I beg to differ with Stan. There are close to about half-a-dozen FOSS products out there that does EMR. Actually, EMR has lately become a buzz word and none of them, including the big commercial ones meet what is really required for the doctors. From a data collection perspective, all of them meet the need. The big question and hurdle comes when a subset of this data has to be moved to another system/entity/lab/audits etc etc to outmoded, proprietary systems, which all talk a slightly differing protocol. There exists a HL7 protocol which should take care of this problems. But, as you may all know there are so many standards that you can choose any one of them. There are various versions of HL7 and when I researched the commercial systems ( believe me I have heard the demo/sales pitch of about 20 systems).
Another issue is CCHIT certification. This is a big boys club to keep others out, especially FOSS.CMS ( medicaid and medicare) does not insist that docs have a CCHIT-certifed EMRs . CCHIT is not like FDA. Similar is the issue with ePrescription. This is a closed/political protocol invented by SureScript, and you (FOSS) can't get your hands on it, or, a big club fee has to be paid. AllScripts is an accomplice in this. Right now, they have a free web based prescription for doctors for a year or so, because from 2009 onwards docs get a bonus from Medicare for using ePrescription. The catch is, I haven't seen any HIPAA or confidential agreement with the doc, when I signed up for this service.I will not be using it for this very reason. The only confidence is that they have Medicare's blessing ( fill in your own lobbyists rhetorics here ). There is tremendous vendor lockins going on. Not that it was not always the case, except that it's more visible now with FOSS around. VITL is evil as far as I am concerned. Vermont has no business, funding them as they are already on the wrong track. It's solely for GE to get the business and VITL is a front end for that. Again think LOBBYING. Coming to support, like no body out there to implement, install , hand holdings etc. they are scare in close proximity , but if for a moment you forget and think that you are calling a Vermont number while calling a California number, you have support. This is the mentality that if you are paying big bucks to a BIG name, you are getting support. If there is one problem I see in FOSS is this : there are consultants out there who are looking for jobs, and even though your subconscious says FOSS, you don't care if it's proprietary. FOSS gets lip service as an industry. Of course, we all use FOSS because it comes free and there's opportunities to make more mula. FOSS is something only Stallman has to worry about. Sorry for that cynicism. A little background of mine to put things in perspective - I started my career in Bell Labs as a EE in 1972, then moved to IBM. After 15 years there I took their bail out. I have only used UNIX. I am much more of an application programmer and a language fanatic. I can do Sys Admin only when you have a knife up my throat :-) This field changes so rapidly that I don't know what I am good at any more. Most importantly, I am not looking for a job. I have managed this pediatric practice for the past 15 years. I don't mind partnering with any pure FOSS soul out there. My other interest is the stock market and I am a day trader, many hours a day I am looking at charts till my eye balls pop out. Well, I have ubuntu on some 15 machines of various kind - from a PS3, a Nokia 770(not buntu), eeePC, XO. I have managed not owning a car for the last ONE year. I am 60 years old. My only kid is in MIT ;-) Thanks for this opportunity. - balu On 1/15/09, Stanley Brinkerhoff <[email protected]> wrote: > I have been personally involved with groups that are looking for EMR's from > small vision care offices; to my current role at a Community Mental Health > organization; as well as the Vermont State Hospital. > > The cost of an EMR is one small component of a decision, say a 5-10% issue. > A bigger concern is support, maintenance, state reporting, and having > someone help you through implementation who had done previous > implementations. > > If there was a large organization beind a FOSS EMR that was a solid > product, they would have no problem competing at the same price point the > closed source EMR's are selling for. EMR's are not applications -- they are > philosophies. When you commit to using an EMR the software you choose is > only a small portion of the entire cost. > > Without a strong vendor with experience and clients to backup their product; > FOSS will *always* be a non-starter for midsize to large organizations. It > might make sense to the single doctor office; but even then; whats a $10k > EMR that just works out of the box and you can call for support vs. > something that might be broken invarious detremental ways (theres no one to > sue when a patient dies because the EMR didnt save the drug alergy). > > This isnt VITL's fault -- it would be honestly dangerous and inappropriate > for them to suggest an open source EMR for the sake of FOSS inclusion. If > VITL's role was drastically different (support and develop a FOSS EMR for > Vermont) then it might make sense -- but their role isn't that of developer > or implementor -- its to build a network to share information between > established EMR's. > > Please keep flames off list -- I will gladly reply. > > Stan > > > On Thu, Jan 15, 2009 at 8:30 AM, Dan Connelly <[email protected] >> wrote: > >> Balu: >> >> Please, let's continue a discussion on-line about VITL's position on FOSS. >> >> In particular, can you post to VAGUE (or re-post if I missed it) your >> correspondence with Mr. Hans C. Kastensmith of Capitol Health Associates >> concerning VITL's not having recommended any FOSS EMRs. >> >> i see that his (un-dated) reply to you is posted here: >> http://www.vitl.net/uploads/1225882351.pdf >> >> In any case, I am curious as to what standards VITL needs and how a FOSS >> system could comply. I assume that CCHIT certification is horribly >> expensive and that this is part of the problem. Am I correct? >> >> -- Dan Connelly >> >> >> >> Balu Raman wrote: >> >> On 1/14/09, Stanley Brinkerhoff <[email protected]> >> <[email protected]> wrote: >> >> >> Where can I read more about your statement that "The provider is the >> cheapest component of the health care system.". >> >> Stan >> >> >> >> It is not written any where that I know of, but one can come to that >> conclusion if you do some research from the cost of one encounter with >> provider. By provider I mean the Primary care provider, and does not >> include specialists. By the way, primary care providers are getting >> scarce. The cost of practicing is the reason and payments to primary >> care hasn't kept up with the extra costs imposed by the system. My >> statement is based on experience managing a primary care practice for >> 20 years. If you discount all the technology, bureaucracy, insurance >> executives compensation etc etc costs, the provider's cost is minimal. >> Compare that with the lawyer's. >> >> We are wandering off the main topic of this list. If you want to >> discuss you can contact me off the list. >> >> - balu >> >> >> >> >> >
