . My office manager and I will be attending at the request of my medical group. The group had previously agreed (tenatively) to go with VistA, but they still want me to look at other alternatives. I haven't seen the actual report, but I have heard that AAFP is now strongly recommending that physicians get an EMR system. I think this will push many into buying in--perhaps for fear of liability if something happens after such a strong directive is ignored. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. For example, if labs are not obtained in a standard format that could be shared with others, then users will end up scanning the report and storing it as a graphic. This is no better than a paper chart. And while many labs probably have such an interface, I know that my hospital doesn't. And I suspect a majority of small hospitals don't (and remember that MUCH of America's health care is given by small practices working with small hospitals). So after AAFP and other organizations push doctors into coughing up the $100-200k needed to get a new system up and running, will patient care be better? I'm not convinced it will. I have heard that thought leaders feel that a good EMR could achieve a 20% reduction in health care expendatures. But unless my EMR will somehow let me instantly access a lab/study ordered by another physician in another city, I don't see how this could happen. And now system I have seen addresses this issue. With HIPPA nervousness abounding, no one will release records without a written signature from a patient, and I not heard of any quicker electronic solution to this problem. I keep a relatively well organized paper chart with tabs etc. It is fast and complete. It easily stores the carbon copies of scripts that I write, letters that patients write me, copies of their advance directives etc etc. All these things would have to be scanned in an EMR, and then possibly lost in a shuffle of filenames (i.e. image1462). My charts are portable: they can travel in the car with me, or I can take them to the hospital when admitting a patient. They're flexible: I could have a visit in a patient's home if required (i.e. I don't have to have a computer station set up.) They're hi-res: Most computer screens have to magnify the image so that a scanned image is readable. Thus a full scanned page often won't fit on a screen and still be legible. So you have to scroll around. Paper doesn't have this problem. As one who has put in a significant amount of time working with VistA, I don't want to sound like a Luddite anti-technologist. But I am seriously concerned that physicians are being pushed into making a sudden technology change away from a system that has withstood the test of time. I'm also concerned about a lock-in issue. I suspect that none of us use the same word processor that we did 10 years ago, but rather technology has progressed and we regularly purchase the latest and greatest. But will physicians be willing to purchase system after system the way we do computers now? I doubt it. If our group buys a non-VistA EMR, I imagine we will keep it at least 10 years. We'll be locked into 2004 technology until 2014. (Our current system is 1980's technology) So what do I think the solution is to all this? Well, VistA goes a long way. First, it is easily conceivable that VistA could be
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
P.S. Michael, do you think it would be worthwile for me to attend the VistA office meeting, or is it primarily targeted for venders? Thanks, Kevin --- Michael Ginsburg [EMAIL PROTECTED] wrote: That makes a lot of sense and is one of the potential ROI's for an EHR that has been overlooked. Will they offer a discount for physicians that use EHR's? Are there circumstances under which they would consider offering a discount? [EMAIL PROTECTED] 10/19/2004 12:10:20 PM Well, the company is State Volunteer Mutual Insurace Company, and it is physician run an owned. They have regular education programs with the idea of promoting good practice patterns to AVOID malpractice cases in the first place. I guess they believe that an EMR will reduce malpractice events. Kevin --- Michael Ginsburg [EMAIL PROTECTED] wrote: Kevin, I am most interested in your first sentence. Why is your medical malpractice company hosting the conference? Mike [EMAIL PROTECTED] 10/19/2004 8:17:45 AM Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . My office manager and I will be attending at the request of my medical group. The group had previously agreed (tenatively) to go with VistA, but they still want me to look at other alternatives. I haven't seen the actual report, but I have heard that AAFP is now strongly recommending that physicians get an EMR system. I think this will push many into buying in--perhaps for fear of liability if something happens after such a strong directive is ignored. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. For example, if labs are not obtained in a standard format that could be shared with others, then users will end up scanning the report and storing it as a graphic. This is no better than a paper chart. And while many labs probably have such an interface, I know that my hospital doesn't. And I suspect a majority of small hospitals don't (and remember that MUCH of America's health care is given by small practices working with small hospitals). So after AAFP and other organizations push doctors into coughing up the $100-200k needed to get a new system up and running, will patient care be better? I'm not convinced it will. I have heard that thought leaders feel that a good EMR could achieve a 20% reduction in health care expendatures. But unless my EMR will somehow let me instantly access a lab/study ordered by another physician in another city, I don't see how this could happen. And now system I have seen addresses this issue. With HIPPA nervousness abounding, no one will release records without a written signature from a patient, and I not heard of any quicker electronic solution to this problem. I keep a relatively well organized paper chart with tabs etc. It is fast and complete. It easily stores the carbon copies of scripts that I write, letters that patients write me, copies of their advance directives etc etc. All these things would have to be scanned in an EMR, and then possibly lost in a shuffle of filenames (i.e. image1462). My charts are portable: they can travel in the car with me, or I can take them to the hospital when admitting a patient. They're flexible: I could have a visit in a patient's home if required (i.e. I don't have to have a computer station set up.) They're hi-res: Most computer screens have to magnify the image so that a scanned image is readable. Thus a full scanned page often won't fit on a screen and still be legible. So you have to scroll around. Paper doesn't have this problem. As one who has put in a significant amount of time working with VistA, I don't want to sound like a Luddite anti-technologist. But I am seriously concerned that physicians are being pushed into making a sudden technology change away from a system that has withstood the test of time. I'm also concerned about a lock-in issue. I suspect that none of us use the same word processor that we did 10 years ago, but rather technology has progressed and we regularly purchase the latest and greatest. But will physicians be willing to purchase system after system the way we do computers now? I doubt it. If our group buys a non-VistA EMR, I imagine we will keep it at least 10 years. We'll be locked into 2004 technology until 2014. (Our current system is 1980's technology) So what do I think the solution is to all this? Well, VistA goes a long way.
