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Monday Morning Update 10/25/10

October 24, 2010 News 26 Comments

From Polemic: “Re: Epic-certified resources. Only Epic knows and they’re not sharing. That leaves everyone else to make sense of what it means when someone claims to be Epic-certified (what module, what release, etc.) Tightly controlled certification keeps qualified people in high demand, but doesn’t seem to take into account the rate at which they are signing new accounts. One has to wonder whether the ‘we’re Epic, you’ll do it our way’ approach won’t perhaps come back to bite them someday.”

From Celling Yourself: “Re: AirStrip’s Sprint announcement. I don’t get this. AirStrip’s target customer carries an iPhone, which doesn’t work on Sprint.” It is interesting since the deal offers hospitals Sprint’s help creating an in-building Sprint infrastructure for running AirStrip’s apps on 4G smart phones, but AirStrip says it’s staying carrier agnostic. I can’t imagine docs giving up their iPhones (and thus AT&T now and possibly Verizon soon) or carrying a second Sprint-capable device only for on-property access. It sounds like little more than a targeted Sprint promo for its infrastructure business.

From Former McKessoner: “Re: long overdue. I’m one of the many departures from the McKesson senior sales ranks since the June 1 beginning of the fiscal year. It took over 10 years, but the Horizon undoing is coming fast. No new business, customers grudgingly upgrading.” Unverified. All I’ve seen is the recent KLAS report, which says Horizon lost more clients than it gained in 2009 (along with the other faders you might expect — QuadraMed, GE, and Eclipsys). The company has announced nothing pertaining to its Horizon strategy as far as I know, so unless a customer verifies they were told something officially (and those I’ve asked haven’t responded), I’d say it’s business as usual.

From Introspect: “Re: Houston hacker. Here’s an update with the hospital’s side of the story. I wish you had withheld judgment until at least hearing both sides of the story.” I agree, although I assumed the newspaper’s account was accurate and complete and I did hedge my bets by referencing the hospital’s “apparent” security incompetence. The original article said the hospital had to hire outside help to fix the problems the kid claimed he told them about. The CIO’s story is different, although he didn’t mention the problems the kid says he discovered. He says the 21-year-old had installed “back door” code on the hospital’s server that would have let him bypass security to log on at any time, which he accomplished by using a doctor’s password instead of actually penetrating the hospital’s security (I’m surprised he was able to do that with a doctor’s security privileges, which I assume means any doctor could do the same, but that’s not my area of expertise). As the CIO says, “He didn’t discover a breach, he was the breach.” The outside help was engaged to make sure the kid didn’t do anything else, the CIO told the newspaper.

10-23-2010 6-20-32 PM

At least most readers think their employer’s economic conditions are no worse than they were six months ago, although more say they’re unchanged than better New poll to your right: what’s your experience working for an employer that has won a “best place to work” award?

It’s easy to confuse patients about healthcare benefits. A non-profit clinic in California sends out ID cards to all its recent patients that include the patient’s name, medical record number, and doctor name. They wanted to speed up registration by giving staff information needed to look up patients in their new EMR. Puzzled patients seen at the clinic but not its regular patients are calling their providers and insurance companies demanding to know why they’ve been turfed off to a new clinic and doctor.

10-23-2010 8-30-45 PM

RemCare, fresh off $2.7 million in new financing, renames itself (warning: PDF) after its product, Care Team Connect. The Illinois company’s product helps hospital care managers by creating evidence-based discharge care plans and coordinating care, reducing readmissions.

Vanguard Communications, which offers the MedMarketLink marketing service for specialty practices, signs a partnership deal with Intuit Health to market its portal.

HP announces its Slate 500 would-be iPad competitor, which it will market to businesses (note the medical apps featured in the above promo). It’s more expensive (starting at $799) and runs Windows 7, meaning that unlike the iPad, it supports Flash. It comes with 2 GB of memory (which is needs since it’s running Windows), has a shorter battery life (Windows again), and does not support 3G (WiFi only). I’m guessing all of those facts led to the decision to steer a wide berth around the consumer market created and owned by Apple in the hopes that businesses are so pro-Windows they’ll pay more to get less. This will be problematic: all those users with iPhones, iPods, and iPads at home are not likely to be thrilled by their employer’s offering. Apple doesn’t make mistakes too often, but failure to reach detente over Flash is a big one since that’s one of few chinks in its armor and it involves all of its products as its competitors will tell you constantly.

