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Re: [openhealth] Digest Number 68

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  • Ron Nath
    To all: I have been trying to become a beta tester for the Vista Office EHR (VOE) just released but so far have had no success. Either I hear back nothing
    Message 1 of 11 , Oct 2, 2005
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      To all:

      I have been trying to become a beta tester for the Vista Office EHR
      (VOE) just released but so far have had no success. Either I hear back
      nothing from the list of "approved" vendors or they are asking for big
      $$ upfront for a beta product. I thought VOE was supposed to solve the
      problem of pricey EHRs. Is there any way to download a version of VOE
      without going through the vendors? I would expect it to be made
      available through the Freedom of Information Act (FOIA). Has anyone
      actually been able to become a beta site tester?

      Thanks.

      Ron
    • Mike
      Until VOE comes out of beta, FOIA doesn t apply. Beta test site qualifications are just now being finalized. CMS is intent on having successful beta sites, so
      Message 2 of 11 , Oct 3, 2005
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        Until VOE comes out of beta, FOIA doesn't apply. Beta
        test site qualifications are just now being finalized.
        CMS is intent on having successful beta sites, so
        they're encouraging vendor involvement. And while
        there is a cost for vendor services, we have found
        that VOE is still less expensive than other,
        functionally comparable EHR's.

        Mike

        --- Ron Nath <s.nath@...> wrote:

        > To all:
        >
        > I have been trying to become a beta tester for the
        > Vista Office EHR
        > (VOE) just released but so far have had no success.
        > Either I hear back
        > nothing from the list of "approved" vendors or they
        > are asking for big
        > $$ upfront for a beta product. I thought VOE was
        > supposed to solve the
        > problem of pricey EHRs. Is there any way to
        > download a version of VOE
        > without going through the vendors? I would expect
        > it to be made
        > available through the Freedom of Information Act
        > (FOIA). Has anyone
        > actually been able to become a beta site tester?
        >
        > Thanks.
        >
        > Ron
        >
        >




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      • John Leo Zimmer, MD
        ... From: openhealth@yahoogroups.com [mailto:openhealth@yahoogroups.com] On Behalf Of Mike Sent: Monday, October 03, 2005 6:55 AM ...we have found that VOE is
        Message 3 of 11 , Oct 3, 2005
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          -----Original Message-----
          From: openhealth@yahoogroups.com [mailto:openhealth@yahoogroups.com] On
          Behalf Of Mike
          Sent: Monday, October 03, 2005 6:55 AM

          ...we have found
          that VOE is still less expensive than other,
          functionally comparable EHR's.


          Who's "we"?

          We know... make that "I know" that the cost of VOE will include licensing
          costs for Cache', the version of the MUMPS language which CMS has chosen to
          use... and a few hundred per year for licensing the AMA's CPT codes.

          I know or can calculate the costs of hardware: a server and workstations,
          laptops or tablets, networking, backup, printers.

          I know the cost for licensing VOE itself... Zero.
          Or rather, licensing is neither necessary nor available for public domain
          software.

          I would like to see the numbers on what "we" think VOE will cost, installed,
          for say a solo practice, a 5 provider, 10 provider, 100 provider practice.

          Regards, jlz

          Just reading the tea leaves like everyone else.
        • Joseph Dal Molin
          Ron, Please contact me off line regarding the specifics of your situation and the responses you have received so far. There are three ways you can obtain a
          Message 4 of 11 , Oct 3, 2005
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            Ron,

            Please contact me off line regarding the specifics of your situation and
            the responses you have received so far. There are three ways you can
            obtain a copy of VistA Office: 1) You are an approved vendor, ie. you
            have passed the vendor qualification test on the VVSO site 2) You are an
            approved developer willing to contribute to improving VOE 3) You are a
            vendor in training to become a "qualified vendor". We are in the process
            of setting up our website etc. to address 2) and 3) and will be going
            live with the test again today or tomorrow.

            The only VOE implementations that will be allowed during the Beta phase
            at this time will be at CMS approved Beta sites which are supported by
            "qualified vendors". This will allow the team to iron out any bugs, make
            additional improvements, test the support infrastructure, address the
            EHR standards which are in development, and last but not least establish
            solid benchmarks and case studies of what it takes to implement VOE.

            Cheers,

            Joseph

            --
            Joseph Dal Molin
            Program Manager, VVSO
            WorldVistA
            www.worldvista.org/vvso
            1.416.232.1206

            Ron Nath wrote:
            > To all:
            >
            > I have been trying to become a beta tester for the Vista Office EHR
            > (VOE) just released but so far have had no success. Either I hear back
            > nothing from the list of "approved" vendors or they are asking for big
            > $$ upfront for a beta product. I thought VOE was supposed to solve the
            > problem of pricey EHRs. Is there any way to download a version of VOE
            > without going through the vendors? I would expect it to be made
            > available through the Freedom of Information Act (FOIA). Has anyone
            > actually been able to become a beta site tester?
            >
            > Thanks.
            >
            > Ron
            >
            >
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          • Rod Roark
            ... Would you please quote the FOIA section that justifies this statement? Regards, -- Rod
            Message 5 of 11 , Oct 3, 2005
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              On Monday 03 October 2005 04:54 am, Mike <galaynta@...> rote:
              > Until VOE comes out of beta, FOIA doesn't apply.

