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Monday Morning Update 5/30/11

May 28, 2011 News 10 Comments

5-28-2011 7-49-59 PM

From Pericles: “Re: Allscripts outage at Allegheny General. The article refers to the company’s ‘New Jersey headquarters’ instead of Chicago. Could they have named the wrong vendor?” I assume the problem was with a hosted version of the Sunrise application, which is run from the former Eclipsys hosting center in Mountain Lakes, NJ. That operation and service was turned over to ACS/Xerox just over a month ago in a 10-year, $500 million outsourcing deal.

From Nosmo King: “Re: Nuance. As result of the Nuance partnership with 3MHiS that created CAPD (Computer-Assisted Physician Documentation), there are rumors that Nuance might buy the troubled document creation and management business of 3MHiS, formerly known as SoftMed.” Unverified.

5-28-2011 9-16-21 PM

From Mercy IT Gal: “Re: St. John’s Regional Medical Center, Joplin. It’s been a crazy week here at Mercy. A lot of time and effort is going into making sure the patients are taken care of, making sure our co-workers are OK, and securing the assets that were in the hospital. The mobile hospital is pretty wild – looks like a MASH unit (picture attached). The mobile hospital is an attempt by Mercy to show the community of Joplin that we’re not going anywhere. Mercy is committed to the Joplin community and will not abandon them in their time of need, even if it means setting up a temporary structure until we can get something new built. The frustration at work can get pretty high at times, but I can tell you that this week I’ve been pretty proud of working at Mercy. It’s amazing how people have come together looking for a way to help. Probably one of the best stories I’ve heard is from someone who volunteered to answer the hotline assigned to checking to make sure our Joplin co-workers were safe. She said she got a call from someone who had some damage, but was overall OK. She was concerned about her job and stated that she didn’t want to go to Freeman because Freeman is a for-profit hospital.  She said her heart was at Mercy and that’s where she wanted to be. I didn’t mean to turn this into a propaganda e-mail touting the virtues of Mercy, but as you can guess, this has been an emotional week and I guess it’s getting to me. Thanks again for all the hard work you do to keep us healthcare geeks informed and entertained. In case you don’t hear it often enough it really is appreciated. I hope you take some time to relax over the holiday weekend with Mrs. HIStalk.”

5-29-2011 12-19-15 PM 5-29-2011 12-20-13 PM
5-29-2011 12-21-40 PM 5-29-2011 12-25-28 PM

Update 5/29: the temporary hospital was scheduled to open Sunday afternoon in time for the President’s visit. Above are additional pictures from St. John’s – the photo album is here. The one with the printer in the lower left is what’s left of the data center.

From Sy Alice: “Re: abstract from the American Urological Association meeting. I imagine the good doctor could have phrased this better: “Good treatments are available for all patients and, depending on what the patient is willing to do, every man can get an erection if he sees a physician specializing in sexual dysfunction.” I’m not touching that with a … well, I’m just not touching that.

5-28-2011 6-46-37 PM

From The PACS Designer: “Re: CloudFoundry. CloudFoundry is the world’s first open Platform as a Service (PaaS) offering. The CloudFoundry.org Web site is a community-driven open source project that is led by VMware. With the CloudFoundry Beta, you can try for free the VMware Horizon App Manager, which is an open, user-centric management service for accessing cloud applications.”

From Lab Rat: “Re: Epic Beaker. I wouldn’t even think about implementing it until Epic gets back to work on it, especially in a larger hospital. Label printing is way more complicated to set up than with Cerner or Meditech and instruments were having troubles with the labels.” A Beaker site contact I asked agrees that it needs work.  

5-28-2011 4-05-00 PM
Photo: Patriot Guard Riders 

Monday is Memorial Day, a day to honor those men and women who have died in military service to the United States. Try to squeeze in a few minutes among picnics, car races, and the beach this long weekend to remember the fallen who earned that one day of honor the hard way (many of them barely old enough to vote). It’s perfectly fine to be anti-war and anti-military and still be supportive of those in the service – most of the fallen didn’t get to pick the cause they died for, so you can’t hold that against them. I ran one of my favorite poems on Memorial Day 2005 and a time or two since. My flag is flying and I hope yours is too – it’s the (very) least we can do.