RE: [Hardhats-members] Fwd: Text of Article from Modern Physician
The VA is heavily involved with Reference Terminology efforts, both within the VA (continuous evolution of our Enterprise Reference Terminology and tools for it's upkeep and distribution) as well as engaged in standards setting groups (HL7 as well as numerous specialty domains, e.g., lab, pharmacy, nursing, etc.) Even before everything gets re-hosted, we will be adding unique IDs (VHA Unique IDs or VUIDs) to as many of the table entries in VistA as we can. (Concepts and their VUIDs that are shared or likely to be shared across all systems, e.g., to assign a unique ID to each allergen ... a strawberry allergy might have an assigned number of 1004325786 ... and every entry of strawberries in each system in the VA would get that number associated with it so that allergies for a given patient would have that code and not the variations on the spelling or abbreviations of strawberry. Furthermore, that code would be associated with various other codes for concepts like food, allergy, etc. We'll also be moving towards using HL7 V 3 message structures (soon I hope!) -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Bill Walton Sent: Tuesday, October 19, 2004 12:07 PM To: [EMAIL PROTECTED] Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician Cameron Schlehuber wrote: /snip/ Having standard health data interchange standards as ubiquitous as the exchange standards banks use is critical to the VA's and the rest of the world's success at providing a cost saving HER. It's among the VHA's highest priority if not THE highest. Any chance you could say more about what's going on in this area? Thanks, Bill --- This SF.net email is sponsored by: IT Product Guide on ITManagersJournal Use IT products in your business? Tell us what you think of them. Give us Your Opinions, Get Free ThinkGeek Gift Certificates! Click to find out more http://productguide.itmanagersjournal.com/guidepromo.tmpl ___ Hardhats-members mailing list [EMAIL PROTECTED] https://lists.sourceforge.net/lists/listinfo/hardhats-members
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
I suspect by lab interface Kevin is referring to getting lab results back from Lab Corp, Quest and the like and entering the results directly into the EMR. Some years ago, the cost to do that was usually about $5000 collected by the EMR company and another $5000 collected by the lab for an interface for ONE lab. I don't know it that is true any longer, but I strongly suspect it is. Getting labs to make their output compliant with some standard would be a big step forward and one that I think may have to be mandated by the government sooner or later as there will be little incentive to change otherwise. Now if the VA did not do their own lab for the most part, they are big enough to force a standardized interface. On Tuesday 19 October 2004 02:22 pm, Cameron Schlehuber wrote: I think those are excellent observations! As for lab results, most lab instruments have electronic interfaces built in. (In my experience, even the oldest equipment had at least a rudimentary electronic output.) With regard to upgrading, the VA has been extremely conservative with regard to what kind of equipment the end user needs for access to VistA, as well as the server side hardware and software. Unless you're getting into diagnostic imaging, hardware (and code set license) costs will be in line with support costs (I would guess support costs over a 3 to 5 year upgrade cycle would be nearly the same as the hardware and license fees for the same time period). Having standard health data interchange standards as ubiquitous as the exchange standards banks use is critical to the VA's and the rest of the world's success at providing a cost saving HER. It's among the VHA's highest priority if not THE highest. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Kevin Toppenberg Sent: Tuesday, October 19, 2004 5:18 AM To: [EMAIL PROTECTED] Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . My office manager and I will be attending at the request of my medical group. The group had previously agreed (tenatively) to go with VistA, but they still want me to look at other alternatives. I haven't seen the actual report, but I have heard that AAFP is now strongly recommending that physicians get an EMR system. I think this will push many into buying in--perhaps for fear of liability if something happens after such a strong directive is ignored. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. For example, if labs are not obtained in a standard format that could be shared with others, then users will end up scanning the report and storing it as a graphic. This is no better than a paper chart. And while many labs probably have such an interface, I know that my hospital doesn't. And I suspect a majority of small hospitals don't (and remember that MUCH of America's health care is given by small practices working with small hospitals). So after AAFP and other organizations push doctors into coughing up the $100-200k needed to get a new system up and running, will patient care be better? I'm not convinced it will. I have heard that thought leaders feel that a good EMR could achieve a 20% reduction in health care expendatures. But unless my EMR will somehow let me instantly access a lab/study ordered by another physician in another city, I don't see how this could happen. And now system I have seen addresses this issue. With HIPPA nervousness abounding, no one will release records without a written signature from a patient, and I not heard of any quicker electronic solution to this problem. I keep a relatively well organized paper chart with tabs etc. It is fast and complete. It easily stores the carbon copies of scripts that I write, letters that patients write me, copies of their advance directives etc etc. All these things would have to be scanned in an EMR, and then possibly lost in a shuffle of filenames (i.e. image1462). My charts are portable: they can travel in the car with me, or I can take them to the hospital when admitting a patient. They're flexible: I could have a visit in a patient's home if required (i.e. I don't have to have a computer station set up.) They're hi-res: Most computer screens have to magnify the image so that a scanned image is readable. Thus a full scanned page often won't fit on a screen and still be legible. So you have to scroll around. Paper doesn't have this problem. As one who has put in a significant amount of time working with VistA, I don't want
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