Mobile Health Expo announces its 2010 award winners. HIStalk sponsors winning were PatientKeeper (best patient safety innovation) and Voalte (outstanding contribution to nurse communications).

Greenway acquires Visual MED’s PACS technology, which will power its PrimeIMAGE solution for its PrimeSUITE 2011 EHR.

The radiologist who founded teleradiology services vendor Virtual Radiologic launches an early stage venture fund that will invest in consumer, healthcare, and technology companies. Sean Casey was kicked out of the company, which he started and took public, with $68 million worth of stock. It was the subject of a private equity buyout for $294 million this past May.

HHS CTO Todd Park is added to the speaker lineup of the mHealth Summit next month, run by the NIH, its foundation, and the mHealth Alliance. Also speaking: Bill Gates, Ted Turner, and US CTO Aneesh Chopra. I’ll be filing daily reports from there as will HIStalk Mobile editor Dr. Travis Good.

The Austrian man who was the first person to use a mind-controlled robotic arm for driving dies in a single-car crash that may or may not have been related to the technology.

I can’t decide if HIMSS is clueless or evil with this announcement: attendees at the Orlando annual conference in February will be tracked by RFID for the benefit of exhibitors, who can “… derive a more accurate score of a visitor’s buying potential.” RSNA has been doing this, apparently, triggering specific booth ads to play based on who’s around (Philips is a happy customer cited in the above promo video). An RFID tag will be attached to conference badges that will let vendors track attendees by job and employer (and name if the conference allows it), ending the days of anonymous and obligation-free booth cruising. The technology will log booth visits and duration by product being viewed and will alert vendors in real-time when a “key prospect” is in the area (CIO alert! Ignore everyone else!) The conference keeps getting more similar to a cattle butchering operation: you’re herded into a holding pen (the exhibit hall) since the token educational offerings (getting less useful every year) intentionally go dark during major booth hours, you’re fed and watered in the exhibit hall with vendor snacks until it’s your turn with the the high-paying exhibitors, and now you’ll be tracked like livestock throughout the process. Let me just say that, as a paying attendee and member, I resent the hell out of this (I’m sure I can get info on how to cripple the RFID tag and I’ll run it here if so). I can imagine what was going through the minds of the HIMSS dim bulbs who approved this: hey, we can charge vendors even more by selling them the personal information of attendees, vendors can pounce like snakes when attendees identified by job title as a decision-maker enter their air space, companies can monitor whether competitors are encroaching into their proprietary neighborhood, and HIMSS can justify its exorbitant exhibiting costs by showing who dropped by. People seemed to be resigned to letting HIMSS do whatever it wants in the name of picking the pockets of its vendor members. I say it’s time for provider members to push back and make the conference theirs again. Being tracked as nothing more than a roving sales prospect is just insulting. HIMSS apparently doesn’t extend its claimed interest in patient privacy to its own paying customers in the Ladies Drink Free model in which it pimps access to low-paying providers to high-paying vendors.

AHRQ spends $26.5 million of its ARRA money to hire a high-powered PR agency. Ogilvy Washington will “market and promote” the findings of Patient-Centered Outcomes Research in a newly created Publicity Center. I didn’t volunteer to have my taxes used for wasteful economic stimulus projects, but if I had, I’m pretty sure dozens of millions for a HHS PR wouldn’t have been on my list even though the general idea of comparative effectiveness research is a good one (but hugely expensive – $1.1 billion in stimulus money).

Four NICU babies in a hospital in Canada are given insulin instead of heparin in their TPNs, killing one of them.

Shares in athenahealth jumped by 23% on Friday after good Q3 numbers that beat estimates.

E-mail me.


10-23-2010 6-58-14 PM 

From BeKind: “Re: the Senate Committee on Veterans’ Affairs testimony about MUMPS. This dialog occurred at 75:26 in the video.”

Senator Richard Burr: If you maintain MUMPS can the private sector have full access into the VA system, into the MUMPS system, for the exchange of electronic information?

Roger W. Baker, Assistant Secretary for Information and Technology, Department of Veterans Affairs: I would answer it this way, I believe just as much as if we implemented it in any other language because at the bottom it’s the data that’s important.

Senator Burr: Let me turn to Mr. Tullman if I can just simply because he’s out there. Now, let’s see what the limitation is.