Listening: Lez Zeppelin, an all-girl Led Zep cover band (not as weird as it sounds since Robert Plant shrieked like a girl most of the time anyway and cute girl rockers are always better). I’m not a fan of cover bands or even Led Zeppelin in general, but somehow I like their albums (yes, they’ve done two) that are note-for-note covers of the originals. I’m air guitaring to Dazed and Confused right now, wishing I was watching them live. Also: Manchester Orchestra, Atlanta-based emo-ey indie that veers into hard-rocking territory every now and then and sounds just fine.

5-28-2011 4-18-22 PM

About two-thirds of provider respondents aren’t so sure their employer has good enough security practices to keep their medical records private. New poll to your right: how loyal are you to working in healthcare?

I was going to run a poll on CHIME’s CIO credential, but I remembered that I did that two years ago. The opinion then was 91% negative (13% said it’s a vanity credential, 33% said it has no connection to competency, and 43% said it’s just another way for CHIME to make money).

5-28-2011 4-43-45 PM

Six-employee MobiuSoft of Flint, MI says they’ll hire up to 144 more folks in the next 18 months if their HIE product earns certification (that’s what I’m inferring from the newspaper article, anyway). Former Genesys PHO VP Jerry Van Horn formed the company in 2009.

Quality Systems (NextGen) announces Q4 numbers: revenue up 24%, EPS $0.64 vs. $0.45, beating analyst expectations for both.

5-28-2011 7-14-08 PM 5-28-2011 7-27-01 PM

Thanks to new HIStalk and HIStalk Practice Platinum Sponsor Gateway EDI of St. Louis, MO. The 30-year-old company’s 85,000 physician users trust its fully integrated tools and proactive service team to monitor their claims, catching and fixing issues before they cause problems for their practices. The fast-growing company’s founder was a physician who created new solutions when existing claims processing tools weren’t doing the job. Users rave about the personal support they get from the customer service department, with one happy physician customer calling them “the Nordstrom of EDI.” Providers get paid faster, big practices enjoy the customization capabilities of the Web-based software, and vendors offering Gateway EDI’s solutions with their PM software give customers an all-in-one solution. Thanks to Gateway EDI for supporting HIStalk and HIStalk Practice.

ED doc Kevin Kitka, DO of Mercy/St. Johns Regional Medical Center of Joplin, MO describes what it was like to be working in the hospital as it was severely damaged by the recent tornadoes. He’s an excellent writer:

A small child of approximately 3-4 years of age was crying; he had a large avulsion of skin to his neck and spine. The gaping wound revealed his cervical spine and upper thoracic spine bones. I could actually count his vertebrae with my fingers. This was a child, his whole life ahead of him, suffering life threatening wounds in front of me, his eyes pleading me to help him. We could not find any pediatric C collars in the darkness, and water from the shattered main pipes was once again showering down upon all of us. Fortunately, we were able to get him immobilized with towels, and start an IV with fluids and pain meds before shipping him out. We felt paralyzed and helpless ourselves.

Speaking of St. Johns, nearby hospitals accepting its evacuated patients had a heavy OB load. The hospitals credit GE Healthcare for rushing a team of employee volunteers to get fetal monitoring set up, one of them driving four hours to get to the hospital and another doing configuration from her laptop while hunkered down in her pantry because her own Dallas neighborhood was under a tornado watch.

Allscripts fires PwC as the auditor of its financial statements. I don’t really understand the reasons or the impact from the SEC filing, but maybe someone can enlighten me.

5-28-2011 5-03-43 PM 5-28-2011 5-04-24 PM

It looks like Cerner has a new logo and a tag line of “Health care is too important to stay the same.” I like the new one much better – it uses green (my favorite color, and everybody wants to use green these days) and it ditches the robotic-looking, all-caps-shouting CERNER in favor of a cute, non-threatening rounded font that everybody uses when trying to look Web 2.0.

