Turns out the fish are starting to feed. Check out this website that talks about the “EHR Stimulus Tour: Educating the Nation.” Ok, I don’t really want you to check out the website, since I think it’s kind of sad. At the bottom it lists the “EHR Stimulus Alliance.” The following companies are listed in this EHR alliance:
Allscripts
Cisco
Citrix
Dell
intel
intuit
Microsoft
Nuance

What a group of large companies trying to sell a bunch of product. I guess we should have expected something like this, but maybe I’m just a little surprised that they made a website for an EHR stimulus tour and everything. Interestingly the twitter link on the site goes to an Allscripts twitter account. I think we can clearly see who’s behind this website.

Honestly, this reminds me of an Amway or other MLM convention. Is it any wonder the type of information that will be given at this type of tour? I guess $18 billion is a lot of motivation to market your EHR software. I just wish they were stopping in Las Vegas so that I could go and check them out.

I’ve had a number of people ask me my thoughts on this Wall Street Journal article which talks about open source EHR and in particular the open source EHR developed by the VA hospitals called Vista.

I must admit that I’ve been enamored by the concept of free EMR. One of my most popular blog posts was this guest post about Free EMR by Medicare. Turns out that Vista is one of those open source (free) emr software that keeps popping up. I imagine it will continue to pop up for a long time to come.

Let me offer three points that I keep hearing over and over when I hear people talk about open source Vista.

1. (We’ll start with the good) Those that go to the VA are quite happy that no matter what VA hospital they go to, they have their information available. I’ve heard this on multiple occasions. I’m not sure if people are saying this because they’ve actually experienced it (which is likely considering the transient nature of veterans) or because they’ve had the concept drilled into their head. Either way, this is the major perception and considering it’s all one nice package I’m inclined to think it’s a huge advantage of Vista in the VA hospitals. I’d love to hear someone address how this “EHR interoperability” using Vista would work in commercial hospitals.

2. The users of Vista really don’t like using the program. It’s clunky, unwieldy and not the friend of the user. I’ve heard this multiple places and not just from doctors, but also from nurses and the IT people supporting the software.

3. The “database” that Vista uses, MUMPS, is a piece of junk and a major anchor on what could be an otherwise interesting open source project. I’m sure there’s some really interesting history behind the VA’s decision to use this MUMPS “database” system instead of one of the current SQL based database systems. Unfortunately, I’ve seen numerous people talking about the pains of MUMPS and the problem it creates for the future of open source EHR Vista.

I’ll admit that I’m not an expert on Vista, but I’m just telling you about the common themes I’ve read over and over again. Any other ones we should know about or other perspectives on Vista EHR?

I read this nice post about an EMR system reporting “number of patients.” Here’s a quick snippet of the EMR reporting problem:

They considered a patient to be someone who had started a course of treatment. However, the clinical operations considered a patient to be someone who walked through the door.

Both of these are valid numbers, but when finance asked for ‘how many patients did you see,’ the two came up with wildly different numbers.

I can’t tell you how many times I’ve had discussions like this. For example, I’ve been asked the question, how many patients have we seen in the clinic? Do you mean people who have come to the clinic or total appointments for those people? Do you include nurse only visits for immunizations or do you just mean doctors’ visits? etc etc etc.

The cool part is now we’re past those basic EMR reporting and can now start looking at cool questions like, how many patients with a BMI in a specific range were properly diagnosed as obese? Was this addressed during the patient visit? That’s when the data in an EMR starts to be really cool.