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March 22, 2011 News 12 Comments

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Politicians from Epic’s home state of Wisconsin urge the VA and DoD reconsider their plans to develop an open source replacement for VistA, asking for “appropriate consideration” for “commercial EHRs.” Epic admits it provided information to Wisconsin’s members of Congress as well as to those from other states, although a company spokesperson stresses that it does not hire lobbyists. Expert Tom Munnecke was quoted as saying, “The open-source VA VistA model was always under attack by those who wanted to lock the government in to their proprietary architecture. The VA showed repeatedly that an open model was superior.”

3-22-2011 9-06-09 PM

The Alembic Foundation announces its formation as a nonprofit that will build and manage open source technologies that empower citizens. Its first project is Aurion, which will extend the work of the CONNECT project as a private sector custodian. David Riley and Vanessa Manchester, Alembic’s president and COO, respectively, helped develop CONNECT for the Federal Health Architecture as independent contractors before starting Alembic. They also mention a keen interest in Personally Identifiable Information.

Reader Comments

From Frank Poggio: “Re: Medicare Payment Advisory Commission’s recommendation of a 1% physician pay increase. If a doc gets payments of $400k per year from Medicare, that means they will get a $4k increase in payment if volume and mix stay the same. But .. CMS has never accepted the MPAC recommendation without lowering it, so probably will be more like 0.5% (a $2,500 increase). Now if the doc does not do the EMR dance and misses MU, they will get hit with a 33% reduction in his/her Medicare adjustment, reducing the $2,500 by $800!! In other words, if I do not spend $40k+ on an ambulatory EMR (not including installation, training, etc.) it will cost me $800. Sounds like a no-brainer to me. Forget the $800 and do it when you are really prepared and ready to, not when the government says JUMP!”

3-22-2011 9-40-24 PM

From Nolan Smith: “Re: Duke CIO. Duke University Health System has picked a new CIO. Look for an announcement soon.”

3-22-2011 7-57-06 PM

From Lazlo Hollyfeld: “Re: NHIN Direct. I give the federal government credit. I never throught they would get this far. Gradually added vendors and now have almost every important ambulatory EMR vendor. I do wonder, though, why athenahealth is MIA, especially since Bush takes every chance he gets to bring up the ‘walled garden’ analogy of his EMR competitors?” ONC announces that 60 organizations (including the vendors on the list above) will support the Direct Project’s protocols, which will allow simple EHR-to-EHR messaging and secure e-mail (using the provider’s Direct Address) to replace paper and faxes.

HIStalk Announcements and Requests

Several readers suggested holding off a couple of weeks before deciding whether to make the “new” format (this one) permanent, so here’s your last chance to vote.

image I wrote some pretty good editorials for Inside Healthcare IT over several years because I wasn’t as busy with HIStalk then and I have a desperate need to be loved (it must have been that because I worked cheap). I’ve reacquired the rights to the large collection (something like 175 editorials) and will start running them occasionally on HIStalk. They’re fun to read because they cover what was big news at the time (much of which still is), not to mention that I wrote them on a tight deadline that made me usually go way over the top in both subject and style (the title of one of my early ones: Just Back From HIMSS? Finish Implementing Yesterday’s Fads First.) I ran a few of them here years ago, but most haven’t seen the light of day unless you were a subscriber to that newsletter.

Acquisitions, Funding, Business, and Stock

Xerox-owned Affiliated Computer Services (ACS) will acquire CredenceHealth, a provider of clinical surveillance software, and will integrate its clinical surveillance tools into ACS’s Midas managed care solutions.

Cerner shares hit an all time-high this week, closing Tuesday at $107.80 and giving the company a market cap of $9 billion. Neal Patterson holds $459 million worth.

