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  • Microsoft and healthcare - a terrible mix

    None of us are strangers to the thousands of exploits that come out for Microsoft products.

    It's a bad thing for every industry, but healthcare is the most critical. People's lives are at stake when your system is not reliable. When is this nightmare going to happen: 'Mrs. Jones, while we were performing the valve replacement for your son's sub-aortic stenosis, the data we use to determine which valve to use for replacement was corrupt, and we lost your son."

    I have seen MANY EMR's - all of them windows based. I've yet to really find a physician (and I work with about 600 or so) that like the choices available, and almost all of them are reluctant to use Microsoft technology.

    The cost of EMRs are also outrageous. We have so many vendors coming in trying to sell us stuff that doesn't do what we need it isn't even funny.

    Physicians (most) are not programmers. They are the life line of society. Physicians know what they need in an EMR, but nobody to meet those needs, much less "cost effectively".

    My question to the physicians is this, "If you had access to a programmer, and could guide the development of an EMR without the use of Microsoft infrastructure, basically creating the perfect EMR because you decide the direction the application takes - would you be interested?"

    I'm a programmer, and have always been an open source advocate. I've done a lot of things, even made national recognition with a lot of them (CNN, Newsweek, and some others), and I'm 31.

    I work in the healthcare industry, and I am so tired of seeing docs get the run around from IT that I've decided to make a difference.

    I want to create (and have started) making the perfect EMR, designed to exact physician specifications.

    I need physician input. Are there any docs out there who are interested in helping create the perfect EMR?

    A consortium of physicians, coupled with a leading programmer, to create the perfect EMR, and do it for free.

    I've already heard the "you can't do that", "it's not possible", etc. Don't bother with those comments.

    The medical profession is one of the few areas that the people are passionate about what they do, and believe in what seems to be the impossible.

    This forum (www.docsboard.com) is the perfect starting point, because you are all physicians, and already have a love of technology.

    I've already got the patient demographic tracking complete. I now need the intimate experience of real physicians to make the medical portion work.

    Mike

  • #2
    Originally posted by mpike
    None of us are strangers to the thousands of exploits that come out for Microsoft products.

    I want to create (and have started) making the perfect EMR, designed to exact physician specifications.

    I need physician input. Are there any docs out there who are interested in helping create the perfect EMR?

    A consortium of physicians, coupled with a leading programmer, to create the perfect EMR, and do it for free.

    I've already heard the "you can't do that", "it's not possible", etc. Don't bother with those comments.
    ..........

    I've already got the patient demographic tracking complete. I now need the intimate experience of real physicians to make the medical portion work.

    Mike
    Well..... don't know where to start with your post. Congratulate you for having the intestinal fortitude to take on such an ambitious project or ridicule you for being naive (no insult intended). I too was told that writing an EMR/ starting an EMR company was "not possible" and "crazy". Instead of listening, I took the early program that I wrote, brought in professional programmers (now numbering 15) and ploweed ahead. Although I am intimately acquainted with clinical medicine and technology, the road to our success has taken 6 years, going on 6 versions and still is not the "perfect" EMR. In fact, there is no such thing. The perfect EMR for me, or a cardiologist will be almost unusable by another specialty like oncology. We have spent 14 million getting here. It is not unusual in this industry for companies to have spent 50 million and not have a commercially viable product when the dust settles. As far as using Linux and Open Source, 'been there, done that'. The tools are lacking for performing many mandatory functions. Drivers for digicams, telephony, etc... are just not available. As much as I hate Microsoft (and I really do dislike their brand of corporate ethics), I cannot ignore them. Their .net architecture provides for functional capabilities that cannot be duplicated with Java and Linux and MySQL in a timely and cost effective manner. The TCO (total cost of ownership) actually becomes higher for EMR purchasers when you factor in these extra costs from development tool deficiencies.

    AAFP already tried the Open Source EMR route. That initiative failed predictably. The EMR market is far too much of a niche market for Open Source to ever succeed. That is not to mean that some free and inexpensive products will not find a place, it is just that there is no financial justification for any of them to gain enough traction to become mainstream. By the way, when I started I only had to contend with one inexpensive product - SOAPware. Now you have Amazing Charts, AlBorg's home grown EMR and a slew of others. They perform the basics, but lack the bells and whistles that most sophisticated physician organization's demand. You are coming very late to a crowded game.

    With all of the government push to create codified vocabularies, CCR and incorporate DOQ-IT and other clinical decision support tools, and the proposed EMR certification coming down the line, the requirements and costs to build and maintain a viable EMR are almost insurmountable.