5-28-2011 5-18-13 PM 

5-28-2011 5-21-46 PM

Cerner’s just-published 2010 annual report has a chatty letter from president, chairman, and co-founder Neal Patterson with some fun quotes:

  • Thirty-one years ago, had we known exactly how hard, how long and how costly it would be, we might have chosen a different industry. I am thankful today for how youth and ignorance can sometimes prevail over conventional wisdom.
  • In my professional experience, vision is the thing you as a leader use to give your organization the courage and motivation to invest in new ideas years before they produce economic returns.
  • We view our work over the past 30 years as analogous to building the foundations and laying the electrical grid for a great city that hasn’t been built. Reaching the place where we can actually start to build on top of that foundation is inspiring for us and our clients. Things are starting to get fun.
  • In the past several years, we have made changes to our health plan, fired our third party administrator (we prefer to think of it as eliminating our first insurance company), launched an on-site new age clinic and pharmacy, incorporated biometric measurements for our population, realigned the economic incentives for associates in our health plan price tags and rolled out a data-based wellness management program that
    provides personalized health profiles for our associates.
  • The Cerner of today is known for care; we expect the Cerner of five or 10 years from now will be recognized for health as much as care. As I mentioned, we can see a plausible scenario where health actually becomes the bigger portion of our growth.
  • This is the start of my fourth decade at Cerner. This is the first decade that I will not finish—at least not in the role of CEO. Unfortunately, there is a direct correlation between years of experience and chronological age. Often when I share Cerner’s age (31 years), I make the offsetting remark that Paul, Cliff and I were all in our 20s when we started Cerner. In my case, I was 29. If you add thirty-something to any age, the numbers start getting large. I don’t intend to end this decade as Cerner’s 70-year-old CEO … which is frustrating because this is going to be the most exciting decade yet.
  • [This is an entry on his personal to-do list, referring to his sister-in-law Linda, who died of sepsis due to lack of care coordination] Save Linda’s life. Make it systematic that preventable events that harm people are exposed to the appropriate caregivers and eliminated. This will not bring back Linda, but it may prevent the next 50-year-old schoolteacher from rural America from dying unnecessarily from the uninformed, sometimes inadequate, sloppy, delay-ridden thing we call a healthcare system.

Here’s Vince Ciotti’s latest HIStory, which points out the parallel of a 1960s government program that drove financial systems development and sales much like ARRA is doing for EMRs today.

McKesson’s lawsuit against Epic isn’t over. A federal court will rehear McKesson’s case, which claims that Epic’s MyChart infringes on a RelayHealth patent covering patient-doctor communication via the Web. The previous ruling let Epic off the hook, saying that Epic’s customers and not the company itself set up MyChart. The issue at hand is whether Epic encouraged its customers to do so, and if so, whether that constitutes patent infringement.

Rennselaer Polytechnic Institute is awarded a $1.2 million NIH grant to develop patient-specific “phantoms” that can model the organ-specific radiation exposure involved in CT scans.

5-28-2011 8-06-35 PM

The new management team at Guam Memorial Hospital finds financial irregularities that include paying $25K per year for software that generates a form that they say could easily be photocopied instead.

Interesting: Regenstrief doctors are developing software that will use EMR data to determine which warnings and side effects are relevant to individual patients, creating dynamic prescription labels.

High-powered venture capital firm Venrock adds Bob Kocher, MD as a partner, expanding to three partners who will focus on healthcare IT companies. He was previously with McKinsey, Brookings, and the Obama administration. Venrock’s previous investments include athenahealth, RelayHealth, Awarepoint, Castlight Health, Coderyte, and Vocera.

Hospital and population health applications vendor Healthways outsources its application development and technology management services to HP in a 10-year, $380 million deal.

GE Healthcare and Thomson Reuters will offer drug companies and other researchers a database that combines de-identified patient EMR data from GE with de-identified claims and prescription data from Thomson Reuters.

A study of 17 physicians in a clinic moving from an old EMR to a new and more powerful one finds that prescribing errors dropped, but mostly because use of unapproved abbreviations was reduced. The total number of other errors increased at the 12-week mark and was identical to baseline at 12 months, suggesting that EMR implementation may cause errors early on and have little effect after a year. Most of those same doctors said the alerts weren’t useful, it was too slow in handling prescriptions and refill requests, and the more sophisticated system wasn’t any safer than the old one.

5-28-2011 8-52-50 PM

England’s NHS Direct hotline launches a free mobile app that allows patients to assess symptoms, get self-care advice, and contact NHS’s telephone nurses. It’s Android-only for now, with an iPhone app coming in a few weeks.

Population and risk management software vendor MedVentive raises $1.5 million in convertible promissory notes and warrants. I interviewed Nancy Ham (president and CEO) and Nancy Brown (chief growth officer) last August. I asked some reasonably good questions about technology support for ACOs and whether providers are fixated on EMRs while ignoring potentially more important solutions.