The issue of lab data communication has largely been addressed by to sets of messaging standards: 1) Instrument Interface with lab information systems (particulalry Point-of-Care instrumentation) is address by NCCLS (1 Nov to be: Clinical and Laboratory Standards Institutue - CLSI) POCT1A 2) HL7 v2.x standards and CLSI LIS2A and LIS5A which define instrument-computer and computer-computer system data exchanges. #1 uses message formats from #2 but defines low-lvel protocols similar to LIS1A (the CLSI stds were previously ASTM E-31). The EHR locations of these data (ASTM E-1384) have been mapped to the lab standards and are being related to the newer V3 HL7 standards. VistA has an HL7 messaging module that can deal with these messaging flow how ever the CLSI POCT1A use with respect to lab data flow is in a later state of evolution. Discussions are underway with World VistA about work with the clinical lab specialty societies to address these issues in concert with society educational forums and other meetings. The lab companies below usually have this capability but use of the LOINC vocabulary (present in VistA) within healthcare enterpise business processes is an additional dimension that both lab service and lab information system Suppliers have had difficulty with. Thus this probleme area will require collbaorative work with these healthcare disciplines. On Tue, 19 Oct 2004, Nancy E. Anthracite wrote: I suspect by lab interface Kevin is referring to getting lab results back from Lab Corp, Quest and the like and entering the results directly into the EMR. Some years ago, the cost to do that was usually about $5000 collected by the EMR company and another $5000 collected by the lab for an interface for ONE lab. I don't know it that is true any longer, but I strongly suspect it is. Getting labs to make their output compliant with some standard would be a big step forward and one that I think may have to be mandated by the government sooner or later as there will be little incentive to change otherwise. Now if the VA did not do their own lab for the most part, they are big enough to force a standardized interface. On Tuesday 19 October 2004 02:22 pm, Cameron Schlehuber wrote: I think those are excellent observations! As for lab results, most lab instruments have electronic interfaces built in. (In my experience, even the oldest equipment had at least a rudimentary electronic output.) With regard to upgrading, the VA has been extremely conservative with regard to what kind of equipment the end user needs for access to VistA, as well as the server side hardware and software. Unless you're getting into diagnostic imaging, hardware (and code set license) costs will be in line with support costs (I would guess support costs over a 3 to 5 year upgrade cycle would be nearly the same as the hardware and license fees for the same time period). Having standard health data interchange standards as ubiquitous as the exchange standards banks use is critical to the VA's and the rest of the world's success at providing a cost saving HER. It's among the VHA's highest priority if not THE highest. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Kevin Toppenberg Sent: Tuesday, October 19, 2004 5:18 AM To: [EMAIL PROTECTED] Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician Hello all, In Tennessee, our medical malpractice company is hosting an EMR conference this December (and why it is them is interesting) . My office manager and I will be attending at the request of my medical group. The group had previously agreed (tenatively) to go with VistA, but they still want me to look at other alternatives. I haven't seen the actual report, but I have heard that AAFP is now strongly recommending that physicians get an EMR system. I think this will push many into buying in--perhaps for fear of liability if something happens after such a strong directive is ignored. This will be an business expense, not an investment, because there will be little (and I suspect no) financial return on this expendature. But frankly, I worry that this will be an expensive wild goose chase. I believe the power of an EMR will not be realized unless there is interoperability. For example, if labs are not obtained in a standard format that could be shared with others, then users will end up scanning the report and storing it as a graphic. This is no better than a paper chart. And while many labs probably have such an interface, I know that my hospital doesn't. And I suspect a majority of small hospitals don't (and remember that MUCH of America's health care is given by small practices working with small hospitals). So after AAFP and other organizations push doctors into coughing up the $100-200k needed to get a new system up and running, will patient care be better? I'm not convinced it will. I have heard that thought leaders feel that a good EMR could
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
A. Forrey wrote: /snip/ Discussions are underway with World VistA about work with the clinical lab specialty societies to address these issues in concert with society educational forums and other meetings. Really?!?!?! I thought this was where we'd hear about stuff like that. Or is there a seperate, secret WV forum we peons just don't get to know about? Is this type of info just club members only type info? Or what? Do any of the WV folks have *any* idea what a proper OSS community looks like? WV is really starting to look like just the other side of the same coin to me. --- This SF.net email is sponsored by: IT Product Guide on ITManagersJournal Use IT products in your business? Tell us what you think of them. Give us Your Opinions, Get Free ThinkGeek Gift Certificates! Click to find out more http://productguide.itmanagersjournal.com/guidepromo.tmpl ___ Hardhats-members mailing list [EMAIL PROTECTED] https://lists.sourceforge.net/lists/listinfo/hardhats-members
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
Bill, Im glad you mentioned the California HealthCare Foundation and this article; Ive found the information there quite helpful over the years (www.chcf.org). When Forrester Research published, Electronic Medical Records: A buyers Guide for Small Physician Practices, last year they included the spreadsheet EMR Evaluation Tool for one to use to evaluate other EMR products. Even though I did not necessary agree with the weighting and all the evaluation criteria that this study used, I used it to evaluate VistA when the tool came out. Based on my opinion, personal experience and personal bias using the EMR Evaluation tool, VistA fell into the Strong Performers range of the Forrester Wave chart, it was not the lowest that score of the group but if my memory serves me it was close. I am positive that others would get other scores, both above and below what I scored it at. Now, I gave my evaluation a bit of free reign and as my memory serves me it was as follows: The references to a Relation database I just ignored. (I will agree to disagree on the MUMPS debate.) The references to a Browser-Based Graphical user interface I score based on Graphical which CPRS is. Where they talked about support I used Average. Where they talked to a companys executive team about the future I used Adequate. Where they looked at Market Presence I scored it as if the VA was part of it. I am sure there were other places in the scoring that I used my opinionbut I tried to be fair in my understanding of VistA. I am in the western part of North Dakota until Tuesday when I fly out to DC, I