A Kaiser Health News article says that insurance companies are investing in less-regulated businesses to keep their profits high, potentially also giving them control over more of the healthcare system. Mentioned: UnitedHealth Group’s acquisitions (including Picis), Aetna’s purchase of Medicity, and Humana’s acquisition of clinic operator Concentra. Former ONC head David Brailer is quoted: “If you’re a health plan, you either become a care delivery system or an information services company. The traditional business is dead.” 

Apple sues Amazon, saying the company improperly used its trademarked “App Store” name. Some EHR vendors have used that name as well, so this is probably a good reason to stop.

A class action lawsuit trial against Tenet Healthcare starts Monday, brought by people inside Memorial Medical Center, a New Orleans hospital it owned in which 45 people died following Hurricane Katrina in 2005. The suit claims the hospital had inadequate backup electrical systems and wasn’t prepared to handle a disaster. Tenet is alleged to have initially turned down the hospital’s requests for supplies and evacuation helicopters. Doctors at the hospital have already admitted they intentionally killed suffering patients with drugs in the four days it took for help to arrive.


United Hospital (MN) chooses Isabel Healthcare’s diagnosis support system to integrate with its Epic EMR.

The Military Health System awards Evolvent seven new task orders, including a transition from ICD-9 to IDC-10 code sets and 5010 updates.


3-22-2011 1-56-43 PM

CodeRyte chair and president Richard B. Toren joins the Medsphere board of directors.

Prognosis Health Information Systems adds several execs to its management team, including Bryan Haardt as EVP of technology, Stephen Payne as CFO, Paul Sinclair as COO, and Jay Colfer as EVP of client solutions.

Integration provider 4medica appoints Gregory Church director of marketing.

3-22-2011 7-25-23 PM

John Schrenker, former CIO of Lakeside Health System (NY), will run the new online master’s degree program in health information administration of Roberts Wesleyan College.

Announcements and Implementations

3-22-2011 12-43-35 PM

MidMichigan Health goes live on Cerner after spending 398,000 person-hours preparing, not including the time of Cerner employees or that of contractor Deloitte Consulting. The total project cost for MidMichigan’s four hospitals: $50.1 million.

Banner Health (AZ) will spend $200 million to upgrade its Cerner systems in 23 hospitals, expecting to recoup $125-$150 million from federal EHR incentives.

Henry Ford Health System (MI) goes live on its $100 million CarePlus Next Generation EHR at its Ann Arbor location. Henry Ford’s IT team, including six executives and 150 programmers, spent six years developing the system, which is sold commercially by Reliance Software System (RelWare) as EXR.

Innovation and Research

athenahealth VP John Lewis says that his company is “definitely considering” retooling its product to work on Safari and Mozilla browsers and not just Internet Explorer, but notes it would require “a big chunk of additional cost in research and development.”



I mentioned Vince Ciotti’s HIS-tory presentation at HIMSS. He’s putting together a version for HIStalk, the first installment of which is above. Assuming SlideShare works, anyway, not a given since they seem determined to mess it up by grafting it onto Facebook and Twitter. My first choice was Microsoft’s Windows Live SkyDrive, but I couldn’t get it to work right.

3-22-2011 7-22-59 PM

The new $1 billion children’s hospital in Victoria, Australia will open in November using software applications it previously described as “old and outdated” and potentially dangerous to patients. The hospital had turned down the government’s HealthSMART system to go its own way and requested $24 million to buy an unnamed US system, but the new government forgot to budget for it.

3-22-2011 1-04-08 PM

Two New York men are arrested for selling oxycodone out of a Lickety Split ice cream truck. Kids would buy their frozen treats and grownup addicts would line up make their purchases, turning the truck into a $1 million a year business. They pair will be giving up their mobile freezer for a different kind of cooler.

