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Monday Morning Update 4/13/09

April 11, 2009 News 14 Comments

From Ben Mehling: "Re: open source. I can state emphatically that Medsphere is ‘truly open source’. This fact is easily verifiable with a quick visit to http://medsphere.org where anyone can download copies of our software and use them within the provisions of OSI (http://opensource.org/) and FSF (http://www.fsf.org/) approved licenses under which we release software. Medsphere.org is also our community’s central hub for discussion, support and development activities — anyone interested in open source and healthcare is welcome. We’re happy to discuss this with anyone that still has concerns, either publicly or privately." Ben is director of advanced technology at Medsphere.


From MiamiRocksters: "Re: Satyam. Looks like IBM is still in the running." The company will be sold off by the end of the month, with bids due Monday. IBM said it was pulling out because of Satyam’s exposure to US class action lawsuits for accounting fraud, but I bet they’re still in the hunt (building the net present value of the lawsuit risk into the offering price, of course). Two Indian companies have been bandied about as front runners to buy Satyam, but Cognizant, HP, and CSC are also said to be interested. And why not? The accounting scandal was limited to a few hands and the business should still be sound, at least once the bad PR can be soothed. The Pricewaterhousecoopers auditors are still in jail, as should be whomever thought up that ridiculous company name.

From Kenneth Parcell: "Re: HIMSS. It was OK. The traffic seemed lighter, but the transportation was reliable and convenient. My only beef was that the shuttle service to the airport took over one hour. Chicago is a wonderful city and I would definitely enjoy it if HIMSS decided to return. Most interesting technology was Google’s PHR suppository repository. Wish I had a picture, but it looks like a little white capsule with Google written on the side. I assume it is placed in the appropriate orifice where it seeks all health information from the source. When finished, the collected data is linked to your PHR and you can Google search clinical information about yourself, such as ‘Find abnormal growths’ and ‘Am I getting enough fiber?’ Not sure why I saw others rubbing the repository on their lips … perhaps they were salesmen and were confused about where to stick it." So far, the poll to your right is running 2:1 for a Chicago return.


From Being John Doe: "Re: Cerner’s answer to HIMSS?" Link. It’s a Cerner YouTube video about its Second Life world or whatever the fantasy-nerds call it. I have to think all those companies that hired hipsters to create Second Life sites are regretting that decision. I didn’t see or hear Second Life mentioned even once during the entire HIMSS conference.

A New York Times article profiles the use of an EMR (from e-MDs) of a rural doctor, who summarizes as follows: "I’ll never go back to the old system. I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.” This is what I’ve been saying here for years: the main value of electronic records is being able to review and create electronic data from anywhere. Just getting data into an electronic form is where the payoff lives. I’ve argued that HITECH should have rewarded providers for sharing data on a national framework such as NHIN, paying them per patient (or, even better, per record type). Using technology is one form of "meaningful use," but making data available to other providers is more so. The power is in the network, not the desktop.

And in that regard, Dale Sanders, CIO of Northwestern Medical Faculty Foundation (thanks to Dr. Lyle for the link) might change your EMR perception with his phony news article about an EMR created by Amazon.com. It’s a deceptively simple and light-hearted piece, but think about what he’s saying about software personalization, analytics, architecture, and social networking, a contrast of pre-Internet EMRs to what could be given what we know today.


C-Span has video coverage of a White House discussion on healthcare reform led by Nancy-Ann DeParle this past Wednesday. She seems fun.

The AMICAS-Emageon headcount reduction, according to one very informed source, is over 100.


Global nonprofit IntraHealth International launches IntraHealth Open, offering free downloads of celebrity remixes of "Wake Up (It’s Africa Calling)" and accepting donations to support open health software solutions for the developing world.

CCHIT musings: everybody wants CCHIT to "certify" EMRs on everything from usability to the financial stability of the vendor. Is that really necessary? Stimulus payments will be tied to using a product certified by CCHIT (or some other group), so it doesn’t make sense for users of already-certified systems to lose money because their vendor can’t meet new usability standards (even though that provider is actually using the product without complaint). CCHIT was formed to evaluate interoperability and reduce physician risk, back when its certification had little impact on the income of either vendors or providers. We need to be careful about wanting CCHIT to turn into KLAS, churning out a "Top X" ranking instead of certifying minimum requirements and letting the market decide which vendor is doing all the non-essential stuff better. Surely doctors are smart enough to buy wisely.

