It is possible to update NextGen in a way that overwrites on-site customization. The technical term for that is “screwing up the update,” and it has happened in the wild at places outside Lehigh Valley/Doylestown.

It is also possible to customize NextGen in a way that prevents that risk, including protecting previous customizations.

Details available upon request.

My 2 cents:
No one has figured out the secret sauce recipe i.e., what will work for the consumer and the provider. Adding to this challenge is the potential need to have a PHR structured to address specific diseases, something that Project HealthDesign is looking into. Maybe the ecosystem approach of Microsoft’s HealthVault is the solution, maybe something else, I just don’t know at this point, but seeing some majors get into this space is encouraging – if they stick with it.

There are so many variations of the PHR theme in the market today, how is a consumer even suppose to decide what is in THEIR best interests in making such a choice. This also extends into such issues as portability, privacy and security as a lot of the PHR vendors today have weak to non-existent policies.

This is going to take hard work and significant investment. Standards and common data models for clinicals and claims data are still evolving which will hinder some of the grander plans for PHRs. In my conversation with the folks at CHIP (creators of Indivo), they told me that this was their biggest challenge going forward.

Educating the public/consumer on the value to them to take greater control and responsibility for their health records. This is where the Doctor/Provider – Patient relationship will play such a critical role. This last point may ultimately prove the most important of all for the vast majority of Americans and thus the burgeoning market.

I would try to get in touch with Barnes-Jewish (BJC) out in St. Louis, MO. They are using NextGen there…seem to like it.