Below is a long but interesting series of emails I received from Roger Erickson and I am posting with his permission. Start at the bottom, work your way up and be prepared for quite a ride. As you will see at the top, Roger sent me these emails after finding my name with a google search! Clearly, he is one of us whether he knew it before now or not!
The rows of asterisks separate the emails as I received them or sent them. ************************************************* Re: OpenEMRs �& WorldVistA mtg Date: Mon Mar 28 15:11:04 2005 From: Roger Erickson <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] Nancy Anthracite wrote: > OK with you if I post some extracts of your email on the mailing list of the � > VistA advocates, including WorldVistA members, read, and use your name? Sure > It is great to see someone else as riled up about this as I am! �Are you a > physician? Nope. I'm a PhD neurophysiology researcher, more interested in social systems now than just in nervous systems. �However, making systems work is my passion. �I'm more interested in "system health" than the health of particular individuals. -- � �regards, roger ********************************************* Re: OpenEMRs & WorldVistA mtg Date: Mon Mar 28 13:06:13 2005 From: Nancy Anthracite <[EMAIL PROTECTED]> To: Roger Erickson <[EMAIL PROTECTED]> Reply to: [EMAIL PROTECTED] OK with you if I post some extracts of your email on the mailing list of the VistA advocates, including WorldVistA members, read, and use your name? It is at https://lists.sourceforge.net/lists/listinfo/hardhats-members At the moment, there aren't enough members that are active consistently to sustain local chapters. We meet about 3 times a year, usually trying to do it in various places to give everyone a chance to be close to a meeting once year. We are pretty active virtually and by phone. The meetings attract the vendors, the newbies, the interested and the WV regulars, so that pulled in 135 for the last meeting and hopefully more this time. The "work" at the meetings is the networking and idea swapping,etc., that fuels the fires for all of the work that goes on between meetings. It is great to see someone else as riled up about this as I am! Are you a physician? I am. Re: OpenEMRs & WorldVistA mtg Date: Mon Mar 28 11:52:44 2005 From: Roger Erickson <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] Hi Nancy, Thanks for your email. Nancy Anthracite wrote: > Roger, your name sounds familiar but I confess I don't know how I got on your > list of recipients I just did a Google search of OS-EMRs and looked up a few names to forward my commentary to. (just frustrated and motivated) > but thank you for putting me there and thank you for > standing up for Open Source. Hey, it's the only democratic thing to do. We have ~300 million people in this county, and the biggest drain on our economy (and environment) is that we can't seem to share enough information. If you've ever heard the timing off in a V-8 engine, you know it's horribly noisy, powerless & a gas guzzler - but that's nothing compared to the excess hot air and inefficiency in our "P-300million". > Are you aware of www.WorldVistA.org Yes, but don't think I can make it to the meeting. I'll be in Oregon until Apr 6, and probably can't get away again that soon. If I do go, What's the overall purpose of the meeting? Is it really necessary to have people travel to one central site? How far away is WorldVistA from having regional chapters in every county? (so that training/development can be local & virtual) I would suggest pooling some money and sending a road show to one existing Fed/State funded Rural Health Clinic in each of the 50 states. THAT would put WorldVistA on the map and get publicity. -- regards, roger 301-349-0798 __________________________________________________________________ Roger Erickson, Pres | [EMAIL PROTECTED] | "People will do anything within their power http://www.270Tech.net | to avoid thinking" ********************************************************************** re: what some of the Feds are telling clinicians, behind the scenes Date: Wed Mar 23 15:49:18 2005 From: Roger Erickson <[EMAIL PROTECTED]> To: It's no wonder that small clinics are slow to hear of real, open solutions. They all need to get out more often. see below This sounds like the opposite of democracy - letting the misinformed lead the uninformed into the hands of the "dis-informers". If clinicians follow this advice, we'll all be drinking snake oil chosen by GE on the advice of Microsoft. (NOT what Ben Franklin, Tom Paine & Thomas Jefferson advised.) Anyone care to contribute to a series to be penned under the collective acronym "The Health Care Federalist"? -------- Original Message -------- Subject: RE: OpenEMRs for Rural Health Clinics Date: Wed, 23 Mar 2005 15:02:46 -0500 From: (someone at AHRQ.GOV> To: 'Roger Erickson' <[EMAIL PROTECTED]> 1. AHRQ has no authority to look into HRSA or RHC relationships with vendors. The HHS Office of Inspector General (OIG) would have jurisdiction of any alleged waste, fraud, & abuse. [ok] 2. I personally feel that open source software still requires tech support. Small clinics don't have the personnel on staff. Open source software is buggy and has no one with a financial interest in addressing them. Hiring a tech support vendor for open source has some of the same lock-in as selecting a proprietary software. [not ok - naieve about IT] 3. I agree that the winner can't yet be predicted, and that 90% of clinics will then lose their entire HIT