Glen Tullman, Allscripts CEO: What I would say is again that you can extract data from any system. What we’re really talking about, and I don’t want to get too technical, is the native exchange of information. So you can pull information out of a mainframe system and put it into a PC if you want two people to talk to each other. The question is why would you do that when you could have two PCs that were talking with each other? So again we think MUMPS was the right decision to make when it was made. We think there’s a reason to carry it forward. We’re just saying as we go forward into the future we need to broaden the understanding of what systems to use, what architectures to use, and what the general reason we need these systems for and that is for communication and I think that’s this idea of this community is important and no one’s using MUMPS to build systems that communicate and exchange data efficiently today in anywhere else but the US government.

Wow, there’s a lot of interesting stuff in this video of the committee meeting, which runs two hours (meaning I didn’t listen to every word yet). The chair, bless his heart, leads off by reminding everybody that the VA and its contractors flopped big-time with CoreFLS and the projects it had to kill because they weren’t being managed well. Ed Meagher talks about the VistA Modernization Committee’s recommendation to put VistA on a stabilization program while developing its replacement. Glen criticizes MUMPS-based systems (meaning not just VistA, but his company’s competitors Epic, MEDITECH, QuadraMed, etc.) and saying the military’s evolution requires new EMR requirements for data sharing. He also says its replacement should be either Microsoft-based or open source (technically, VistA sort of open source, so I assume he means non-MUMPS open source). He says its time for the government to learn from the private sector.

Tom Munnecke, a former VA guy who helped build VistA, testifies at around the 61 minute mark. He credits the original VistA developers, all of whom were clinicians turned developers, for its success, starting it with “good enough” and then refining it from field experience instead of sitting around writing specs. He said MUMPS criticism isn’t new, going back to the beginning, but it works and has been stable. He likes the open source idea for a VistA replacement but cautions against throwing out the lessons learned from VistA. He also advocates additional forms of communication other than the EMR, saying that 25% of VistA’s use was the Mailman app used to simply communicate among professionals (comparing that to today’s social networking). He talks up personalization that can be delivered by cheap, easily implemented tools.

The chairman also asks VA CIO Roger Baker directly what assurances he can give that they won’t screw up again like they did with their replacement scheduling system. He cites the VA’s cancelled or retooled projects as proof that they’ll kill projects with minimal chance for success (the “fail fast” approach of identifying and killing the dog projects fast before they cost too much). Munnecke agrees, but says users need to scale back expectations and allow the software to develop instead of going for the gold-plated Cadillac upfront.  

Munnecke: “Mr. Tullman’s comments have a number of technical issues that I think we need to talk about over coffee some time, but I probably largely agree with his conclusion. I don’t want to be characterized as pro-MUMPS. I do want to be characterized as having a very successful legacy system that has accomplished a lot and just going with the standards of the information technology industry and thinking we’re going to take the shiny new technologies and word on PowerPoint presentations and develop a successful system is not going to work.” When interrupted by Sen. Burr’s comment that he’s never heard anybody comment that DoD actually has working EMR software and wondering why it’s so hard to send DoD medical records to the VA, to which Munnecke replies, “I think you’d have to look at DoD actually throttling back CHCS and crippling the features that were design into it for communication in order to protect their bureaucratic stovepipes.”

Sen. Burr’s summation (in which he repeatedly refers to VistA as “the MUMS system”): “It is absolutely essential, in my estimation, that private sector companies buy in to what technology decisions you make at VA because of exactly what Mr. Tullman references, and that’s that this is no longer our population of people that we’re taking care of. They’re bouncing back and forth … if we want to reach the efficiencies long-term of private healthcare, as most have realized, then we’ve got to have this interoperability solved … if a company like Allscripts, a leader, is questioning whether they’ll be able to exchange through your system, I think we ought to pause for a minute and talk to those companies and find out what is your concern …”

Then came the comments BeKind mentioned above. Sen. Burr mentions that three people in the room have iPads, yet soldiers returning from the military hospital at Landstuhl have paper medical records taped to their chests, saying that the VA should collaborate with the private sector.

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Currently there are "26 comments" on this Article:

  1. With all due respect to Glen Tullman, his systems have wreaked havoc in hospitals physician organization care systems throughout the USA, but most notably in Philadelphia. There is a lawsuit agains Allscripts, ca 2006, from one of the key hospitals in Philly. You, Mr. H., on this blog recently covered an Allscripts failure in Pittsburgh.
    How was he selected to be the “expert” for the private sector, may I ask? Was it because he advises the POTUS? Quite frankly, his testimony was heard by our group as an informercial for his company’s devices.