will try to find my scoring sheet for this when Im back in Fargo if anybody is interested please drop me a line and I will forward it to you. One of the reason I never brought this tool up to the VistA community is that I did this as an exercise for myself and what I took away from this exercise is that VistA is a viable option to other similar products on the market today. Also, that there is work to be done on many levels of VistAfrom the coding to the installing, training and support of VistA and these are opportunities for us all. The time to do this is now. Sincerely, Mark Amundson PharmD Amundson Partners Inc Fargo, ND 58102 [EMAIL PROTECTED] 701-261-8852 On Fri, 15 Oct 2004 14:47 , 'Bill Walton' [EMAIL PROTECTED] sent: Mark, Mark Amundson wrote: Bill Could you give me a quick head to head comparison of VistA/CPRS and Logician. Glad to. Thanks for asking. Please note that I did not choose Logician as an example because I think it's a market-leading product. Not even close, based on my own experience leading a due diligence project for a group of 7 neurology practices last year, and based on published results from folks like the AC Group and TEPR. I chose it precisely *because* it's not. I'd like the group to consider the market reality that even a mediocre product can win the day (remember Windows vs. Mac?). I have used Logician as a clinician (Last time was 2.5 years ago and I do not remember the version), but my experience is that VistA/ CPRS is a better, friendlier product that was superior in many regards. Ease of use, which is what I interpret "better, friendlier" to mean, is an important but very subjective measure. Certainly not the only one that's recommended that physicians evaluate in their selection criteria. I'll use the high-level criteria recommended by Forrester Research in their October 2003 paper, "Electronic Medical Records: A Buyer's Guide for Small Physician Practices" prepared for the California Healthcare Foundation. You can find it at http://www.chcf.org/documents/ihealth/ForresterEMRBuyersGuideRevise.pdf Forrester recommends three high level criteria: 1) The quality of the current offering, including features, ease of use, support and service, and cost; 2) The vendor's strategy, meaning the future plans the company has for its EMR; and 3) The vendor's market presence, in terms of financial strength, customer base, and partnerships with other firms. I've dealt with these in some detail below, but will sum it up here. The lack of documentation and M-base combine to make it very hard to forecast VistA's viability if it has to compete with other Open Source EMR systems with established reputations and market presence. From a market perspective, it boils down to supply and demand. If demand for EMR systems increases and the supply of people capable of installing, servicing, and enhancing VistA does not, physicians will choose VistA's competitors. As an example from another market, there are lots of people who want to buy a Hybrid car (the waiting list for a Toyota Prius is 9 months to a year). Some consumers wait. Most just buy something else. So, for the sake of discussion, let's take a look at how the Logician "salesman" might present his case based on Forrester's recomended selection criteria. 1) The quality of the current offering,
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
This is GREAT news!Andthe Health IT Strategist article, together with the VistA Office release, are "shots heard 'round the world" signaling VistA's long term viability. Or are they? Before you "pop the cork" I thinkyoushould consider another, very probable (based on my 16 years of experience IT products and services)possibility. The "we're there" case is really only viable to the extent that VistA Office will be the only "industrial strength" Open Source (i.e., free) EHRsoftware available tocommunity-based physicians. What happens when that changes? How does VistA fare in head-to-head competition with, say, "Open Logician"? My background saysVistA loses, big time. On every single front that matter from a market viability perspective. Iwon't rain on your parade anymore here except to say that unless the VistA community addresses the marketability issues that have, more than once, been pointed out here, the recent HHSinitiatives regarding VistA are not "21 gun salutes." They're shots to the head. I thinkyou need to begina serious discussion of survival strategy. Best regards, Bill - Original Message - From: Michael Ginsburg To: [EMAIL PROTECTED] Sent: Friday, October 15, 2004 8:04 AM Subject: [Hardhats-members] Fwd: Text of Article from Modern Physician This is from Modern Physician: IT vendors invited to show interest in new vistas By Joseph Conn / October 13, 2004 Next week, the CMS will hold a meeting with information technology vendors interested in using a proposed version of the Department of Veterans Affairs' comprehensive computerized electronic record and IT system -- the Veterans Health Information Systems Technology Architecture, or Vista -- modified for use in physician offices. The CMS/VA effort aims to bring the Vista Office Electronic Health Record, a proven, affordable version of an electronic medical records system, to the small-group office practice, where EMR penetration rates are lowest due to system costs. The vendors meeting on the Vista-Electronic Health Records project is scheduled for Oct. 20 in Washington, D.C. At the meeting, CMS and VA officials will gauge the level of vendor interest in the project as well as raise awareness of the initiative, according to Capt. Cynthia Wark, an officer in the Public Health Service and deputy director of the information systems group in the CMS' Office of Clinical Standards and Quality. "We just want to figure out if we put this out on the street, are any of the vendors going to pick up on it," said Wark. "We're trying to gauge the interest. The other thing is to let people know what we're doing." Wark is a registered nurse with certification in medical informatics from the American Nurses Association. She comes to the job from the Indian Health Service, which uses a modified version of the VA clinical IT system. Under CMS' Physician Focused Quality Initiative, the federal agency has joined with the VA in a plan to scale the massive Vista program to office size. "One of our goals is to help physician offices get over the impediment of an investment in a software product -- and why not do it (with Vista) since the government has invested a lot of money in a product that without too much modification physicians can use in their office," Wark said. Vista, which comprises about 100 program modules -- including programs to run activities as far-ranging as an inpatient pharmacy or an out-patient mental health service -- also includes a module called Computerized Patient Record System, or CPRS, which is an electronic medical record system. The Vista CPRS has already been adapted to the office practices by several private consultants working independently of CMS. (See the current Health IT Strategist.) Copies of the Vista software are available free under the Freedom of Information Act, but the VA provides no support for installation and maintenance of Vista by outside users. License fees also are required for the Cache database and computer language on which the system runs on the server side, and for Windows for some applications that have a graphical user interface on the provider side. The Pacific Telehealth and Technology Hui, based in Hawaii, a joint venture of the VA and the Defense Department, has ported Vista to the open-source Linux operating system and GT.M database. Their aim was make the system more broadly available by reducing licensing fees. The software can be downloaded for free on the Internet at the Web site of WorldVista, a not-for-profit organization of Vista supporters. CMS' Vista Office EHR will run on the Cache database and the Windows