Sponsor Updates

  • The use of AirStrip OB by Lovelace Health Systems (part of Ardent Health Services, which uses it in all of its hospitals) is profiled in the New Mexico business paper.
  • Billian’s HealthDATA is hosting a June 8 Webinar called Providers’ Perceptions: Mobility in Healthcare. They’re also offering a free white paper titled Social Media Strategy for Healthcare Vendors.

E-mail Mr. H.

A Reader’s Response to HIStory 5/23/11

In Mr. HIStalk’s Monday Morning Update (5/23/11), Vince Ciotti’s HIStory slide show installment focused on the former Lockheed / Technicon … / Alltel / Eclipsys companies and their health information systems. However, this installment is full of factual errors.

Ron Johnson was NOT one of the original Lockheed engineers. Ron was hired at the Technicon company (1980?) as director of marketing, and he was let go after a brief stint.

In addition, the late George Kennedy was NOT one of the original Lockheed engineers. At Technicon, compared to others, George’s role was thin and short-lived. 

Ralph Korpman, MD was involved as a pathologist for the Technicon laboratory information system and famously sold a version of it to the then-HBOC (lawsuits followed; settled out of court).

Jack Whitehead, who owned Technicon Instruments, a laboratory system company (Tarrytown NY), bought the original Lockheed system (along with many of its engineers) and named the company Technicon Medical Information Systems (TMIS), as it was called when I joined the company in 1978. TMIS was set up to take the Lockheed system and commercialize it. 

It was pretty clear who drove that vision in those early days. Unsung heroes, such as Sam Virts, Ralph Boyce, Dick Kortum, Chuck Tapella, Bob McCord, Mel Hodge, Stan Grahams, Bob Williams, Dave Brown, Carole Widener, RN, Shirley Hughes, RN, ……….. (and forgive me for leaving out so many who deserve to be included here).

Around the same time that TMIS started, Spectra 2000 Medical Information Systems was started by another group of former Lockheed engineers and initially financed by Transamerica (LA). This company was later bought by Medicus; Richard Jelineck, PhD, et al. The two competing TMIS and Spectra systems obviously were similar. What set the systems apart functionally was Spectra’s MIS provided the first colored screen text. However, Technicon’s MIS was fully installed and used in a hospital based on documented cost / benefits.

In 1975, two reports were written about the TMIS system: One was written by Battelle Columbus (OH) Laboratories – Final Report on Evaluation of the Implementation of a Medical Information System in General Community Hospital. The other was Demonstration and Evaluation of a Total Hospital Information System – El Camino Hospital, Mountain View CA.

El Camino Hospital has never employed physicians nor have physicians ever owned the hospital. ECH was and still is a community-based, district facility. The community physicians from the Sunnyvale Clinic and the smaller Mountain View Clinic were key supporters of the TMIS. Other, key, physician leaders, such as Ralph Watson, were part of smaller physician practices / groups. The fact that these community physicians were not employed and there was success in gaining wide-scale adoption of CPOE during the 1970s is an accomplishment that other companies and products required 25+ years and paid incentives to achieve.

In 1981, Jack Whitehead sold TMIS and the lab system division, Technicon Instruments, to Revlon. TMIS became Technicon Data Systems (TDS). In 1984-85ish, Revlon sold TDS back to Jack Whitehead’s son, John, who again took the company private and renamed the company TDS Healthcare Systems. Technicon Instruments was sold to a number of companies after Revlon, with its legacy now part of the medical division of Siemens. The name “Technicon” was bought by Bayer and cannot be reused.

In 1996-97, John Whitehead sold TDS Healthcare Systems to Alltel. This lasted 2-3 years before Alltel sold it to Harvey Wilson (formerly of SMS) who started Eclipsys with the idea that he would take the Brigham & Women’s home-grown HIS, put it in a “box”, and take the market by storm.  Harvey lasted awhile at Eclipsys, but his vision never even came close to fruition. 

Yes, a handful of those old Technicon, TDS, … systems still chug away.  On the other hand, Mr. Ciotti writes that he is a frustrated English major, and he can’t even use / spell the word "it’s" correctly! Thankfully he wasn’t a frustrated history major, because he really would have had no excuse for all the “HIStory” errors in this installment (and others?).