Sponsor Updates

  • Cumberland Consulting group promotes Elizabeth Durst to executive consultant.
  • Sage Healthcare finalizes a uniform community health center contract with the Texas Association of Community Health Centers.
  • California Health Information Partnership and Services Organizations (CalHIPSO) identifies eight vendors to participate in a Stage 1 contract negotiation process: Allscripts, eClinicalWorks, GE (Practice and Advanced Systems), Greenway, NextGen, athenahealth, McKesson (Practice Partner), and e-MDs.
  • Quest Diagnostics launches a 12-week, 10-city Care360 EHR Road Test tour to provide live demonstrations of the Care360 EHR software.
  • Fujifilm Medical Systems and Nuance Communications partner to sell Nuance’s PowerScribe 360 dictation system to Fujifilm’s base of radiology customers.
  • MD-IT posts a product video to YouTube.
  • Consulting firm asquaredm offers a free guide called The Physician Compensation RVU Fallacy: Part 2.
  • Health Assocation of New York State (HANYS) expands its relationship with RelayHealth as its preferred partner for revenue cycle management solutions for its member hospitals and health systems.


Mr. H, Inga, Dr. Jayne, Dr. Gregg.

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Currently there are "12 comments" on this Article:

  1. This isn’t about Open Source at all. This is about government waste and politics

    The amount federal taxpayer dollors spent on VistA and DoD AHLTA and CHCHS 1&2 far exceed the entire Market Cap of Cerner (which you peg at $ 9B and all the money Epic has ever made in it’s entire history (maybe 3 to 4 B???). Could probably throw in Meditech as well and not even get close.

    Open source is a misdirection here and we’d be idiots to fall for it.

    Good rule of thumb, count the number of times you see the words SAIC or Northrup Gruman associated with someone who is connected with this open source initiative and add a billion dollars.

    This isn’t about well intentioned programmers feeling that spark and contributing a CPOE system. This is about huge government consulting contracts to do self development and another 1000 to 3000 programmers being hired (probably to work in West Virginia where Jay Rockefeller openly advocates for open source in a huge way because it supports more federal taxpayer funded developers in his district).

    The Wisconsin delegate may have been inspired by the Epic story but they got the message right. Go commercial where you can – it allways turns out better and cheaper than government developed work. Government is meant to govern, not develop software, build cars, make cell phones, etc.

    If I were a taxpayer who worked at Cerner I’d rather they went out ofr commercial off the shelf where available.

    Let people compete fairly and openly and quit selling out our taxpayers to defense contractors!!!

  2. So Epic doesn’t hire lobbyists, they just lobby state and federal politicians to get things they want. Amazing more people turn a blind eye to how sleazy a company Epic is.

    Before you get too high and mighty on government waste, keep in mind that Kaiser has spent a shocking $7 billion to create and maintain KP HealthConnect with Epic at the core. Kaiser isn’t even half the size of the VA and DOD, and has spent nearly as much in a shorter amount of time to get a system that’s barely even equivalent to what the government has to offer.

  3. Keep in mind that the way VistA was developed by the VA (using internal resources and clinicians) was very different from the way AHLTA was developed (big government consultants). Talking about them as if they were the same is an error. I don’t know the finances, but I suspect the development cost of VistA was less than AHLTA by a long shot.

  4. Vince Ciotti’s HIS-tory presentation was a nice trek down memory lane. Having “been there & done that”, I always enjoy reading his reflections on days gone by.

    Vince, if you read this comment … Thanks (again) for the memories!

  5. Re: Isabel (United Hospital in MN). Is there any new evidence out there on Isabel? I’ve seen literature where it comes up with a correct diagnosis a high percentage of the time, but have never seen any trials on its effects on clinical outcomes (or how MD’s do with or without the system).

  6. I think Tom M. had the right idea 20 years ago, but those days are long gone. The VA doesn’t develop like that anymore.

    So many home brew shops put in noble efforts, but the necessary level of R&D is beyond what they can afford in terms of dollars and I think something new has happened. One by one they are giving up trying to be good developers and focusing on being good doctors and healthcare providers.

    To make a really good EMR, you need the input of many sites and the accountability of people that need to meet user’s needs in order to survive. You can’t achieve commercial quality with a classic IT department (federal or otherwise) approach.

