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Department of Defense (DOD) and Open Source EHR

Posted on February 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was intrigued by a report by the Center for New American Security that was covered in this article on HealthcareDive. In the report, they make a good case for why the Department of Defense (DOD) should select an open source EHR solution as opposed to a commercial solution. Here’s an excerpt from the article:

“I think the commercial systems are very good at what they do,” Ondra said. However, “they are not ideally designed for efficiency and enhancement of care delivery, and I think the DOD can do better with an open source system both in the near-term, and more importantly in the long-term, because of the type of innovation and creativity that can more quickly come into these systems.”

Reports like this make a pretty good case for open source. Plus, I love that it also pointed out that commercial EHR vendors were built on the back of the fee for service model which doesn’t matter to the DOD. It was also interesting to think about the DOD’s selection of an open source EHR system as an investment in other hospitals since the money they spend on an open source EHR could help to catalyze the ongoing development of a free open source EHR solution.

While these arguments make a lot of sense, it seems that the DOD has decided not to go with an open source EHR solution and instead is opting for a commercial alternative. In this article (Thanks Paul) the DOD has narrowed the list of contenders for the $11 Billion DOD EHR contract (DHMSM) to just: CSC/HP/Allscripts, Leidos/Accenture/Cerner, and IBM/Epic who “fall within the competitive range.” They reported that PwC/Google/GDIT/DSS/Medsphere and Intersystems did not fall within the competitive range.

I’ll be interested to hear Medsphere’s take on this since every report I’ve ever read has Medsphere and their open source Vista solution as much less expensive than the commercial alternatives (Epic, Cerner, Eclipsys). So, I can’t imagine that the Medsphere bid was so much more than the others. Unless the consultants are charging through the nose for it. Or maybe the open source Vista option wasn’t “in the competitive range” because it was too cheap. Wouldn’t that be hilarious to consider. Hopefully the government isn’t that stupid, but…

I don’t claim to have any clue on how these $11 billion government contract bids work. I’m just a casual observer from the sideline. It seems like 3 companies remain in the ring. I guess the Google juice wasn’t enough for the PwC/Medsphere bid.

Top 10 Hospital EHR Vendors By Installed Systems

Posted on December 21, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I came across this list of Top 10 Hospital EHR vendors by installed systems on Dark Daily (a great resource, particularly if you’re into Labs). The data is a little dated, but I thought it would be interesting to consider the numbers in 2011 and how they might look different today. Here’s the list:

Vendor Name Total Installations Percent of Installations
• Meditech 1212 25.50%
• Cerner 606 12.80%
• McKesson 573 12.10%
• Epic Systems 413 8.70%
• Siemens Healthcare 397 8.40%
• CPSI 392 8.30%
• Healthcare Management Systems 347 7.30%
• Self-developed 273 5.80%
• Healthland 223 4.70%
• Eclipsys (Bought by Allscripts) 185 3.90%

This list was taken from the HIMSS Analytics database. I wish I had access so I could compare these numbers for 2012. The interesting thing is that I’m not sure the Hospital EHR vendor numbers would be all that much different. Epic is the media darling, but its focus is squarely on the large hospital systems so they often lag behind when it comes to total installations.

Hospital EMR Crashes And Burns Because Community Docs Hate It

Posted on January 4, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

While we may argue over the stats — is it 30 percent, 40 percent, even 50 percent? — everyone knows that the failure rates for hospital EMR installations are frighteningly high. So it never hurts to look at specific cases and see if we can avoid that particular train wreck.

So here you have it. Courtesy of medical informaticist Brian Martin, we have a compelling tale of a $50 million EMR installation that went belly-up largely because the hospital didn’t “get” the needs of its 1100+ community-based physicians.  That’s $100,000 per bed, or if you prefer, $50,000 per staff physician, he notes. Ouch.

Since Martin tells the tale so well, I’ll turn the story over to him:

I did a post-implementation technology audit for the board of directors of a 500+ bed hospital with 1100+ physicians on staff. The hospital had spent over $50 million acquiring and deploying the then Alltell/Eclipsys EMR/CPOE system, which at that time ran on an IBM ES/9000 mainframe.

Soon after implementation, BoD members fielded numerous complaints from staff physicians who refused to use the system because of its perceived lack of usability…

Fast forward a few years; the BoD approved a significant expenditure to replace the EMR/CPOE system with Epic…Note that the Eclipsys system was based on a very successful implementation of the original Lockheed/Technicon Data Systems CPOE in use at the NIH Clinical Center, so we were dealing with field-tested and validated software that had seen successful clinical implementations.

The implementation failure had more to do with not understanding the technological needs and expectations of community-based independent physicians who comprised the hospital’s staff physicians, and therefore not incorporating their needs and expectations into the technology selection process.

<clap clap clap> What a great overview! Much to think about there. It’s definitely a reminder that even the best EMR technology isn’t worth much if users balk. (Why we’d need that reminder at this point, I can’t imagine, but hospitals still steamroll EMRs over unwilling docs regularly.)

I’d like to think that this kind of fiasco is largely a thing of the past. With Meaningful Use forcing hospitals and doctors to work together more closely, one would hope that boards of directors would build acceptance before they spend, if for no other reason than they’ll get walloped later if they don’t.

But hospital leaders are still among the most conservative creatures on earth, and the kind of top-down style we see in action here isn’t going anywhere soon. Oh well — what’s a $50M mistake among friends?