    If you do proceed, good luck... and get a testosterone (lithium?) level checked - your testicles must be giant.
    David Winn, M.D., FAAFP
    CEO/Founder, e-MDs

    There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

    Comment


    • #3
      >>Dr. Winn: With all of the government push to create codified vocabularies, CCR and incorporate DOQ-IT and other clinical decision support tools, and the proposed EMR certification coming down the line, the requirements and costs to build and maintain a viable EMR are almost insurmountable.<<

      Governmental interference and the ever changing landscape of standards are 2 obstacles that many docs find insurmountable. Most docs are afraid to commit to an EMR that can't guarantee operability with government requirements for billing and reporting for at least 5 years and I don't see any vendors making such a warranty to small practices.

      I think for you to succeed you must be fast to market with moderate functionality that is self healing as most docs don't want to train or maintain software.

      Comment


      • #4
        Originally posted by Kursk
        >>Dr. Winn: With all of the government push to create codified vocabularies, CCR and incorporate DOQ-IT and other clinical decision support tools, and the proposed EMR certification coming down the line, the requirements and costs to build and maintain a viable EMR are almost insurmountable.<<

        Governmental interference and the ever changing landscape of standards are 2 obstacles that many docs find insurmountable. Most docs are afraid to commit to an EMR that can't guarantee operability with government requirements for billing and reporting for at least 5 years and I don't see any vendors making such a warranty to small practices.

        I think for you to succeed you must be fast to market with moderate functionality that is self healing as most docs don't want to train or maintain software.
        I can't argue with you. Until CCR is a reality and EMRs can freely share medical records, physicians will be (and should be) reluctant to commit to any one vendor. The only reason to jump on the band wagon now is to try and recognize operational efficiencies that will pay for the system (plus some) while the industry shakes out.
        David Winn, M.D., FAAFP
        CEO/Founder, e-MDs

        There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

        Comment


        • #5
          Mike, FileMaker Pro can turn you into a cross platform, including handheld, programmer in minutes. It is mostly point and click programming and can take the number of hits a day required in a medical practice.

          There is going to be much dissention about what I just said. There is the easy way and the hard way, the choice is yours.

          FMP is not microsoft. It split from apple ~ 10 years ago.
          Did-a-chick? Dum-a-chum? Dad-a-cham? Ded-a-check?

          Comment


          • #6
            Yup and there is no way !

            "There is going to be much dissention about what I just said. There is the easy way and the hard way, the choice is yours."
            Yup and there is no way and thats the way I am going.. I aint even touchin' this thread . I got a web site or two to build LOL..
            NT stickman

            oz

            Comment


            • #7
              I am not sure there is an easy way unless you mean accepting a lot of limitations.

              Comment


              • #8
                "I think for you to succeed you must be fast to market with moderate functionality that is self healing as most docs don't want to train or maintain software."
                Rather than look at self healing should not prevention be the idea ??
                The idea of Docs or anyone untrained to maintain software is stupid to start with. Server based software should be difficullt to install for the same !@#$ing reason self open heart surgury is not a bright idea. Some folks think that all software is or will be click next , next , next , OK OK and no thanks I dont want to join MSN..
                Server based software is complex due to many reasons and the environment plays a great part on how effective systems will be..
                Bullet proof sytems are easy, bullet proof users are not.
                Tis easy to make fool of an engineer, but you cannot make an engineer out of a fool.
                I dont have time right now but with in the week I will show how powerful html can be and how you can have 20 different Gui's but in reality all the same..

                Oz

                Comment


                • #9
                  There is no motivation like changing the world

                  Originally posted by DrWinn
                  Well..... don't know where to start with your post. Congratulate you for having the intestinal fortitude to take on such an ambitious project or ridicule you for being naive (no insult intended). I too was told that writing an EMR/ starting an EMR company was "not possible" and "crazy". Instead of listening, I took the early program that I wrote, brought in professional programmers (now numbering 15) and ploweed ahead. Although I am intimately acquainted with clinical medicine and technology, the road to our success has taken 6 years, going on 6 versions and still is not the "perfect" EMR. In fact, there is no such thing. The perfect EMR for me, or a cardiologist will be almost unusable by another specialty like oncology. We have spent 14 million getting here. It is not unusual in this industry for companies to have spent 50 million and not have a commercially viable product when the dust settles. As far as using Linux and Open Source, 'been there, done that'. The tools are lacking for performing many mandatory functions. Drivers for digicams, telephony, etc... are just not available. As much as I hate Microsoft (and I really do dislike their brand of corporate ethics), I cannot ignore them. Their .net architecture provides for functional capabilities that cannot be duplicated with Java and Linux and MySQL in a timely and cost effective manner..
                  Thanks for your input... no insult taken, in fact, just motivates me more.