Ivo Nelson e-mailed to say his ongoing pub event HIMSS was so popular that Encore might do it next year in Atlanta. That’s the home base of the Fado’s chain, about which he mentioned that his deal with a more authentic Chicago pub fell through at the last minute because it decided to close for the weekend (hey, if they’ve got Guinness and a green flag or two, who cares?) I’m also interested in ideas for the HIStalk bash there, assuming I can get sponsors and all that. I have thoughts on just about everything except location since I don’t know Atlanta very well.

A note to all you supposedly expert media people covering Dennis Quaid’s speech: please stop capitalizing heparin. It’s a generic name, not a brand name. Thank you.

Some open source people believe they saw the beginning of mainstreaming of open source at the HIMSS conference. I don’t see that happening. Reason: hospital CIOs were raised under the influence of application vendors, often have worked for them in the past, and even more often hoping to work for them in the future, and overseeing Epic or Cerner shops is a resume builder. CIOs, like the hospitals they work for, don’t like to be the first in their area or size range to do something different. Most importantly, healthcare is driven by special interests, lobbyists, vendor people volunteering for influential committees, and job-creating potential. Open source doesn’t have any of those (not to mention a non-government track record). Even the VA seems to be itching to dump VistA in favor of commercial products (again, rightly or wrongly). When you talk about hospitals using open source, that’s mostly VistA, which would be fantastically lucky to get 1% market penetration. Not a rosy opinion, I know, but I promise to update it when any open source clinician application hits 50 hospital clients. If hospitals aren’t interested even when starved for capital as they are today, they never will be.

Since the President is promising everything to everybody and printing whatever amount of current those promises require, he goes ahead and adds "give all veterans a new electronic medical records system" to his Santa list.

New York offers $60 million in financing for HIT projects, this time targeted to medical home applications.

I see the e-mail update signups have been going like gangbusters, so that box to your upper right is calling your name, at least if you want to be among the first to know important stuff. Inga pores over the stats like a CPA, so it makes her happy.

Odd lawsuit: the patient of a plastic surgeon who claims her face-lift surgery was botched has posted an ongoing stream of nasty comments and videos all over the Web, blaming the doctor. He sued her for defamation for doing so and then, according to the patient, called the mental health department claiming she had e-mailed him saying that she planned to commit suicide live on the Internet, getting her Baker Acted. The doctor says she is psychotic and hurting business for his $5,999 Tax Time Special breast augmentation surgery. Here is her site, with a ton of documentation (seems convincing to me, but I’m not taking sides because both parties sound litigious).


The Conficker worm hits University of Utah’s health sciences schools and its hospitals.

Harris Corp. gets a $14 million, one-year contract to provide an imaging system for 65 DoD hospitals, announced at HIMSS. Also announced: Harris donated $10,000 to the Wounded Warrior Project.

E-mail me.

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Currently there are "14 comments" on this Article:

  1. Medsphere,

    Does Medsphere not develop a “commercialized” version of Vista? I know Vista is opensource, however, it is not made for commercial hospitals. It was my understanding that Medsphere develops “plug-ins” or “bolt-ons” to enhance Vista functionality.

    Correct me if I am wrong…but it has been a while since I have been…;).

  2. re : From Kenneth Parcell Most interesting technology was Google’s PHR suppository repository. Wish I had a picture, but it looks like a little white capsule with Google written on the side. I assume it is placed in the appropriate orifice where it seeks all health information from the source. When finished, the collected data is linked to your PHR and you can Google search clinical information about yourself, such as ‘Find abnormal growths’ and ‘Am I getting enough fiber?’
    I looked online for this…and found nothing. Can Kenneth Parcell give more info, like the name of the product etc. Interesting to say the least.

  3. Medsphere does develop a commercialized open source version of VistA. It has some nice enhancements. It also has the “plug-in’s” and “bolt-on’s” to add key features required by their customers. It is a nice product. Like any product, the real key is the implementation that links the processes and the technology.

