Balu: Here is similar view on the "free market" v. FOSS EMR. Check the "Some dude" discussion on this Slasher site, a site devoted to exactly the FOSS EMR debate we are having.
http://linuxmednews.com/ -- Dan Balu Raman wrote: > 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 >>> >>> >>> >>> >>> >>> > >