              Would you please quote the FOIA section that justifies this statement?

              Regards,

              -- Rod
            • Will Ross
              John, There is no simple answer to the cost of an EHR implementation, VOE or otherwise, for solo, 5 provider, 10 provider, etc. This is caused first by an
              Message 6 of 11 , Oct 4, 2005
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                John,

                There is no simple answer to the cost of an EHR implementation, VOE
                or otherwise, for solo, 5 provider, 10 provider, etc. This is
                caused first by an absence of data, and second by an extreme
                variability in site-level technology life cycle costs which are
                independent of the software application layer. EHR software is just
                another electronic workflow solution which rides on top of the
                underlying technology infrastructure at any practice, along with
                scheduling, billing, lab, email, calendaring, etc. In many cases
                there is no clean way to break out the costs between the underlying
                technology infrastructure layer (servers, cable plant, bandwidth,
                provisioning and administration, security measures, backups, after-
                hours support, etc.) and the EHR (or other application) software in
                use at a typical office.

                In my prior life as an IT Manager in the non-healthcare sector during
                the 1990s, I found it best to speak in cost ranges (or estimates +/-
                some x% cost factor) for the entire technology operating budget.
                Trying to isolate the specific cost of a single application in the
                overall technology environment is not necessarily a good use of time,
                nor does it provide data that is relevant in similar institutional
                settings. Applying this as a general rule to the healthcare
                sector, I would answer your query by starting with the total annual
                technology budget as a % of total operating costs for the typical
                practice. I expect (no avalanche of data to support this yet) that
                we will find that technology cost ranges below something like (insert
                weasel words here!) 5% of total operating costs will be inadequate to
                provide a robust and satisfactory clinical software environment.
                The practice-level costing studies I have seen to date do not give me
                the confidence to estimate these cost values yet, but the work of
                Robert Miller and others gives me hope that we are not far from
                establishing preliminary cost ranges for small practices.

                Understanding the basis for technology costs precedes the specific
                comparison of VOE costs versus any other EHR solution. Claims for
                VOE costs compared to the costs of other EHR software have to be
                looked at carefully. Claims for such costs will vary based on who
                is making the claim, the site-level technology sophistication which
                is the basis for the costing claims, and the extensiveness of
                technology utilization at the site(s) in question.

                [wr]

                - - - - - - - -

                On Oct 3, 2005, at 7:24 AM, John Leo Zimmer, MD wrote:

                > -----Original Message-----
                > From: openhealth@yahoogroups.com
                > [mailto:openhealth@yahoogroups.com] On
                > Behalf Of Mike
                > Sent: Monday, October 03, 2005 6:55 AM
                >
                > ...we have found
                > that VOE is still less expensive than other,
                > functionally comparable EHR's.
                >
                >
                > Who's "we"?
                >
                > We know... make that "I know" that the cost of VOE will include
                > licensing
                > costs for Cache', the version of the MUMPS language which CMS has
                > chosen to
                > use... and a few hundred per year for licensing the AMA's CPT codes.
                >
                > I know or can calculate the costs of hardware: a server and
                > workstations,
                > laptops or tablets, networking, backup, printers.
                >
                > I know the cost for licensing VOE itself... Zero.
                > Or rather, licensing is neither necessary nor available for public
                > domain
                > software.
                >
                > I would like to see the numbers on what "we" think VOE will cost,
                > installed,
                > for say a solo practice, a 5 provider, 10 provider, 100 provider
                > practice.
                >
                > Regards, jlz
                >
                > Just reading the tea leaves like everyone else.
                >
                >
                >
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                >
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                >
                >


                [wr]

                - - - - - - - -

                will ross
                mendocino informatics
                216 west perkins street, suite 206
                ukiah, california 95482 usa
                707.272.7255 [voice]
                707.462.5015 [fax]

                - - - - - - - -
              • Adrian Midgley
                ... There is some experience in the UK where, although there may now be an uncomputerised family practice, I have no idea where it might be found. However,
                Message 7 of 11 , Oct 4, 2005
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                  On Tue, 2005-10-04 at 02:33 -0700, Will Ross wrote:

                  > There is no simple answer to the cost of an EHR implementation, VOE
                  > or otherwise, for solo, 5 provider, 10 provider, etc. This is
                  > caused first by an absence of data, and second by an extreme
                  > variability in site-level technology life cycle costs which are
                  > independent of the software application layer.


                  There is some experience in the UK where, although there may now be an
                  uncomputerised family practice, I have no idea where it might be found.

                  However, ours were installing, 30 years ago and onward, onto
                  organisations where the most complex technology was possibly the
                  typewriter.

                  I can see that the situation is a bit different where you have extensive
                  office automation and it includes workflows (is the latter common?
                  mostly in the UK it is applications and tasks, connected by the people
                  rather than the computers).