                  I am saddened to hear it has cost you so much to develop an EMR with so many resources. Either I am an exceptional programmer, or you did not get the best batch of developers.

                  Before I go on with my response, let me give you a little background on me. I am a programmer, maybe exceptional, maybe not. But, I've been on CNN, in Newsweek, Federal Computer Week magazine, and about 80 others. In fact, an application I wrote almost put WebMD in to bankruptcy. Not that I had anything against them, but, they had an inferior product (much like Microsoft and every EMR I have seen). And while WebMD had an army of programmers and hundreds of windows boxes, Redhat Linux and me took them down with an application that ultimately took me less than one day to develop (of course it grew from there). Everyone (including a WebMD sales rep who threatened to kick my ass after I debuted the application at the national health technology conference for HHS) laughed and said it wasn't possible. When people tell me something isn't possible, itís that much more motivation to do it. I havenít failed yet.

                  Don't take my word for it though... here is just one of the many stories on what I have written:

                  http://www.fcw.com/fcw/articles/2003...h-05-05-03.asp

                  Now on with the response

                  I'll pull out each thing you said and address it individually:

                  Originally posted by DrWinn
                  Well..... don't know where to start with your post. Congratulate you for having the intestinal fortitude to take on such an ambitious project or ridicule you for being naive (no insult intended).
                  I'll accept the congratulations, as I disagree with being naive. The project is ambitious, and I readily admit I cannot do it alone (the programming I can, but I need the physicians to help guide the functionality).

                  Originally posted by DrWinn
                  As far as using Linux and Open Source, 'been there, done that'. The tools are lacking for performing many mandatory functions. Drivers for digicams, telephony, etc... are just not available.
                  I didn't specifically mention Linux, although it is very viable. Please name a few of the mandatory functions that Linux cannot do that Windows can. I actually have a different approach, and that is implementing OS X technology (yes from Apple Ė OS X if you didnít know is based on open source technologies FreeBSD/Unix). As you may have read above, Linux was what I used for E-Series. When I was introduced to OS X a little over a year ago, I haven't turned back. Let me take a real world application example. I wrote "X-Consult" - we are doing remote pharmacy consultations (with video and audio) across the country. With the new H.264 Codec, we can communicate at HD resolution with as little as a 256K DSL. We can do full telephony with as little as a dial up. This isn't something "we are thinking about" - we are doing it today, without a single windows server, and a shrinking number of Microsoft based workstations. The difference between open source programmers and "the rest of the world" is this: money doesn't mean anything, just creating the best product available. Obviously it is working, MySQL has over 6 million active installations, and PHP (for example) has over 15 million. Microsoft SQL has nowhere near that. MySQL continues to grow, as people migrate AWAY from Microsoft database technologies.

                  Originally posted by DrWinn
                  As much as I hate Microsoft (and I really do dislike their brand of corporate ethics), I cannot ignore them. Their .net architecture provides for functional capabilities that cannot be duplicated with Java and Linux and MySQL in a timely and cost effective manner..
                  I would never guess you dislike Microsoft, especially from your comment in another thread about Longhorn being the second coming. Longhorn is not going to be released until sometime in 2007. I also have a copy of it (albeit the beta versions). Mac OS X Tiger already has all of the technologies you mentioned, they are here now, and work now (official release 1H 2005). As far as .NET - MONO is an open source equivalent.

                  Originally posted by DrWinn
                  The TCO (total cost of ownership) actually becomes higher for EMR purchasers when you factor in these extra costs from development tool deficiencies.
                  Can you please give some examples of the development tool deficiencies? I cannot think of any, but there are 2000 some odd reasons to not trust Microsoft technology in healthcare (don't want to list them all, just check all of your windows exploits).

                  Originally posted by DrWinn
                  AFP already tried the Open Source EMR route. That initiative failed predictably. The EMR market is far too much of a niche market for Open Source to ever succeed.
                  If you are referring to OpenEMR.net - I would not call it a failure. I would also not say it is the best product. It is a great starting point, but lacks a few items which will surely be added. The fact I downloaded it and had it running in under 5 minutes is pretty good... It's not the direction I am going with my project, but I would not put down their efforts, because they have done pretty well considering the circumstances. My application is not opensource, but it is free - at this point it's too risky to release the source code to just anyone and have it end up with a commercial logo on it.

