Bill,
I�m glad you mentioned the California HealthCare Foundation and this article; I�ve found the information there quite helpful over the years (www.chcf.org). When Forrester Research published, Electronic Medical Records: A buyer�s 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
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 company�s 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 opinion but 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 I�m 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
Sincerely,
Mark Amundson PharmD
Amundson Partners Inc
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, 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
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