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 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 solutions, and plan for gradual transitions. And VistA has a great potential meeting some of these goals. Hope to see you all at the WorldVistA conference. Kevin --- Joseph Conn <[EMAIL PROTECTED]> wrote: > Re: market size > > According to an AMA survey from 2001, 33% of what it > calls "patient care physicians" are in solo > practice, another 11% are in practice in > two-physician offices, 8.5% in three-physician > offices. These exclude government and military docs. > That 52.5% is in practices so small most EMR > vendors I've spoken with don't want to bother with > them because the sales costs excede the returns. > > The vendors' interests might change some 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 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 === message truncated === __________________________________ Do you Yahoo!? Yahoo! Mail Address AutoComplete - You start. We finish. http://promotions.yahoo.com/new_mail ------------------------------------------------------- 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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