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Buy EHR vs Build EHR

I’ve long had an interest in the topic of when hospitals chose to buy their EHR software versus build their EHR software. In fact, we’ve written multiple times on the subject including Anne Zieger’s piece on “Some Hospitals Still Choosing To Build Own EMR“.

With this as background, I was really intrigued by Dr. Edmund Billings’ blog post looking at how open source EHR is the best of both buy and build worlds. Here’s a good section of his article which frames the debate:

In a Buy vs. Build decision, the key drivers are control and cost. Do you have control over your system at a cost you can afford? The decision calculus then shifts to ownership on two levels: First, can we have true ownership of our solution and make it work ourselves? Second, is the total cost of ownership economically sustainable?

Dr. Billings then goes on to make the case that open source EHR is the best of both worlds. He compares the open source EHR vista to Linux and Red Hat to Medsphere. It’s a pretty app comparison of what Medsphere is trying to do. Dr. Billings does point out that an enterprise EHR is not an operating system (like RedHat/Linux). Although, I find that ironic since I’ve written before about how I think that the EHR is the operating system of healthcare.

One major difference between Linux and VistA is how they’re implemented. Linux could be implemented by an organization on just a server or two while still running all the old servers on something else. Then, over time they could add in more Linux servers. This isn’t the case with VistA. Everyone wants an Enterprise EHR to be implemented across the entire system. I don’t see someone implementing VistA in one department and then growing from there. Maybe we should do it this way, but that’s not what I see happening in the market. They buy an EHR system they can use across their whole organization.

This difference aside, open source does provide an interesting balance between the buy vs build mentality. I wonder why hospital organizations have chosen other EHR vendors over the open source EHR alternatives.

October 14, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Great Whitepaper Summary of OpenVista Features

The week after I got my first job implementing EHR, I went into the medical records office where I was shown an article about the government’s decision to open source the Vista EHR software. The HIM manager was drawn by the idea of a free EHR. Of course, the clinic I was working for had already invested hundreds of thousands of dollars on an EHR system. In fact, this is likely what made the HIM manager so interested in the idea of a free EHR. She didn’t know why we’d spent hundreds of thousands of dollars when the government was offering an EHR for free.

What she didn’t understand was that just because the software is free doesn’t mean that the EHR is free. Plus, she (and I at the time) had little understanding of what the Vista EHR software really encompasses. Implementing Vista in that small clinic would have been like taking a sledgehammer to a 2 penny nail. In fact, that might even be underestimating the breadth of what could be done with Vista.

Of course, if we had been in the hospital environment, then we should have definitely considered Vista. However, back then there were a lot of unknowns with how Vista would transition to open source and how it would work in a commercial healthcare environment. 8+ years later, the companies working with the open source EHR is much more mature.

One of the leaders when it comes to implementing Vista in hospitals is a company called Medsphere. Medsphere’s version of Vista is called OpenVista. What’s amazing is the stark contrast in costs between an open source EHR versus many of the proprietary alternatives. No doubt Medsphere and others are benefiting from the billions of dollars the VA spent developing Vista.

For those of you not familiar with Medsphere and OpenVista, check out this whitepaper summary of OpenVista. It’s a really great summary of the capabilities of the software and what Medsphere has done to improve on the Vista software.

I’m sure there are still many hospital CIOs that aren’t brave enough to choose an open source EHR when “know one gets fired for buying Epic.” Although, I think it’s a big mistake when hospital CIOs don’t even consider the open source EHR options. When you see the breadth and depth of what’s available in Vista, it’s definitely worth considering.

Plus, since it’s open source, you can still develop custom additions to the software without worrying whether your EHR vendor will let you create a deep connection to the EHR software. I see an open source EHR software as a great option for those hospitals that are use to developing custom applications in house, but also see how a commercial vendor has expertise that they don’t have in house.

What are your thoughts on Vista as a hospital EHR?

July 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

W. VA. Rolls Out Enhancements To VistA

Officials with the West Virginia bureau of behavior health and health facilities are putting some finishing touches on VistA installations cutting across the state, adding computerized laboratory information to a six-year-old implementation.

West Virginia officials have implemented Vista in seven communities, Modern Healthcare reports. Facilities include an acute-care hospital, two psychiatric hospitals, four long-term care hospitals, a nursing home and two ambulatory care clinics.  The facilities are all connected to a central database in Charleston via T1 lines.

The state has been working on contract with Medsphere Systems Corp. to install a VistA version known as FOIA VistA, a version in the public domain that can be obtained freely from the VA under the Freedom of Information Act, Modern Healthcare notes.

Though VistA itself is free, the state has spent heavily on installing it across the seven sites.  Since FY 2005, West Virginia has paid Medsphere $8.4 million for system implementation, development and support, and is contracted to pay the vendor $939,800 this year for support.

In addition to paying Medsphere a monthly fee for systems support, the state pays licensing fees to InterSystems, developer of Cache, a version of the MUMPS database and programming language. It also licenses Keane’s financial system, which interfaces with VistA.