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
On Fri, 15 Oct 2004, Bill Walton wrote: This is GREAT news! And the Health IT Strategist article, together with the VistA Office release, are shots heard 'round the world signaling VistA's long term viability. Or are they? Before you pop the cork I think you should consider another, very probable (based on my 16 years of experience IT products and services) possibility. The we're there case is really only viable to the extent that VistA Office will be the only industrial strength Open Source (i.e., free) EHR software available to community-based physicians. What happens when that changes? As with any other informatics product this is not a Make-a-Sale game any health information architecture will evolve and it must evolve with the support, in this case, with te involvement of the health Professional specialty disciplines. Clear capability targets are needed stated in implementing technology-independent language so that the VistA Open Source community can manage its evolution and the proprietary product vendors can manage theirs. Acquirers must understand that there is not Free Lunch and it is what do you pay for what you get. Acquirers must procure compoenents and build their individual information architecture to serve their enterprise and they must have the knowledge and skills to do that effectively. Thye can utilize open and closed sources. How does VistA fare in head-to-head competition with, say, Open Logician? With an appropriate strategy. My background says VistA loses, big time. On every single front that matter from a market viability perspective. Your opinions are yours but I do not agree as an acquirer. I won't rain on your parade anymore here except to say that unless the VistA community addresses the marketability issues that have, more than once, been pointed out here, the recent HHS initiatives regarding VistA are not 21 gun salutes. No one says they are. They are just the beginning of addressing the problem by both Suppliers and Acquirers. They're shots to the head. Both Users and Suppliers are in an immature market and we all need to learn. I think you need to begin a serious discussion of survival strategy. And you too! in my view. Best regards, Bill - Original Message - From: Michael Ginsburg To: [EMAIL PROTECTED] Sent: Friday, October 15, 2004 8:04 AM Subject: [Hardhats-members] Fwd: Text of Article from Modern Physician This is from Modern Physician: IT vendors invited to show interest in new vistas By Joseph Conn / October 13, 2004 Next week, the CMS will hold a meeting with information technology vendors interested in using a proposed version of the Department of Veterans Affairs' comprehensive computerized electronic record and IT system -- the Veterans Health Information Systems Technology Architecture, or Vista -- modified for use in physician offices. The CMS/VA effort aims to bring the Vista Office Electronic Health Record, a proven, affordable version of an electronic medical records system, to the small-group office practice, where EMR penetration rates are lowest due to system costs. The vendors meeting on the Vista-Electronic Health Records project is scheduled for Oct. 20 in Washington, D.C. At the meeting, CMS and VA officials will gauge the level of vendor interest in the project as well as raise awareness of the initiative, according to Capt. Cynthia Wark, an officer in the Public Health Service and deputy director of the information systems group in the CMS' Office of Clinical Standards and Quality. We just want to figure out if we put this out on the street, are any of the vendors going to pick up on it, said Wark. We're trying to gauge the interest. The other thing is to let people know what we're doing. Wark is a registered nurse with certification in medical informatics from the American Nurses Association. She comes to the job from the Indian Health Service, which uses a modified version of the VA clinical IT system. Under CMS' Physician Focused Quality Initiative, the federal agency has joined with the VA in a plan to scale the massive Vista program to office size. One of our goals is to help physician offices get over the impediment of an investment in a software product -- and why not do it (with Vista) since the government has invested a lot of money in a product that without too much modification physicians can use in their office, Wark said. Vista, which comprises about 100 program modules -- including programs to run activities as far-ranging as an inpatient pharmacy or an out-patient mental health service -- also includes a module called Computerized Patient Record System, or CPRS, which is an electronic medical record system. The Vista CPRS has already been adapted to the office practices by several private consultants working independently of CMS. (See the current Health IT Strategist.) Copies of the Vista software are available free under the Freedom of Information Act, but
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
Mark, Mark Amundson wrote: Bill Could you give me a quick head to head comparison of VistA/CPRS and Logician. Glad to. Thanks for asking. Please note that I did not choose Logician as an example because I think it's a market-leading product. Not even close, based on my own experience leading a due diligence project for a group of 7 neurology practices last year, and based on published results from folks like the AC Group and TEPR. I chose it precisely *because* it's not. I'd like the group to consider the market reality that even a mediocre product can win the day (remember Windows vs. Mac?). I have used Logician as a clinician (Last time was 2.5 years ago and I do not remember the version), but my experience is that VistA/ CPRS is a better, friendlier product that was superior in many regards. Ease of use, which is what I interpret better, friendlier to mean, is an important but very subjective measure. Certainly not the only one that's recommended that physicians evaluate in their selection criteria. I'll use the high-level criteria recommended by Forrester Research in their October 2003 paper, Electronic Medical Records: A Buyer's Guide for Small Physician Practices prepared