  2. Tullman: “…We’re just saying as we go forward into the future we need to broaden the understanding of what systems to use, what architectures to use, and what the general reason we need these systems for…”

    Glen, do you need to boaden your understanding of safety? Please tell us which of your devices have been approved for safety and efficacy.

  3. Well, I guess I might rethink going into the exhibition hall at HIMSS this year – I agree with you, bad move on their part. Huge invasion of privacy – HIMSS is NOT the cheapest conference for attendees in general and to have them ‘stalk’ their attendeesnis over the top.

    Thank for your extensive excerpts from the hearing. I have to roll my eyes at some congressman/senator even knowing what the heck they are talking about wrt technology. It is hard for any large enterprise to be successful at integrating applications over a large geographical area and long time frame for use of those applications. Has anyone been super successful at this? In working with medical device systems, the lifetime of a system is 5-7 years and in some cases 20 years. Managing the transition and hopeful backwards compatibility is very difficult with just one hospital, let alone an enterprise. The VA and DoD are two separate departments/agencies of the US Govt managed by two separate internal administrations – expecting perfect interoperability is sure to disappoint.

    In addition, regarding the last comment: Just because a individual citizen has purchased an iPad doesn’t mean purchasing an iPad is a smart corporate or enterprise decision.

  4. While I doubt the kid had malicious intent, what he did was just stupid – most organisations do not trust such input. The hospitals reaction is fairly stereotypical and reflects what has happened in pretty much every other industry under similar circumstances.

    If he installed a “back door” based on access he got from a physician, that in and of itself is a huge security flaw for the organisation.

    As for the comments about MUMPS, I know KLAS scores are often questioned here but Ensemble does well in KLAS rankings, is MUMPS based and is used explicitly for helping different systems to talk to one another so MUMPS shouldn’t be a limitation on interoperability.

  5. Can naysayers please stop saying “devices” when referring to EHRs or CPOE – just throw us this little bone. There is a correct use of term device but it’s hardware or medical devices. Otherwise agree with Mary.

    Glen applauded for turning flailing eScribing company into a huge corporation with enterprise offerings (noticed I didn’t say solution). While a great PR machine and consummate self promoter, the emperor has no clothes. Where’s the beef?

    Glen hasn’t grasped the enterprise yet shooting blanks Epic’s way while pushing an integration strategy out of the Horizon and Sorian playbook. Has he noticed this hasn’t played out well?

    Wake up Glen. You can impress Congress and even technical people focused on platforms and glitz, but we won’t be fooled again. Try talking to people who don’t tell you what you want to hear. You still have a chance if you man up.

  6. RE:HIMSS conference…seems they are going the way of the Pharmacist Group (ASHP) midyear…used to be an awesome educational program but now a vendor controled marketing tool that we have to pay for. You think the HIMSS folks can expand the chip reading to the local bars…then the vendors will know exactly which brew they can use to help decision making for each specific client….they must have hired George orwell as a special marketing consultant

  7. Re:RFID – there are two kinds of RFID, active and passive. Passive devices are easy to protect against – there are many rfid shields available(particularly common now that new US passports contain passive RFID chips)

    Active devices require a power source so they can broadcast. These can be deactivated by removing the battery/power source.

    I cannot speak specifically to HIMSS use of RFID beyond saying it sounds misguided, but I have been to other IT-related conventions that use RFID such as HOPE(hope.net) which had such RFID tags and used it as part of an attendee meta data project (amd.hope.net). The AMD project was wonderful in that you could log into a secure site and see people who had been going to the same talks as you and message them allowing you to meet new people with similar interests.

  8. I agree on the sensors at HIMMS, everybody want their data in some shape or form. Well I think I have a counter attack for attendees:) I wrote this up on my blog as a real concern and the ever more reason to put a password on your Smart Phone as if this software does what it promotes, a Smart Phone turns into a bug and can record and send a conversation to your monitoring software for $59.95. I have seen software like this advertised but not to where the phone becomes a bug; and watch out for those company issued Smart Phones. We may have elevated mobile security to a new level here and have a HIPAA emergency at hand:)

    http://ducknetweb.blogspot.com/2010/10/cell-phone-securityspying-software-just.html

    So buy the software and go to HIMMS and become your own spy as you could use it for your own benefit too:) I am writing this in jest of course but could not pass up the privacy retaliation chuckle here. Might come in handy when one goes to purchase anything they see at HIMMS later:)

