Comments on: Monday Morning Update 1/19/09

By: MM

MM — Sun, 25 Jan 2009 02:44:37 +0000

Lindy and Art,

MD Anderson’s architecture is the best of bothl worlds. It does not require them to build everything. The virtual database, SOA framework they are using (developed, by the way, by Chuck Suitor) gives them great flexibility to integrate commercial systems or build it themselves. Functionality unique to MD Anderson can be built in-house and functionality common in the industry can be purchased and easily integrated.

Is that such a bad thing?

By: Lindy

Lindy — Sat, 24 Jan 2009 14:59:56 +0000

Art – Let’s cut to the chase. Very beneficial that they built an SOA web viewer into all the clinical results from all their 30 odd best of breed systems. That’s a given.

However, I would think their number one patient safety/quality challenge is the thousands of high risk chemo doses they administer daily (still a paper based manual process). Granted, CPOE with decision support for complex regimen based chemo is not easy and a challenge for even the big boys (Eclipsys, Cerner, Epic). Nonetheless, they have yet to tackle this. It took Partners’ Dana Farber nearly 10 yrs to refine the famous home grown already there BICS to do Chemo OE. Memorial Sloan Kettering went commercial and has Chemo OE under Sunrise DM

By: Art_Vandelay

Art_Vandelay — Sat, 24 Jan 2009 00:13:12 +0000

Lindy – how much would they be spending on a vendor system and potentially not getting the functions they want, paying for those they don’t need and wasting all their past investment in their best of breed systems?

With a team of 100, I am sure there are more than a few system architects.

CPOE with a foreign Rx system can be accomplished if you base the design on the foreign systems’ data structures, definitions and rules. Not ideal, but a solution.

By: Lindy

Lindy — Fri, 23 Jan 2009 21:52:29 +0000

No doubt, MDA is pushing the envelope for an SOA based clinical system.
With 100 internal and external folks working on this, it is still a long way from meeting the 100 plus CPR criteria first laid out by IOM. Achieving effective CPOE with decision support between a foreign Rx system and yet to be developed true OE system (not just e-routing of on-line order sheets) is almost impossible given the lack of semantic underpinning (ie where is the controlled medical vocabulary?). Ask Classen.

No doubt that eventually all will be overcome. But at what cost and why. Your burn rate is $10M/yr. You’re 4 yrs in and perhaps halfway done. And if key developers/architects leave??

Good time for us all to re-visit that comprehensive IOM document and understand what truly constitutes an CPR/EMR

By: MM

MM — Tue, 20 Jan 2009 23:11:56 +0000

Lynn Vogel writes: “But the cost of a major architecture change is simply prohibitive for commercial healthcare IT vendors.”

They have their feet in cement and will simply not be able to react to a new, disruptive technology. The opportunity is tremendous to the newcomer with a new approach.

Some elements of a new approach should be: 1) Very low-cost compared to current competitors, 2) non-disruptive, 3) Customizable by user, 3) easy to change and adapt to an ever-changing healthcare landscape……. I believe the technology that will support this approach is SOA as used by MD Anderson.