investment. However, I don't have a solution short of the Feds trying to pick an architecture and mandating it (itself a bad idea). Small clinics should trail in HIT, letting deep pockets institutions support the bleeding edge of technology. [definitely not ok. Very misinformed and fatalistic. Anyone with "deep pockets" want to sell this guy a bridge in Arizona?] Does this mean it was a fortunate accident that VISTA even came about? -- regards, roger 301-349-0798 __________________________________________________________________ Roger Erickson, Pres | [EMAIL PROTECTED] | "People will do anything within their power http://www.270Tech.net | to avoid thinking" *********************************************************************** [Fwd: re: EMRs for Rural Health Clinics] Date: Tue Mar 22 23:02:46 2005 From: Roger Erickson <[EMAIL PROTECTED]> To: Actually, I don't have any record of cc'ing this person. My email may have been passed on by the HRSA. -------- Original Message -------- Subject: RE: Teleconference Questions & Comments - rather shocking oversights, & backup options Date: Tue, 22 Mar 2005 14:20:01 -0500 From: Bill Finerfrock <[EMAIL PROTECTED]> To: 'Roger Erickson' <[EMAIL PROTECTED]>, 'Durrett, Deanna (HRSA)' <[EMAIL PROTECTED]> CC: <[EMAIL PROTECTED]>, "emily costich" <[EMAIL PROTECTED]>, "tom morris" <[EMAIL PROTECTED]> Mr. Erickson Thank you for cc'ing me with a copy of your e-mail to Deanna Durrett. The purpose of the teleconference was to present information to the RHC community on setting up an EMR in an RHC. Mr. Casperson had direct knowledge of this having done this for his Clinic (as well as others). I felt he did an excellent job of presenting a wealth of information in a very tight time frame. I forwarded your comments/concerns to him and his response follows at the end of my e-mail. I appreciate that you have a particular perspective and a strong opinion about "open access EMR". It would have been nice if you had taken the opportunity to ask questions during the Q & A portion of the presentation about this option so he could have addressed this topic. Perhaps you did try to ask and were not able get through due to time constraints. We have received a number of very positive comments about his presentation and it seems as though many participants found it very helpful and informative. In a 45 minute presentation it is not possible to cover every possible topic or option. I'm sorry if you were "shocked" by his failure to address the open access option about which you clearly feel very passionate; however, as you will note in his response, he does not consider this a viable option at this time for rural providers. I suspect you may have a different opinion about the viability of "open access EMR". Perhaps, as you suggest, it is simply lack of knowledge of this alternative. Your interest in this topic is appreciated and I hope you will continue to share your knowledge and expertise with the RHC community. Thanks, Bill Bill Finerfrock Executive Director National Association of Rural Health Clinics 202-543-0348 [EMAIL PROTECTED] Kerry's Response: "Open Source EMR" I believe is a work in process and not ready for implementation and support in rural medical clinics. The strength of the "Open Source EMR" is the ability to have intercommunication capability among systems. The American College of Family Practice is working on a prototype but I don't believe it is anywhere close to being offered as a developed project. I am unfamiliar with VistA the open-source EMR used by the U.S. Department of Veterans Affairs. In retrospect I don't believe this is a viable option for rural clinics unless they have a strong technology person available to oversee and supervise the process. I have been involved with three EMR implementations in eastern Idaho over the past several years. One was within the last year. In these discussions the option for "open Source EMR" was never identified as a viable option. In my research for the presentation I leaned heavily upon the research which was done by the AC group. They are the group that the American College of Rheumatologists contracted with in investigating EMR applications for their membership. I contacted the AC group and have their permission to use their data in this presentation. I believe their research is the most reliable of research sources available. If there was an oversight in presenting "open source EMR it came from my personal experience and investigation of viable EMR options. I believe that at some point in the future we will approach an EMR close to the goals that the open source proponents are wishing for but I believe at this point it is a wish. In retrospect and having read the criticism I still don't think a discussion of "Open Source EMR" as a viable option for EMR implementation in the rural environment would have been suitable for the target audience. If there are other questions please forward them to me so I might respond. Thanks Kerry -- regards, roger 301-349-0798 __________________________________________________________________ Roger Erickson, Pres | [EMAIL PROTECTED] | "People will do anything within their power http://www.270Tech.net | to avoid thinking" *********************************************************************** ---------- Forwarded Message ---------- Subject: re: OpenEMRs for Rural Health Clinics Date: Tuesday 22 March 2005 11:02 pm From: Roger Erickson <[EMAIL PROTECTED]> To: I sat in on a conference call "educating" Federally Certified RHCs (Rural Health Clinics) on EMRs. see