“one has to wonder whether it is not more rational to build your own CDR, by-the-book, instead of wasting resources, buying a product and getting a low-quality product in the end.”

There is another way. Don’t use a CDR. Instead, use the data stored in ancillary systems and go get them when you need it using web services. This is a new conceptual model to the CDR-centric EMR. I call it the virtual database, service-oriented architecture conceptual model. A couple of innovative organizations are using this model. It is much simpler and less costly. And the effort and money you would expend towards building and maintaining a CDR can be spent providing functionality to users.

“It’s not that many of the EMRs don’t have the flexibility -”

No, they don’t. Not the kind of flexibility needed to provide the level of flexibility to have a doctor say “I need it to work this way” and be able to provide it that way in a timely fashion. There is only one way to provide that level of flexibility. And it’s not through a vendor app.

VistA runs on both Cache and GT.M, which are platform independent. Replacing the Alphas with AIX boxen would solve the first problem. The second problem, and the one that spurred this movement in the first place, is one of perception. Java is NEW! MUMPS is OLD. Ergo MUMPS must be bad. Someone has convinced the DOD that this is enough to warrant converting easy to read and maintain M into incomprehensible machine compiled Java.

I’ve seen quotes from those involved that this will also save a ton of money in the long run. Intersystems licenses aren’t free by any means, but converting to Java/Oracle as a cost saving measure? Really?

Great article by Mr. Bugajski and a correct diagnosis of one of the main problems of the Healthcare Informatics industry.

I am a physician with a degree in computer sciences currently employed as Chief Medical Informatics Officer with a medium sized hospital in the USA. We are now in the process of setting up a clinical data repository (CDR) to store and present the users with laboratory results, imaging links and pharmacy orders on top of the diagnosis and procedures.
I found out repeatedly that vendors are not willing to share the database schema of their products with the excuse it is a proprietary document. Unfortunately and unbelievably so, many times this is just an excuse for a complete lack of such a schema. Even worse -the conceptual diagram, logical and physical data model is either non existent, poorly defined or kept in someone’s vault. The analogy that comes to mind is trying to build a house without a blueprint or with one that is kept in the builder’s vault.
With that being said, one has to wonder whether it is not more rational to build your own CDR, by-the-book, instead of wasting resources, buying a product and getting a low-quality product in the end. I guess it is the basic question of build vs. buy.
I strongly recommend anyone in the HIT industry to read the book I have quoted above. I have no doubt it will save millions of $, mountains of users ‘ frustrations and most probably a couple of lives.

Let me ask this: If somebody isn’t performing at their job and are asked to leave, is that a one person layoff?