    HIMMS would have been better off using something like Booth Tag where attendees could scan bar codes at the booths and save information from different exhibitors and also the vendors would have a listing of who actually looked at their product and a smarter way to follow up and cheaper than that union run card scanners vendors have to buy from the show too:) I wrote this up back in May and it looks like a good thing as it gives value to the attendees too with a choice and like you said not a CIO red alert.

    http://ducknetweb.blogspot.com/2010/05/microsoft-tags-booth-tags-coming-to.html

    I love this technology anyway and it is emerging all over the place and have my own case for the FDA and drug companies to start using it and you can now scan Cannon products at Best Buy if you want some practice on how it works, easier than making a phone call and encrypted tags with a gateway can be used to import information with PHRs with HealthVault and Google Health this way too, and the WiFi scales uses the bar codes, so again rather than spying on the attendees with RFID this makes more sense to me. You got me going today:)

    One more item that popped in here on a different topic, the City of Hope situation is being allowed to go forward with creating the new physician group so current MDs will have to join or quit I believe and perhaps the direction of ACO? Bot the doctors and the hospital were suing each other and many hospitals were watching this with open eyes here in CA as it could be setting a precedence. I thought this was worth the mention here as it indicates some major paradigm shifting.

    http://ducknetweb.blogspot.com/2010/10/judge-rules-in-favor-of-city-of-hope-in.html

    Anyway, at HIMMS perhaps we can all play ISpy and find out who does it better:)

  9. Asking Glen to comment on technical matters is like asking Judy to comment on politics.

    Glen is using the national forum to create a competitive edge for himself. Shame on him. Judy wouldn’t do that.

  10. At the hearing, I had a bit of trouble maintaining Senatorial decorum, listening to Glenn say that VistA was a proprietary mainframe system while Allscripts was an “open Microsoft-based” one.

    I also pointed out during some discussion after the hearing with other panel members that I had installed a “good enough” VA/DoD sharing system in 1982 between Loma Linda VA and March Air Force Base Hospital http://munnecke.com/blog/?p=749 – that DoD proceeded to disable. VA/DoD integration is a political problem, not a technical one. It’s like trying to get elephants to mate, only to discover that you are working with two alpha males.

    It was a little bizarre carrying on the MUMPS debate in front of 4 senators, but I think that this distracted folks from the broader issue of open source dynamics at the clinical level. It’s a little about arguing whether Wikipedia should be written in Python or PHP instead of discussing what Wikipedia has accomplished as a open system. Yes, the Python/PHP debate is worthwhile, but why let it overshadow the big picture of an open knowledge system?

    By the way, this dialog is quoted from the unedited version of the transcript. Edited versions are due back by Nov 5, so sharp-eyed readers might be interested in watching what changes.

  11. I’m sure the RFID tracking will lead to a new, time-honored tradition of CIOs swapping badges with their underlings so they can get through the floor without getting mauled by overzealous booth staff. The underlings will enjoy posing as their boss for the day, soaking up all the attention while knowing full well their boss is enjoying a quiet and under-the-radar meander through the booths.

  12. What was Glen Tullman talking about for two PCs talking with each other? Web chat?

    What does this have to do with MUMPS? PC-to-PC talk would not be affected by the database language.

  13. Re: RFID
    Funny as a vendor i have not heard anything about this approach. i am sure it is in something they have sent and will keep you all posted. if they are just monitoring who is entering and exiting the floor – that is good data to have. If they start trying to sell the ability to monitor who is stepping into your booth … that is a bit much and i would think a deterrent to attendees to even visit the floor.

  14. re: ogilvy and PCORI. While I agree $26 million is probably excessive, translation of comparative effectiveness findings into practice is still a major problem, so this may be part of a larger strategy. Any other alternative suggestions?

  15. re: “With all due respect to Glen Tullman, his systems have wreaked havoc in hospitals physician organization care systems throughout the USA, but most notably in Philadelphia. Quite frankly, his testimony was heard by our group as an informercial for his company’s devices.”

    That was my general impression. I suspect he wrote Sen. Burr’s remarks and questions verbatim. Burr threw him softball questions, and didn’t allow me to comment.

    Here is a follow up report on an excellent report on Open Source VistA dynamics from CMU: http://munnecke.com/blog/?p=985

    And speaking of Judy, here is a paper from the 1979 MUMPS Users Group (where much of the original VistA gang came from): http://munnecke.com/blog/?p=906

  16. Tullman is mixing architectural layers in his argument like an amateur – backend db architecture has nothing to do with interoperability. Possibly he has something to gain from this misinformation…?