for the California Healthcare Foundation. You can find it at http://www.chcf.org/documents/ihealth/ForresterEMRBuyersGuideRevise.pdf Forrester recommends three high level criteria: 1) The quality of the current offering, including features, ease of use, support and service, and cost; 2) The vendor's strategy, meaning the future plans the company has for its EMR; and 3) The vendor's market presence, in terms of financial strength, customer base, and partnerships with other firms. I've dealt with these in some detail below, but will sum it up here. The lack of documentation and M-base combine to make it very hard to forecast VistA's viability if it has to compete with other Open Source EMR systems with established reputations and market presence. From a market perspective, it boils down to supply and demand. If demand for EMR systems increases and the supply of people capable of installing, servicing, and enhancing VistA does not, physicians will choose VistA's competitors. As an example from another market, there are lots of people who want to buy a Hybrid car (the waiting list for a Toyota Prius is 9 months to a year). Some consumers wait. Most just buy something else. So, for the sake of discussion, let's take a look at how the Logician salesman might present his case based on Forrester's recomended selection criteria. 1) The quality of the current offering, including features, ease of use, support and service, and cost; Features: a) Interface to PM systems - let's keep the fact that community-based physicians get paid very differently from the VA at the very front of our minds. Logician - has been successfully interfaced many times to various (probably all) PM systems. Hundreds of referencable accounts in this regards. Vista - very little history of interfacing to PM systems other than whatever mechanism the VA uses. A handful of referencable accounts. b) Interface to independent pharmacies - Does VistA do this? Doesn't the VA have it's own pharmacies? Logician has a history of it with lots of referencable accounts. c) Interface to independent diagnostic labs - Does VistA do this? Doesn't the VA have it's own labs? Logician has a history of it with lots of referencable accounts. d) Export / import of patient data to / from other systems? Logician - not built in to the system today, but because it's based on industry standard RDBMS technology it's easy and there are LOTS of programmers out there who could do it for a practice. VistA - not built in to the system today, but I've been told here that it's been examined and as a result of VistA's architecture, would be hard and there are VERY FEW programmers across the country who could do it for a practice. e) Extensibility - of the UI in particular. The docs participating in the due diligence project I mentioned above held that the ability to customize the interface to allow them to use the system within their current workflow was a big deal. If I'd been interested in *winning* this debate, as opposed to simply opening a conversation about what the VistA community needs to consider vis-a-vis market viability, I'd have chosen NextGen for it's strength here. Logician - currently not something practices could do for themselves. GE uses this to generate service revenues. OTOH, GE would undoubtably Open Source this capability as well. I'll bet their UI technology is written in a language that a lot of programmers know and use. Might even be a simple scripting language. So even if Docs don't do it themselves, there won't be a shortage of programmers competing for that work. VistA - CPRS is already Open Source. But written in Delphi (Pascal), certainly not as obscure as M, but not something most Docs will use themselves. Relative to other
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
Hi Michael, - Original Message - From: Michael Ginsburg To: [EMAIL PROTECTED] Sent: Friday, October 15, 2004 1:18 PM Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician In my opinion, (and, as always, I speak only for myself) I wouldagree that in a head to head competition with "Open Logician" that VistA-Office EHR would lose. That is if all you were comparing was functionality. As a system for the physician's office, Logician is a more mature offering, no question. VistA-Office EHR is only in the embryonic stage. However, if you were to compare them in "open source" marketand all that implies and entails, VistA-Office EHR would be the clear winner. To the best of my knowledge, Logician does not have a rabid (and I mean that only in the nicest sense!), international community of developersor an organized community of cooperating vendors who can supply professional services,with all working in concert to promote, support and enhance the application. This community you speak of... how big is it exactly? Compared to the one the exists that could and would sign up to support Open Logician. See my comments re: this topic in my response to Mark. On the topic of 'rabid' ... I've never seen that included in a recommended list of selection criteria. Reliable, yes.References, yes. Responsive, yes. Cost effective, yes. Frankly, I'm not sure thatVistA hasall that yet either and therein lies the challenge and the opportunity!Yes, the serious discussions have to start, but, the VistA community doesn'tneed a survivalstrategy,it needs a growth strategy. We don't disagree on this. It's perspective, I guess. Growth vs. Survival. My background in business has perhaps conditioned me to see that not as a choice, but as an imperative. Grow or die. That's the law of the market. This will be big. There are roughly 400,000 physicians in the US. If we achieve 1% market penetration... Your definition of "big" is underwhelming. If 1% is your honest assessment of VistA Office's real market potential, I'd strongly suggest you keep it to yourself when talking to vendors like HP. In fact, I'd strongly suggest you begin working on a statement to "spin" that in case they've already heard you. "What I really meant..." Even it that's a good number though, the current VistA community couldn't support it unless you think Docs will just line up and wait. They might. I doubt it. What's needed is a serious discussion to address the two core issues. 1) Documentation - it's got to be there. No option. 2) M - it's got to be a non-issue. Best option here may be to wrap VistA in a SOAP bubble and treat it as a web service. GUI front-ends need to be built for bothclinician and sys admin use. Get these issues resolved and VistA has a real chance. But if all you're shooting for is 1%... Back in the early '90's I learned an important lesson. It's easier to get$5 million from a VC than it is $500K. The reason is that they have to invest just as much time and effort into making the business successful either way. The only thing that's different is the size of thepotential reward. Personally, I think the potential here is much larger than 1%. But it all depends on the community getting serious. I am. Best regards, Bill
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