                  Originally posted by DrWinn
                  By the way, when I started I only had to contend with one inexpensive product - SOAPware. Now you have Amazing Charts, AlBorg's home grown EMR and a slew of others. They perform the basics, but lack the bells and whistles that most sophisticated physician organization's demand. You are coming very late to a crowded game.
                  It might be crowded, but as stated in the start of this thread, and as iterated by you, nothing has "everything" - yet.

                  I've already got full DICOM and standard image support, and I can capture and maintain full video including direct interfaces for echocardiograms, etc. And you do not have to have Windows to use it.

                  Originally posted by DrWinn
                  If you do proceed, good luck... and get a testosterone (lithium?) level checked - your testicles must be giant.
                  Thanks for the wish of luck, but I won't need it. I need physicians who want to invest nothing but knowledge. I've got a few right now (one of them being a cardiologist as a matter of fact, assisting with the echo interface guidelines).

                  Let me throw a little something back at you (with no insult intended). You're a physician, you've undoubtedly saved many lives, and for that in my eyes you are valuable to many people. You do however tend to shoot down any technology that you do not understand (open source), or you see as a conflict/threat to what you are developing.

                  I will be presenting this year at the MySQL conference. I would welcome any challenges for an "EMR Faceoff" with anything you may have, and my X-SYS Life Record.

                  I've been working on the EMR project since the first part of September, and it will be ready by Feb 2005. Again, I am only opening it for physicians who want to assist with functional guidance, but you are more than welcome to see what I am allowing the public to see at:

                  http://www.xsyshealth.com

                  Just remember in 1999, Bill Gates said "Linux is not a threat". Today, Microsoft has an entire division dedicated to the "engagement of Linux technologies". They have resorted to frivolous patent lawsuits (which have proved useless thus far, and will continue to do so in the future).

                  In closing, because of all the media coverage from my applications, Microsoft has offered me jobs on three different occasions, and I have met Bill Gates once (when he was trying to stop the government agency I work for from dumping Windows on the server platform, which he did NOT succeed on BTW).

                  I met Steve Jobs in June - a great person - and I believe OS X is going to be as powerful as Linux on the server platform, and (has already started) gaining significant market share on the desktop. Linux Tablet PCs are also already on the market.

                  I guess you could say I totally disagree with everything you have mentioned. Microsoft had a lot of help from the Bush administration, but open source continues to grow. With the new election, maybe a change will level the playing field even more, however, even if MS continues to incorporate their current method of strong arming the industry, they will continue to lose to innovation, in which they have never had any.

                  Mike

                  Disclaimer: Although I am a federal employee, all applications I develop are owned by me, and have no affiliation with the government what so ever (other than they may use them).

                  Comment


                  • #10
                    When you have some time Mike I would like to talk we have many of the same ideas..

                    oz

                    Comment


                    • #11
                      Maybe our developers are not as sharp as you (although several graduated at or near the top of their class and are clearly geniuses). However, I have been proved wrong before.

                      I am a proponent of Open Source where and when it is feasible. We have donated our medication database and have offered up our ICD-9 database to the CCR committee. Our med database alone has some 35,000 meds with associated drug-drug interactions, etc. I would estimate that we have spent at least 2 million building it so far - and we will continue to expand it. You are welcome to download it at our website - and it is free as long as you do not "sell" your application for commercial gain.

                      Our CTO (another very bright guy) has recommended against the open source tools because of the added cost of writing drivers and apps that already exist in the MS space - so if you have knowledge to the contrary I would very much like to talk to you. Again, I applaud you for your efforts. I started before the space got so crowded. It just seems to me that you have a lot of catching up to do and you don't have a lot of time.

                      Also, we (I) believe that a stand alone EMR has limited utility (and viability), so the EMR makes up maybe 25% of our offerings. We also have scheduling, patient tracking, disease management, practice management and a host of other supporting apps that help tie everything together. We must have 2 million lines of code. I can't imagine how one programmer can catch up with that much development. I would love to talk to you. My direct # is 512-257-5209. Maybe we can each learn something from the other.
                      David Winn, M.D., FAAFP
                      CEO/Founder, e-MDs

                      There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

                      Comment


                      • #12
                        One last comment. I am most certainly not a fan of Microsoft. But I am not convinced that the emperor is dead either. Here is a recent post from elmr where I disparage MS.