West Virginia began looking at a common infrastructure for all of its facilities when HIPAA passed back in 1996, noting that the idea behind it was portability and accountability. Now state officials are glad they moved ahead. “It’s expensive,” but “in terms of satisfaction, I think we’d all agree it was well worth it,” deputy commissioner for administration Craig Richards told the magazine.

May 7, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Study: VistA Is Doctors’ Favorite EMR, Beating Epic

Despite more than a decade to work things out, discussions about open source vs. commercial enterprise software always seem to devolve into “religious wars” over the inherent goodness of one business model over the other.  EMR software seems to be no exception to this rule, a state of affairs which has done little to advance the industry as a whole.

Well, maybe the following will help move the discussion into more positive channels.  According to a new survey by Medscape, physicians prefer VistA over Epic, as well as Cerner, Meditech and McKesson, on characteristics which included ease of learning, reliability, value for the money, physician overall satisfaction and staff overall satisfaction.

According to the study, VistA came in at 3.89 out of 5 (five being “like most”), while Epic followed at 3.51, Cerner at 3.15, Meditech at 2.94 and McKesson at 2.91. (The pack was actually led by Amazing Charts (4.22) and Practice Fusion (4.04), both systems aimed at physician practices directly.)

Lest this seem like a flash in the pan, consider the results of a similar study done by the American Academy of Family Physicians in 2011. The AAFP, which asked physicians to compare 30 EMRs on 15 criteria. Of enterprise EMRs included in the study, Epic and VistA were neck at 5th and 6th, with McKesson 19th and Cerner 25th in line.

Now, in all fairness, it should be noted that the author of the blog item I mined for this piece is Edmund Billing, MD, CMO and EVP of Medsphere, whose product is OpenVista. But the stats outlined by Dr. Billing are worth considering nonetheless.

Perhaps we’re not ready for the religious wars to end, but throwing some relevant stats into the conversation couldn’t possibly hurt.  After all, there’s never a bad time to take physician perceptions seriously.

November 26, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Sometimes Epic Doesn’t Win: Public Hospital Goes Open Source

Most of the hospitals I write about go with big, expensive commercial EMR packages and suffer through upgrades and code fix schedules imposed by the vendor.  The process seems pretty miserable, and rather inefficient, but IT departments are stuck with it.

That being said, at least some hospitals take advantage of the open source paradigm, including the following midwestern facility.

Oklahoma-based Stilwell Memorial Hospital, a 50-bed public facility, has decided to install Medsphere Systems Corp.’s OpenVista EHR.  The Medsphere product is an open source derivative of the Department of Defense’s widely praised VistA system.  Rather than millions of upfront bucks, Medsphere charges a subscription fee for OpenVista use.

As part of choosing OpenVista, Stilwell Memorial becomes part of Medsphere’s “Healthcare Open Source Ecosystem,” in which various users share code, system upgrades and tips for managing the system.

The question that pops into my head, as I read the background on this install, is why we’re hearing about a 50-bed hospital making this selection, but few if any medium-sized or large community hospitals.

After all, given its history as a massive DoD implementation, I don’t think there’s any question that VistA scales up well. And we are all over the taint open source once had as too casual a community for hard-core enterprise use, right?  By at least a decade?

The truth, however, is that we probably all know the answer. The reason open source EMR installations are still in the minority is that CEOs and board members like the sound of having a giant, sprawling corporate partner better than working with a community.   Meditech, Epic, Cerner and Siemens are more or less automatically shortlisted.

Sigh. Wouldn’t it be nice if hospital C-suite folks and boards were more flexible?  Great things could happen.

June 18, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Medsphere Makes Varied Pitch for Open Source EMRs

Historically, most of the arguments for using open source software of any kind revolve around cost and stability (e.g. free software is as cheap as it comes, and you can’t find a bigger dev team than the entire open source community).  But at a recent conference backed by an open source EMR vendor, some hospital IT folks argued that open source tech can offer much more.

At Brooklyn-based Lutheran Medical Center,  a 476-bed teaching hospital, execs plan to attest to meeting Meaningful Use Standards in early 2012.  They’re doing so using Medsphere’s OpenVista, which as most readers would know is the daughter of the Veterans Affairs’ VistA platform.

According to LMC CEO Wendy Goldstein, using OpenVista has been critical in preparing for MU attestation.  As with other enterprise-level open source users, Goldstein likes having access to the source code, she told the audience at Medsphere-backed Meaningful Use NOW conference. ( That certainly makes sense, given the pace at which regulatory demands on hospitals are shifting.)

We already know about open source software’s pricing and development advantages, but is that  OpenVista’s only advantages? Perhaps not.

Medsphere claims that open source EMRs are better for taking on huge tasks such as transforming workflow and business processes, an intriguing if as-yet-unproven claim.  Does having access to the source code really make a big difference in how effectively hospitals can customize their EMR?  I’d argue that the jury is still out on that one.

And Meaningful Use NOW speaker Bill Petasnick of Wisconsin’s Froedtert Health System argued that the best way to unify health IT platforms across various organizations might be to use an open source, open-architecture solution.  That may not be realistic from a market perspective, but it’s worth considering. Wouldn’t it be nice if some of the silos fell down?

– P.S.  Want to follow up and check some platforms out?  Check out this list of open source health IT options.

November 30, 2011 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.