ftp://ftp.hrsa.gov/ruralhealth/NARHCEMR.pdf The presentation, while very useful and illuminating, didn't mention open source, and the presenter actively pooh-poohed both VISTA and OpenEMRs when one listener did ask. There were too many people listening in, so I wasn't able to pose a question myself. However, they invited commentary afterwards, and I sent the following email. Surprisingly, the organizers posted a reply, which I'll forward next. I think this is something that should be circulated. Is anyone wondering whether the RHC Association should be unduly influenced by "sponsoring" EMR vendors, and effectively barred from hearing commentary from a variety of vendors, including the OpenEMR community? There's obviously a lack of awareness. Contacts: Deanna Durrett, [EMAIL PROTECTED] [EMAIL PROTECTED] (see http://www.narhc.org ) [EMAIL PROTECTED] [EMAIL PROTECTED] -------- Original Message -------- Subject: Teleconference Questions & Comments - rather shocking oversights, & backup options Date: Wed, 16 Mar 2005 17:17:01 -0500 From: Roger Erickson <[EMAIL PROTECTED]> To: Durrett, Deanna (HRSA) <[EMAIL PROTECTED]> CC: [EMAIL PROTECTED] Deanna, Thanks for organizing this conference call. Kerry Casperson's slides contained a wealth of summary data that were very illuminating for me. However, most illuminating of all was his apparent lack of awareness of low-cost publically funded and open source approaches to EMRs, which are so widespread that it's hard to believe anyone hasn't heard of them (simply search Google for "Open Source EMR"). [Disclaimer: I am not currently associated with any current EMR vendor (given the lack of awareness, I may start one :) ), but am planning with partners to open a CHC in Florida. I make these comments only after completing my own literature search on EMRs, in preparation for launch of our Florida clinic.] 1) Kerry stated that the VA VISTA system had not been available at the time that BFmed started. In reality, the VISTA system has been entirely public, free and open source since it's inception in the 1970s, and is used at hundreds of private institutions (including, apparently, the entire country of Finland). (1 example, among many vendors: http://www.medsphere.com ) ..A year ago, the VA announced a "VISTA-Lite" version appropriate for single practitioners. see http://www.health-itworld.com/enews/06-15-2004_235.html 2) Amazingly, Kerry did not even mention any of the incredibly popular open source EMR systems, which are now available from literally hundreds of provider organizations, and are used by thousands of public/private clinicians. (again, just search Google for "Open Source EMR") This observation is especially significant since MANY of the downstream costs and risks Kerry mentioned are irrelevant for open source approaches. NOTABLY, as Kerry indicated, long-term change management DOES seem to confer the greatest ongoing costs, risks, and "process constriction", which is the primary reason to use publically owned, open source approaches that users can customize at will. In open source systems, the user groups own the data formats, data structures, and source code - so that there are never uncontrollable downstream costs associated with ANY of the following: software licenses of any sort (OS, application, database, etc) hardware/OS compatibility (any machine & OS: Windows, Mac, Linux, etc) per-user up-front license costs or limitations data recovery during system migration forced license payments for upgrade to newer versions scheduled acquisition of desired changes (users can make changes themselves, via in-house staff, through partner clinics, or via hired programmers) vendor lock-in vendor obsolescence (strength in user numbers, not vendor economics) (all the reasons why the VA made a public version in the first place - the economics don't allow an excuse for high-cost private vendors, if you can justify a private EMR, you may as well buy a Ferrari too) 3) A good example of the huge economic incentives favoring transition by small clinics from proprietory to open source EMRs is that made by the PhoenixPM project in California, funded by a grant from the Community Clinics Initiative established by the Tides Foundation and The California Endowment. http://www.phoenixpm.org (over 80 similar grant funded "Open EMR" projects are currently underway) 4) An even simpler approach to EMRs, that may be particularly attractive to cash-strapped RHCs seeking to implement at their own rate, is that developed by the "Open Infrastructure for Outcomes" group, out of UCLA. see http://www.txoutcome.org Like others, the OIO group is assembling a shared database of user-written forms, templates and workflows. 5) re: Backup. Many current vendors now offer continuous, online backup (with HIPAA compliant security) for backup & disaster recovery. One that I'm aware of is http://www.amerivault.com , but similar services are available from many local ISPs as well as large vendors like IBM. -- regards, roger 301-349-0798 __________________________________________________________________ Roger Erickson, Pres | [EMAIL PROTECTED] | "People will do anything within their power http://www.270Tech.net | to avoid thinking" ------------------------------------------------------- -- Nancy Anthracite ------------------------------------------------------- SF email is sponsored by - The IT Product Guide Read honest & candid reviews on hundreds of IT Products from real users. Discover which products truly live up to the hype. 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