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 languages like Java or C++, few programmers currently working in it. Ease of Use - it's a religous topic. I'm not going there. I'll call it a tie. Unless pressed. Support and Service - what most buyers of software want in the way of support is, first and foremost, not to need it. If they do need it, they expect service to be multi-tiered with local resources able to respond very quickly to emergencies. Note that if a Doc's EMR system goes down (and she's gotten rid of her paper-based records, which all the ROI justifications rely on), their practice is shut down until it's brought back up. a) Documentation - the first line of defense WRT being self-supporting is product documentation. I think we all know the score here so I don't think I need to go into it further. b) Call Center / On-site service Logician - established support and service network, including call center and service technicians, with an established record and many referencable accounts. VistA - no established support and service network outside the VA. It's up to vendors who decide to support VistA Office to figure that out. That's, I guess, one of the things they're testing the waters for at the meetings that will, I'm sure they hope, follow upcoming meeting on the 20th. c) Independent (i.e., non-vendor) Service Providers Logician - based on industry standard RDBMS and languages. Lots of programmers and sys admins who, given the existing documentation, could come up to speed quickly. VistA - based on Cache / GT.M and M. Once the documentation *gets produced* there are probably some programmers who would invest the time / money to take what most of them would be a step backward in time. Most would probably just choose to support a system like Logician that uses technologies they already know. Yes, there are Hardhats who could provide support today. But it's a numbers problem. How many installations do you think the community could physically support today? A dozen per year? More? How about thousands? Remember that there are several hundred thousand physicians out there. I haven't seen a number for community-based practices but would assume it's in the tens of thousands. If demand picks up, and that's what the President and HHS intend, VistA will simply be overrun unless the documentation and M issues are addressed before that. Cost - since both systems are free in this scenario, you probably thought I'd call this a tie. A Logician "salesman" certainly wouldn't. Initial cost is a small component of the Total Cost of Ownership (TCO) of a system. The large, existing supply of programmers / sys admins familiar with Logician's underlying technologies would make it very easy to show that VistA loses this one by a wide margin when you figure TCO. 2) The vendor's strategy, meaning the future plans the company has for its EMR; There are a couple of ways to look at this. As I understand it, VistA's future, at least from a technology perspective, has been called into question more than once. The VA's plan for supporting the software has been, and as far as publicized is still, "that's somebody else's problem. OTOH, if we drop down to the vendor level, You could at least *predict* that it would turn out to be a tie. Assuming HHS is successful in getting vendors on-board, whoever chooses to support VistA would say a) they plan to continue to support it, and b) there are other service providers out there anyway. GE would continue to support Logician just like IBM continues to support Eclipse. The rationale is persuasive. You get a larger likelihood of service revenue, there's synergy with your other products, and rather than being an expense that goes against your bottom line, the salaries of folks you have working on it get to be deducted as a charitable contribution. And, of course, they'd promote the formation of as large a group of other service providers as they could. GE doesn't even *want* to be in the small-practice business. Neither, for that matter, does an HP, Perot Systems, EDS, etc. There's not enough net $ in a "sale" for it to be profitable. 3) The vendor's market presence, in terms of financial strength, customer base, and partnerships with other firms. Here again, the question hinges on how successful HHS is in attracting vendors in the upcoming months. And on how long it takes for vendors like GE to simply take the obvious step and make their software open source too. The money's in the services (and for GE at least, in the medical hardware) anyway. Time will tell. Hoping it won't happen is not a high-probability strategy. It's time to make a plan. I'd like to participate to the extent that that's possible. 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! 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