  4. So the ‘bolt-on’s’ and the ‘plug-in’s’ are open source or do you have to purchase those customizations?

  5. Regarding Medsphere and how “open” they are, isn’t that what the legal tussle a couple of years ago between (then) new management and the (foundiing) Shreeve brothers was all about? Indeed, unless I’m remembering things wrong (wouldn’t be the first time), the specific bone of contention was around not publishing tools/plug-ins/enhancers or whatever. With that in mind, is the current announcement an attempt to show that MedSphere has reversed course and returned to its open-source roots? One more thing: I walked up to say hello to Jonathan Bush after his remarks at the HISTalk reception at HIMSS. He was surrounded by only one other person so I thought it would be a good time. Turns out the fellow he was speaking with was somebody senior at Medsphere (CEO perhaps, I didn’t catch the name). Jonathan introduced us and asked me if I was familiar with Medsphere. I said that I was and then reflexively (and stupidly, although perhaps a bit intentionally / provocatively) said that I knew Scott Shreeve. Mystery Medsphere guy then turned his body away from me toward Jonathan and ignored me for the remaining few minutes I was there. Where are the Shreeves these days, anyway?

  6. Regarding the HIMSS transportation to the Chicago airport.You would save time and money taking the Blue Line train from downtown to O’Hare. $2.25 and 45 minutes.Takes you right into.the terminal.

  7. Mr. HISTalk:

    You wrote:

    “HITECH should have rewarded providers for sharing data on a national framework such as NHIN, paying them per patient (or, even better, per record type). Using technology is one form of “meaningful use,” but making data available to other providers is more so. The power is in the network, not the desktop.”

    You have made other similar comments before, to the effect that using an EHR offers little real benefit to a physician, and I have always meant to respond.

    As a practicing physician who has used EHRs for over 12 years, I must take issue with this contention. YES, it is a hugely important benefit just to be able to access patient data anytime and anywhere. However, it doesn’t end there at all. The EHR allows me to organize the data in my patients’ records so it is clear to me and others what their health issues are, what the status is, and what needs to be done for them. Features such as problem lists and automated reminders customizable at the patient level (to name just two) make patient data “organizable” in a way that I just couldn’t do with paper. It is this ability to keep track of what’s going on with my patients, what has happened in the past, and what needs to happen in the future that is-in my opinion-the most important benefit of an EHR. That’s aside from some of the other aspects of EHRs that are felt to be “game-changing” from a medical care perspective, like tools for population-level quality management and direct patient access to the medical record…

  8. I agree with all of the value you derive from your EHR use, Dr. Herzenstube, as well as the potential values you mention. (And more. I also love my EHR.) But, I think Mr. H has a valid point: If there was at least a simple to use document imaging and sharing EHR that physicians could all begin with (i.e., less initial workflow disruption,) wouldn’t the drastic enhancement to data sharing be a HUGE step in the right direction? Unless you have electronic interoperability (few of us,) trying to retrieve even well-formatted, fully competent EHR data is, right now, just about the same as calling for faxed reports or awaiting snail mail copies. If we want the masses of docs to switch, wouldn’t it be reasonable to provide this ability as a first step, an initial module upon which to build once they begin to see the value. Small step, huge benefit. You have to feed the hens a bit before you can get the eggs.

  9. Enjoyed the Himss daily writings, would be interesting to know more about iSoft and its activities in Himss. Thanks.

  10. I love Chicago. I love the people, I love the dining, I love the architecture, I love the character, etc.

    I hate the McCormick center for HIMSS. It’s way too big and spread out. The amount of walking causes me to cancer attending sessions because its too far or not enough time.

    There are conferences that are about exhibits. There are conferences that are about sessions. HIIMSS is both. Stick to the centers where the meeting rooms are outside the exhibit hall or up an escalator. Not the ones where we have to walk across two city blocks to get to a room in 5 minutes.

  11. You said: “When you talk about hospitals using open source, that’s mostly VistA, which would be fantastically lucky to get 1% market penetration.” However, New England Journal of Medicine disagrees with you.

    NEJM said:
    “we found that 1.5% (95% confidence interval [CI], 1.1 to 2.0) of U.S. hospitals had a comprehensive electronic-records system implemented across all major clinical units”

    “If we include federal hospitals run by the Veterans Health Administration (VHA), the proportion of hospitals with comprehensive electronic-records systems increases to 2.9%”

    That would be nearly 50% of market share. Read the article.

    [From Mr. HIStalk] I was not including VA hospitals in the overall market, so I intended 1% to mean 50 or so non-VA, non-military hospitals.

  12. Medsphere is an opensource product that has nice enhancements. What you contract for is the implementation services that go along with that product. This cost is as much as a non opensource product in my two experiences with MedSphere. All in all, not a bad product but it is definitely not free.

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