Title: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician As a participant in the birth and development of the DVA Healthcare Information system from 1972 onward, and as a private practice IT professional for the last 16 years, I have a similar sense of alarm as Bill does. We may not share the same rationale, Bill and I, for why there is cause for concern, but I suspect our conclusions overlap extensively. I have been intrigued by the recent discussions on this forum that reveal familiar ambitions, and divisions of attitudes and views that echo various periods in the past of DHCP/Vista and the surrounding M/MUMPS technology. It may be the eternal pessimist in me, but I am skeptical that earnest dreams fueling this welcome activity in the VistA migration into the private sector can be realized. I would like to be involved as an agent leading to success, but having confronted these issues in the past, I am at a loss for some new, fresh ideas that could facilitate finding the path to success. About all I can say for the present activties is to counsel all to (1) simplify the issues, (2) concentrate your resources, and (3) focus of the mission critical elements. ( ...and remember what Humpty Dumpty told Aliceall that matters is who is the Master.) Regards, Richard. -- Richard Davis Mformation SYStems Company tel: 508-869-6976 e-mail: [EMAIL PROTECTED] From: Bill Walton [EMAIL PROTECTED] Reply-To: [EMAIL PROTECTED] Date: Fri, 15 Oct 2004 10:30:09 -0500 To: [EMAIL PROTECTED] Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician This is GREAT news! And the Health IT Strategist article, together with the VistA Office release, are shots heard 'round the world signaling VistA's long term viability. Or are they? Before you pop the cork I think you should consider another, very probable (based on my 16 years of experience IT products and services) possibility. The we're there case is really only viable to the extent that VistA Office will be the only industrial strength Open Source (i.e., free) EHR software available to community-based physicians. What happens when that changes? How does VistA fare in head-to-head competition with, say, Open Logician? My background says VistA loses, big time. On every single front that matter from a market viability perspective. I won't rain on your parade anymore here except to say that unless the VistA community addresses the marketability issues that have, more than once, been pointed out here, the recent HHS initiatives regarding VistA are not 21 gun salutes. They're shots to the head. I think you need to begin a serious discussion of survival strategy. Best regards, Bill - Original Message - From: Michael Ginsburg mailto:[EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, October 15, 2004 8:04 AM Subject: [Hardhats-members] Fwd: Text of Article from Modern Physician This is from Modern Physician: IT vendors invited to show interest in new vistas By Joseph Conn mailto:[EMAIL PROTECTED] / October 13, 2004 Next week, the CMS will hold a meeting with information technology vendors interested in using a proposed version of the Department of Veterans Affairs' comprehensive computerized electronic record and IT system -- the Veterans Health Information Systems Technology Architecture, or Vista -- modified for use in physician offices. The CMS/VA effort aims to bring the Vista Office Electronic Health Record, a proven, affordable version of an electronic medical records system, to the small-group office practice, where EMR penetration rates are lowest due to system costs. The vendors meeting on the Vista-Electronic Health Records project is scheduled for Oct. 20 in Washington, D.C. At the meeting, CMS and VA officials will gauge the level of vendor interest in the project as well as raise awareness of the initiative, according to Capt. Cynthia Wark, an officer in the Public Health Service and deputy director of the information systems group in the CMS' Office of Clinical Standards and Quality. We just want to figure out if we put this out on the street, are any of the vendors going to pick up on it, said Wark. We're trying to gauge the interest. The other thing is to let people know what we're doing. Wark is a registered nurse with certification in medical informatics from the American Nurses Association. She comes to the job from the Indian Health Service, which uses a modified version of the VA clinical IT system. Under CMS' Physician Focused Quality Initiative, the federal agency has joined with the VA in a plan to scale the massive Vista program to office size. One of our goals is to help physician offices get over the impediment of an investment in a software product -- and why not do it (with Vista) since the government has invested a lot of money in a product that without too much modification physicians can use in their office, Wark said. Vista, which comprises about 100 program
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
Bill, Let's not confuse ourselves. As far as I know, there are no commercial vendors planning to release their products as Open Source or to put them in the public domain. If I'm wrong, please let us know! If I'm right, than the VistA community, regardless of theactual number, is larger than a non-existent (fill in the blank) community. So worrying about something that doesn't exist isn't going to help us. Having said that, the size of the VistA community will be important as we move forward. It's the law of Small Numbers. 1% market penetration is 4000! That's a lot of potential customers for any business.These are customers that will need help implementing their systems, training their users and fixing problems when they arise. They will also be constantly demanding upgrades and improvements. Figuring out how to provide all that to the same standardset bythe best non-VistA vendors is the challenge for the VistA community. And I say community because references and credibility are the keys to product acceptance. If a VistA site crashes and burns it will reflect badly and impede the efforts of everyone. You are right, the community needs to get serious. As for documentation, I can assure you that VistA-Office EHR will be a high quality product in all respects, including good documentation. As for M, I see that as being a big plus since it's the only technology that I know of that is purpose-built to handle medical information. But that's just my opinion. Mike [EMAIL PROTECTED] 10/15/2004 4:17:15 PM Hi Michael, - Original Message - From: Michael Ginsburg To: [EMAIL PROTECTED] Sent: Friday, October 15, 2004 1:18 PM Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician In my opinion, (and, as always, I speak only for myself) I wouldagree that in a head to head competition with "Open Logician" that VistA-Office EHR would lose. That is if all you were comparing was functionality. As a system for the physician's office, Logician is a more mature offering, no question. VistA-Office EHR is only in the embryonic stage. However, if you were to compare them in "open source" marketand all that implies and