                        ------------------------------------------------------------------------
                        "This kind of poll lends itself to being abused. Certain vendors might run up their votes by contacting physician friends and having them vote for their company. I believe much of what is posted on internet threads and what is promulgated by certain consultants is fabricated. The fact that some companies win accolades and awards when their products have glaring deficiencies just seems to support this theory. Microsoft, for instance, used hype and deceit to eliminate a competitor that pioneered bringing the Windows concept to the desktop (does anyone remember the name of that company or their GUI?). A well known saying in business is that "superior marketing wins out over superior products". Perhaps big business is really saying 'unethical marketing wins out over superior products'. Sigh.
                        Joel (HTAdvocate) is continually frustrated by examples of unethical business practices that we see every day, but that we refuse to participate in. Hopefully more and more companies will rely on pearls of truth and wisdom to paint a clearer landscape.

                        Might I suggest a rating of companies by their integrity and ethics (of course, this too is subject to flagrant abuse!!). Besides e-MDs, (for the lurking saboteurs, yeah, I think we are pretty durn ethical), I would cast a vote for Soapware, PowerMed and PMSI. Hmmmm, all these companies were founded by and still run by physicians.... fancy that."
                        David Winn, M.D., FAAFP
                        CEO/Founder, e-MDs

                        There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

                        Comment


                        • #13
                          yeah sure

                          sleeping with the emperor and paying the emperor's taxes makes you not a fan but worse a supporter...LOL

                          snip
                          "Our CTO (another very bright guy) has recommended against the open source tools because of the added cost of writing drivers and apps that already exist in the MS space"

                          More FUD

                          snip
                          "AFP already tried the Open Source EMR route. That initiative failed predictably. The EMR market is far too much of a niche market for Open Source to ever succeed."

                          Now you have to be kidding right ? Open source takes up that space along with freeware and shareware..

                          You are making a basic Microsoft mistake here.. Open source is not application specific, its not a server, its more like a way of life, its a an attitude if you will.,its about people caring about results not profits.. Kinda like how HMO doctors should be... sigh

                          I was like you too until I started working hard with open source and now my only regret is I should have done it much sooner.

                          Comment


                          • #14
                            My my... this discussion truely rocks! Beats the 1st Bush/Kerry debate by a long shot. Take the line:

                            "Either I am an exceptional programmer, or you did not get the best batch of developers."

                            Yipes! I'm impressed...

                            The only complaint that I have is the phrase that states:

                            "... AlBorg's home grown EMR and a slew of others. They perform the basics, but lack the bells and whistles that most sophisticated physician organization's demand... "

                            But I know- Dr. Winn has a product to sell, and I must represent the competition, so I'll read that in the light that it was offered. The EMR database that I designed from MS Access which I use at my office is way past the "basics", and at least for me does more than any expen$ive EMR (like e-MDs) can do. If it's currently "missing" a non-basic item, it's because of design, not lack of my skills which go back to the DOS days 15 years ago. I started the MS Word EMR Project this past summer mainly to demonstrate that it could be done on any platform- even in the seemingly "simple" and inexpensive MS Word. Although my bug-laden version 3 (just to wet appetites- there is a Bug.doc file that explains exactly the known bugs being fixed) is downloadable now, last night I successfully compiled it on my laptop, so in the next few hours/days the final template- including scheduler, prescriptions, a toolbox wizard for multiuser setups (yup, still in Word) will be uploaded to my Yahoo Briefcase. Version 4 may even have an ODBC connection with Medisoft for electronic billing. I may even eventually port my oncology chemotherapy applets from Access in future versions. All for free...

                            Mike, I applaud you for your efforts, and I'm sure that many of us true reasonable/free/even "open source" diehards that have already chimed in will be there for you to help out in areas where we can.

                            One last note- although I may bash Microsoft and their business practices/ethics on occasion, I generally feel that their softwares are some of the best out there and few competitors offer the ease of use, the interoperability, and overall redundancy that is seen in their applications.

                            Regards,
                            Al

                            Comment


                            • #15
                              With all of the government push to create codified vocabularies, CCR and incorporate DOQ-IT and other clinical decision support tools, and the proposed EMR certification coming down the line, the requirements and costs to build and maintain a viable EMR are almost insurmountable.

                              But Al, will your EMR be able to be "certified"? The government requirements for certification (and subsequent payment for use thereof) are likely to be quite stout (and changing). Do you have the time and energy to keep up with these changing standards and requirements? What happens to all of the docs using your EMR if you die? There are other things to consider than just lowest cost. Finally, my comment was that sophisticated physician organizatons demand more than what the inexpensive EMRs can offer. Do you really not agree with that? I'm not talking about one doc shops which could probably get by with Word macros (at least until cetification becomes required).
                              David Winn, M.D., FAAFP
                              CEO/Founder, e-MDs

                              There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

                              Comment

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