    The VA probably realizes that it’s not working for them any more and that’s why they’re trying something different.

    Commercial vendors aren’t bad. They live or die by making customers successful. We all bash them from time to time and all they can say is thank you sir, may I have another. Then they go back and try to make things better – or they get beaten by competitors.

    And as far as Epic and politics… they ARE neophytes.

    They can only sit on the sidelines and watch Glen Tullman play hoops with the Prez or maybe a game of Slow Pitch with Senator Burr while he gets some sweet shots at his competition on the record with such memorable one liners like:

    “the fact remains that VistA’s basic platform, which relies on the 25-year old technology called Mumps, cannot support the open, flexible approach needed by those providing care to our nation’s wounded servicemen and women.”

    from: http://veterans.senate.gov/hearings.cfm?action=release.display&release_id=e08907bc-69bc-49c0-a8a6-fbd113139e92

    Someone should explain to Glen that Sybase (oops MS SQL) is also more than 25 years old.

    Anyways, time for a change for the VA and DoD – their users deserve a state of the art system. Our veterans deserve it and our service men and women and their families deserve it.

    They don’t deserve to wait another 10 years to see if someone’s dreams might come true while they spend down another $ 10 B in taxpayer dollars.

    And, we can’t borrow that kind of money from the Chinese any more to run a grand experiment or to feed somebody’s ego.

    Let’s accomplish today what can be done well today.

  7. 1) If you hang around Washington, you’ll know that having lobbyists is a much bigger ball game than being on good terms with your congress people. Epic perhaps has a little more pull in WI than in a larger state with many F500 companies, definitely more pull in Madison.

    2) This whole thing is really interesting to me, because Paul Ryan is one of the up and coming Republicans because of his Roadmap for America, so his position I suppose would be that the government’s solution is too expensive. I would assume his position would probably be to use the cheapest dang thing you can find. The same can be said for the republican senator who was a tea party candidate. Seems like a typical case of politics; Epic wanted to be considered and the congressman wanted to say they were cutting spending and promoting business when in reality, I don’t think they care at all about Epic, they both just used each other.

  8. Great comments by VistA Observer.

    As far as I know (which is not that far), VA does not employ government consultants to lead the ongoing development of VistA CPRS, or the other clinical systems they use like VistA imaging. But that’s not really the most important point. The important point from my view is that VistA was (and is) a tremendous success while AHLTA has been a major failure. Is it because the VA is better at developing software than DoD? Probably not, because they’ve had their share of failures too (Remember the Core FLS fiasco)? I would ask – what is it that made VistA a success and AHLTA a failure? I suspect it has little to do with “government waste” or “open source”. I would also ask – what is it about Epic that allows them to kick everyone’s ass right now? Why are they dramatically more successful than their counterparts?

    VistA is great for the VA, and it works for some hospitals in the private sector. But it can’t work for DoD, given the limitations of its architecture. However, none of the private sector offerings will work right now either, at least not without significant development work to support the unique deployment and security needs of the DoD.

    Not sure what the right answer is. But it seems clear to me that the large number of failures and small number of successes in the EMR world aren’t as easily explained by the ‘commercial vendors vs. government’ argument as some would have us believe. We should really pay attention to the successes and see what we can learn.

  9. Go commercial where you can – it allways turns out better and cheaper than government developed work

    I disagree.

    cf. the UMLS project that powers PubMed.

  10. Re: Open source vs. closed, instead of speculation, there’s the scientific approach to this issue:

    Reading. (We do this in medicine all the time!)

    I recommend “Medical Informatics 20/20: Quality And Electronic Health Records Through Collaboration, Open Solutions, And Innovation” by Goldtesin, Groen and other VistA pioneers.


    disclaimer: I make no $ and have no conflicts of interest regarding this book, except that I am quoted in ch. 1.

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