I am familiar with linuxmednews.org. I have been talking, throwing tantrums with many big players in this area. Some of them are familiar with VITL as I had publicized VITL out there. If you can please read about OpenVista ( not microsoft vista). Another one Indivo where the model is that patients control access to their records. -balu
On 1/16/09, Dan Connelly <[email protected]> wrote: > 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 >>>> >>>> >>>> >>>> >>>> >>>> >> >> > >