This reply was composed by the following, former TMIS / TDS / Alltel /……employees, who remain proud having been able to work with the above, early system, company, and exceptional engineers and clinician developers … and who remain alive and well working in today’s world of healthcare IT:

Jane Baseflug, RN
Connie Berg, RN
Edith Caesar (retired)
Ann Farrell, RN
Deborah (Debby) Kohn, RHIA
Elizabeth West

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Currently there are "10 comments" on this Article:

  1. Glad to hear that Gateway has become a sponsor. Gateway EDI recently has been doing a hard sell to become our preferred vendor for our EMR/PMS, which included three visits with fancy donuts to see our CEO without an appointment (when he’s routinely out of the office). The third time they took pity on us and dropped off the donuts without talking to him. Great donuts and appreciated by our junk food loving engineers and tech support team! Our vegetarian health nut CEO would never have touched them… But the sales pitch might have gone better with some research, an appointment, and if they would match or better the revenue sharing for every customer using our EMR we currently get from ENS, wait no, Ingenix, wait, no, OptumInsight (third name change in three years gets confusing).

  2. You are laden with knowledge to have known the nitty gritty of the AGH crash: “That operation and service was turned over to ACS/Xerox just over a month ago in a 10-year, $500 million outsourcing deal.”

    The hospital undoubtedly was at the mercy of these deals, to the detriment of the hospital. Do you have any wisdom on this?

    [From Mr. HIStalk] A source says it wasn’t just the West Penn Allegheny hospitals and their Sunrise 5.5 upgrade — several other large Sunrise sites had major outages, plus an infrastructure failure in the expansion data center in Piscataway caused slowdowns in still others (the Allscripts hosting business is big — 5,000 devices, two data centers, and a couple of hundred clients running multiple configurations.) The cause is unknown, but they think it’s related to Windows and/or Citrix rather than Sunrise itself. It would be interesting to see what service level agreements and penalties are in place — assuming the hospitals weren’t naive enough to sign a hosting deal without them.

  3. Thoughtful and provocative is your blog…one of the best.

    Since you are covering Pittsburgh, I came across this: http://www.post-gazette.com/pg/11148/1149678-28.stm

    It is unfortunate that the impact of their EHR systems on the bottom line has not been disclosed. Based on what you have reported here and what was in the local papers covering EHR snafus, the operating loss may have jumped by a few million $’s. Are hospitals’ bottom lines better or worse after EHRs and CPOEs, if any one knows or is willing to be truthful about this?

  4. Wow, sorry ladies – I really blew a number of items! My apologies… Believe me, it’s hard covering a complex story like Lockheed/Technicon in a half-dozen Powerpoint slides, which is all Mr. HIStalk has room for each week. I filed away your info for future presentations, and thank you for listing the names of so many Lockheed pioneers.

    I may not have been clear in slide 2, but I wanted to give credit to Messrs. Kennedy, Johnson, Korpman and Childs for their early work at Technicon (not Lockheed). To me its amazing that such HIS luminaries all worked at the same company in those early days. My next installments are about systems I worked at personally, so I hope they’ll be free of so many errors. If not, I invite more feedback: the stories of the early days of the industry need to be told.

    Thanks for the feedback and helping to spread the word.


  5. Re:
    “Allscripts fires PwC as the auditor of its financial statements.”

    Possible reasons /implications:
    1) Allscripts didn’t like /agree with the managing partner. He/she is a key account person – key ‘salesperson’
    2) Fee was too high…found a less expensive alternative. Will probably be just another Big 4 firm…could have bought the account.
    3) Auditor notes there were no dissagreements on how books were kept or presented – only relative to last audit. But in my experience the client can usually see the differences ‘coming’. Typical one is how /when you book revenue or assets. So smart move is to change auditors now and hope you can convince new firm you are ‘right’.
    4)Under SEC rules (Sarbanes Oxley, et al) when a public company changes auditors a public announcement must be made. And the annoucement here is full of caveats /feel good statements to cover both butts.
    5) Worse case senario is: Something is rotten in Denmark…and its just beginning to smell.

  6. Those comments from Neal Patterson read almost like a farewell letter. Sounds like a man who has come close to the retirement point and is reflecting all he has accomplished buliding a company in the past 30 years. Doubt it will happen before the year ends, but I wouldn’t be surprised if he either retires or sells off the company to cash out by the end of 2012. He’s put in a lot of long days, nights, and weekends over the years, so he’s entitled to finally sit back and relax after all this time.