  17. Just announced from McKesson – highlights.

    We will combine our clinical and revenue cycle groups to form the Health Systems Enterprise Solutions organization, which will be led by Rod O’Reilly as president. Rod joins Health Systems Enterprise Solutions from the Medical Imaging Group (MIG).

    With this change, we are also creating a new business unit called Health Systems Performance Management. This organization includes all of our workforce management, surgery, performance management, analytics, supply chain and HR/payroll product solutions. Given the increasing focus on quality and efficiency in healthcare, we have an opportunity to expand our market leadership with products and services that deliver value quickly by enabling customers to benchmark and improve their clinical and financial outcomes.

    To enable accelerated growth in document imaging, the Enterprise Imaging Group (EIG) will become part of the Medical Imaging Group (MIG). EIG has a strong track record of great products and results, with nearly 1,000 facilities using our document management solutions. This realignment will enable us to create appropriate development plans for the next generation of EIG products and leverage MIG’s expertise in the areas of innovation and execution. A search process is under way to identify a successor to Rod O’Reilly as president of the combined group.

    With these changes, Loren Buysman, president of Revenue Cycle Solutions, is leaving McKesson. We thank Loren for his many contributions to McKesson over his career, and wish him well in his future endeavors.

    Sales and Business Unit Integration
    As the market has continued to evolve, we have revised our market segmentation to more clearly identify Horizon Clinicals® and revenue cycle opportunities versus customers and prospects that can be served best with our Paragon® system. Each of our non-enterprise solutions sales teams has continued to identify opportunities to increase market penetration and better position McKesson for larger wins. The combination of all these efforts led to strong sales execution over the past couple of years.

    Customer Success across the MPT level will be led by Jeremy Chandler reporting to me. The creation of the Customer Success organization creates a new emphasis on post-sales customer management and satisfaction. Over time, this new structure will yield single account ownership responsibility for both customer satisfaction and selling.

  18. The Epic talent shortage is killing me. We’re growing our team of recruiters and we have relationships with staffing firms and recruiting agencies (we’re a consulting firm). Everyday it seems we’re hit with new requests/opportunities and we keep coming up short. I wish I had some stats that would demonstrate for our management team how many experienced/certified Epic folks there are on projects vs. un-engaged.

  19. Sorry about the misspelling of HIMSS and I stand corrected with my typo, was a late post but with all the concerns over the security of mobile devices and I’m sure these folks won’t be the last to come up with innovative spy software something along the line here should be addressed as not ignored before it gets out of hand and I would think the FTC would be taking a look at some of these companies too.

    When you look at the one item that states a company caught and fired a sales person for leaking company secrets that put the software on all company phones, it just makes you wonder if anyone can be minding the shop today with any impact as it seems to be getting pretty gray and more dog eat dog by the minute.

  20. re: Blah: “Tom, huge amount of respect for what you did with Fileman. Having worked with it and EPIC Chronicles i think Judy owes you some money.”

    First of all, your respect should be directed at a whole team of folks, not just me because I happen to be in the limelight. George Timson did the bulk of the programming of FileMan, but there were many others who contributed – a demonstration of the value of collective intelligence and the virtues of open source development model. I didn’t invent MUMPS, nor did I single-handedly program VistA and CHCS. I just happen to be getting a lot of attention recently. You can see and hear from some of the others in video interviews I did at http://munnecke.com/blog/?p=928

    My concern was to capture the metadata of the system in a computer readable format – thus, the data dictionary. I still hope that some smart folks can figure out a simple way dealing with this metadata in smarter ways… see http://www.caregraf.org/semanticvista for one interesting approach. I think we need to climb up the ladder of abstraction to smarter linguistics, rather than fall down it into brittle, point-to-point interfaces and lawyer-friendly electronic medical records systems.

    re: “Judy owes you some money” I have to admit, it’s been a bit of a one-way mirror over the years. While what was happening at Epic was proprietary, all of the VistA design was openly available through Freedom of Information requests, and we had regular tutorials and presentations of the technology at various meetings. I was giving papers and lectures all over, and very happy to listen to new ideas and see the trials and tribulations of the system as it spread throughout the government, Finland, Nigeria, and elsewhere.

    It’s been interesting to see how folks from the MUMPS User’s Group meetings of the 1970s have fared. Terry Ragon started Intersysems (recently donated $100 million to MGH), Paul Egerman started IDX, and Judy started Epic, all of whom have a few more zeroes in their net worth than those who developed VistA.

    Maybe they can use some of this money to support an open health IT future.







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