entails, VistA-Office EHR would be the clear winner. To the best of my knowledge, Logician does not have a rabid (and I mean that only in the nicest sense!), international community of developersor an organized community of cooperating vendors who can supply professional services,with all working in concert to promote, support and enhance the application. This community you speak of... how big is it exactly? Compared to the one the exists that could and would sign up to support Open Logician. See my comments re: this topic in my response to Mark. On the topic of 'rabid' ... I've never seen that included in a recommended list of selection criteria. Reliable, yes.References, yes. Responsive, yes. Cost effective, yes. Frankly, I'm not sure thatVistA hasall that yet either and therein lies the challenge and the opportunity!Yes, the serious discussions have to start, but, the VistA community doesn'tneed a survivalstrategy,it needs a growth strategy. We don't disagree on this. It's perspective, I guess. Growth vs. Survival. My background in business has perhaps conditioned me to see that not as a choice, but as an imperative. Grow or die. That's the law of the market. This will be big. There are roughly 400,000 physicians in the US. If we achieve 1% market penetration... Your definition of "big" is underwhelming. If 1% is your honest assessment of VistA Office's real market potential, I'd strongly suggest you keep it to yourself when talking to vendors like HP. In fact, I'd strongly suggest you begin working on a statement to "spin" that in case they've already heard you. "What I really meant..." Even it that's a good number though, the current VistA community couldn't support it unless you think Docs will just line up and wait. They might. I doubt it. What's needed is a serious discussion to address the two core issues. 1) Documentation - it's got to be there. No option. 2) M - it's got to be a non-issue. Best option here may be to wrap VistA in a SOAP bubble and treat it as a web service. GUI front-ends need to be built for bothclinician and sys admin use. Get these issues resolved and VistA has a real chance. But if all you're shooting for is 1%... Back in the early '90's I learned an important lesson. It's easier to get$5 million from a VC than it is $500K. The reason is that they have to invest just as much time and effort into making the business successful either way. The only thing that's different is the size of thepotential reward. Personally, I think the potential here is much larger than 1%. But it all depends on the community getting serious. I am. Best regards, Bill
Re: [Hardhats-members] Fwd: Text of Article from Modern Physician
May I suggest shifting the frame of reference to the global context which is where open source really matters. In this context the numbers of potential adopters for VistA, whether for clinics or hospitals becomes staggering. Not one of any of the current vendors of any system has the capacity or business model to ramp up the way a well designed open source application with an effective community behind it can. VistA is a classic example of a disruptive technology...stay tuned we are just at the beginning of the ride. Joseph On Fri, 2004-10-15 at 17:03, Michael Ginsburg wrote: Bill, Let's not confuse ourselves. As far as I know, there are no commercial vendors planning to release their products as Open Source or to put them in the public domain. If I'm wrong, please let us know! If I'm right, than the VistA community, regardless of the actual number, is larger than a non-existent (fill in the blank) community. So worrying about something that doesn't exist isn't going to help us. Having said that, the size of the VistA community will be important as we move forward. It's the law of Small Numbers. 1% market penetration is 4000! That's a lot of potential customers for any business. These are customers that will need help implementing their systems, training their users and fixing problems when they arise. They will also be constantly demanding upgrades and improvements. Figuring out how to provide all that to the same standard set by the best non-VistA vendors is the challenge for the VistA community. And I say community because references and credibility are the keys to product acceptance. If a VistA site crashes and burns it will reflect badly and impede the efforts of everyone. You are right, the community needs to get serious. As for documentation, I can assure you that VistA-Office EHR will be a high quality product in all respects, including good documentation. As for M, I see that as being a big plus since it's the only technology that I know of that is purpose-built to handle medical information. But that's just my opinion. Mike [EMAIL PROTECTED] 10/15/2004 4:17:15 PM Hi Michael, - Original Message - From: Michael Ginsburg To: [EMAIL PROTECTED] Sent: Friday, October 15, 2004 1:18 PM Subject: Re: [Hardhats-members] Fwd: Text of Article from Modern Physician In my opinion, (and, as always, I speak only for myself) I would agree that in a head to head competition with Open Logician that VistA-Office EHR would lose. That is if all you were comparing was functionality. As a system for the physician's office, Logician is a more mature offering, no question. VistA-Office EHR is only in the embryonic stage. However, if you were to compare them in open source market and all that implies and entails, VistA-Office EHR would be the clear winner. To the best of my knowledge, Logician does not have a rabid (and I mean that only in the nicest sense!), international community of developers or an organized community of cooperating vendors who can supply professional services, with all working in concert to promote, support and enhance the application. This community you speak of... how big is it exactly? Compared to the one the exists that could and would sign up to support Open Logician. See my comments re: this topic in my response to Mark. On the topic of 'rabid' ... I've never seen that included in a recommended list of selection criteria. Reliable, yes. References, yes. Responsive, yes. Cost effective, yes. Frankly, I'm not sure that VistA has all that yet either and therein lies the challenge and the opportunity! Yes, the serious discussions have to start, but, the VistA community doesn't need a survival strategy, it needs a growth strategy. We don't disagree on this. It's perspective, I guess. Growth vs. Survival. My background in business has perhaps conditioned me to see that not as a choice, but as an imperative. Grow or die. That's the law of the market. This will be big. There are roughly 400,000 physicians in the US. If we achieve 1% market penetration... Your definition of big is underwhelming. If 1% is your honest assessment of VistA Office's real market potential, I'd strongly suggest you keep it to yourself when talking to vendors like HP. In fact, I'd strongly suggest you begin working on a statement to spin that in case they've already heard you. What I really meant... Even it that's a good number though, the current VistA community