  7. …anyone but me think that “CAPD” is an unfortunate acronym for this potentially excellent product? You know, being one vowel away from COPD, the disease which robs you of breath whenever you attempt to talk (or move).

    Pharma would never have made such a mistake.

  8. The pictures and story about St. John’s are so sobering. God bless all the saints who are still keeping things going.

    I would be very interested to hear, when things calm down, about whether they had an emergeny preparedness plan, and how helpful it was. Mr. H, do you think you could interview them when appropriate? I am sure many of your readers would find it very helpful.

  9. As hospitals/IT RN at ECH (from early 70s), and later as TDS R&D exec, I saw best of both worlds.

    As 1st commercial EMR, MIS got world-wide acclaim. Visitors from U.S and all corners of world made pilgrimage to California to meet evangelical execs and users and see almost 100% CPOE (pre-PC! -TVs dumb terminal, central MF processing). They left starry-eyed, eager to replicate back home. Few did.

    ECH had no predecessors to learn from but were a goal-oriented, process-driven, mutually respectful TEAM excited by “mission”. Lockheed engineers worked 24×7, side-by-side with ECH clinicians for 2 YEARS of process and business analyses reflected in beauty and longevity in underlying design and implementation tools.

    Like Vince, agree Technicon/TDS had some of smartest, most dedicated (fun) people – too many to name. Group response named often unsung heroes, while some who gained name recognition via later other ventures often overly-associated with Technicon/TDS success.

    The company genuinely “cared” – focused on understanding (lost art), solving complex problems, delivering clinician friendly solutions. John Whitehead’s mantra “we’re in patient care business” gets lip service by many in it for the money and individual gain (only).

    A foundational principle was “USER REQUIREMENTS drive IT”, not visa versa. Engineers innovated when commercial solutions unavailable or underperformed, creating IT industry’s first pointer device (light pen) before Parc or Apple (knowing then clinicians don’t want to type!), advanced printer technology, and data driven screen building (Matrix Coding) and report writing (RFT Coding) tools, some features unmatched in today’s printers and 3/4GL tools. Subsequent vendor developers with newer IT largely automated inefficient, duplicative paper processes and chart forms, burdening not enabling clinicians.

    TDS contractually guaranteed sub-second response time (MF. Assembler, pre-UI), had MD order sets, a “starter set”, structured implementation plans in 80s – created first “permanent patient record” in CHCS project commercialized as TDS/e7000.

    NO ONE thinks TDS was perfect or MIS state of the art today. It’s mind-boggling however that Eclipsys acquired product but NEVER ASKED creators or users what worked to build into later designs / new platform. Epic clients would kill for MIS RN application design.

    Epic earns kudos for success via inpatient / outpatient integration and MD focus – MD bias understandable if unfortunate given ambulatory roots. Sad that industry leader still playing catch up to MIS RN 70s/80s/90s capabilities. (TDS’s Gene Cattarina likely to question longer term effects of Epic reliance on “green beans”).

    RN, Rx, MD collaboration at ECH (and Mayo) embedded in TRULY integrated EMR (MDs not employed thus initial design hospital-centric). ECH was community hospital with progressive RNs and exceptional MD-RN relations and patient care (not coincidental). RNs not viewed primarily as data collectors for MDs (see ONC/MU) or task masters /”form filler out-ers” (later EHRs), but integral part of care team playing KEY role in care delivery and outcomes, benefits realization and MD IT adoption and satisfaction.

    TDS’s Mel Hodge first to use “jumbo jet crash a day” analogy in highlighting unsafe care and to tie cost controls to “MD pen” (orders). CPOE a fundamental goal/expectation from beginning!

    Marquee government, industry and vendor leaders continuing to say (think?) “WE are pioneers!” are best served learning lessons from real pioneers, to apply today.

    – How did ECH achieve broad EMR benefits, happy users, CPOE 40 years ago pre PC with MIS – goals U.S./ ONC dreams of today?

    – Why do TDSers reflect on those as “good old days”?

    – Why has industry (and solutions) not progressed – we digressed and even regressed in many way, since our origins?

    Simple answer: ECH and Technicon/TDS understood what it took to achieve TRUE meaningful use of EMRs, somewhere along the line we lost our way.

    (Sorry for epistle but 40 yrs later (1971 – 2011), $BBs spent, gobs of IT and hype, $40B US incentives – have we learned ???)

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