                  Paradoxically, in the UK we are in the process of unpicking the clinical
                  systems which are now being seized by the government, from teh business
                  administrative systems which are in general going to be rather simple.

                  I would rather like the eventual unpicked business systems to be open
                  source ones, and their support to be delivered by a variety of
                  companies, but this may not happen.


                  However, if you want experience, look to the UK.

                  --
                  A
                • Mike
                  We is (are?) the company I work for, DSS (www.TheVistAExperts.com). We gathered the data the old fashioned way: through market research. We ve talked to a
                  Message 8 of 11 , Oct 4, 2005
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                    "We" is (are?) the company I work for, DSS
                    (www.TheVistAExperts.com). We gathered the data the
                    old fashioned way: through market research. We've
                    talked to a large number of physicians and consultants
                    who have provided us with comparable costs for
                    existing EHR systems. What we don't know for sure is
                    whether these other systems have everything that
                    VistA/CPRS has. We do know what VistA lacks and have
                    enhanced it by adding some of our own, proprietary
                    software into our offering.

                    I can quote you very specific prices and would be
                    happy to do so off this list.

                    Mike Ginsburg

                    --- "John Leo Zimmer, MD" <jlzimmer@...> wrote:

                    > -----Original Message-----
                    > From: openhealth@yahoogroups.com
                    > [mailto:openhealth@yahoogroups.com] On
                    > Behalf Of Mike
                    > Sent: Monday, October 03, 2005 6:55 AM
                    >
                    > ...we have found
                    > that VOE is still less expensive than other,
                    > functionally comparable EHR's.
                    >
                    >
                    > Who's "we"?
                    >
                    > We know... make that "I know" that the cost of VOE
                    > will include licensing
                    > costs for Cache', the version of the MUMPS language
                    > which CMS has chosen to
                    > use... and a few hundred per year for licensing the
                    > AMA's CPT codes.
                    >
                    > I know or can calculate the costs of hardware: a
                    > server and workstations,
                    > laptops or tablets, networking, backup, printers.
                    >
                    > I know the cost for licensing VOE itself... Zero.
                    > Or rather, licensing is neither necessary nor
                    > available for public domain
                    > software.
                    >
                    > I would like to see the numbers on what "we" think
                    > VOE will cost, installed,
                    > for say a solo practice, a 5 provider, 10 provider,
                    > 100 provider practice.
                    >
                    > Regards, jlz
                    >
                    > Just reading the tea leaves like everyone else.
                    >
                    >




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                    http://mail.yahoo.com
                  • Mike
                    No. I can only tell you what was told to me, that FOIA only applies to completed works, not works in progress. Calling the current release a beta puts it into
                    Message 9 of 11 , Oct 4, 2005
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                      No. I can only tell you what was told to me, that FOIA
                      only applies to completed works, not works in
                      progress. Calling the current release a beta puts it
                      into the "works in progress" category.

                      Mike Ginsburg

                      --- Rod Roark <rod@...> wrote:

                      > On Monday 03 October 2005 04:54 am, Mike
                      > <galaynta@...> rote:
                      > > Until VOE comes out of beta, FOIA doesn't apply.
                      >
                      > Would you please quote the FOIA section that
                      > justifies this statement?
                      >
                      > Regards,
                      >
                      > -- Rod
                      >




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                    • Rod Roark
                      Well... I would respectfully suggest that the information told to you is raw horse manure. A good source of information about the FOIA, including the text of
                      Message 10 of 11 , Oct 4, 2005
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                        Well... I would respectfully suggest that the information told to
                        you is raw horse manure.

                        A good source of information about the FOIA, including the text of
                        the statute (which by the way does not include the phrases
                        "in progress" or "beta") and sample requests, may be found at:

                        http://www.gwu.edu/~nsarchiv/nsa/foia.html

                        Frankly I don't think it would be very good publicity for OpenVista,
                        CMS or your company to see the FOIA used to force release of VOE to
                        the parties who have an understandably high degree of interest in
                        seeing its current state. Many of us are making important decisions
                        based on claims made about VOE which can only be verified by
                        independent inspection and testing of the code.

                        Regards,

                        -- Rod

                        On Tuesday 04 October 2005 11:37 am, Mike wrote:
                        > No. I can only tell you what was told to me, that FOIA
                        > only applies to completed works, not works in
                        > progress. Calling the current release a beta puts it
                        > into the "works in progress" category.
                        >
                        > Mike Ginsburg
                        >
                        > --- Rod Roark <rod@...> wrote:
                        >
                        > > On Monday 03 October 2005 04:54 am, Mike
                        > > <galaynta@...> rote:
                        > > > Until VOE comes out of beta, FOIA doesn't apply.
                        > >
                        > > Would you please quote the FOIA section that
                        > > justifies this statement?
                        > >
                        > > Regards,
                        > >
                        > > -- Rod
                      • Mike
                        Thanks for the interesting link. After a quick read, I don t see anything that specifically excludes the information that I was given. But, in any case, my
                        Message 11 of 11 , Oct 5, 2005
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                          Thanks for the interesting link. After a quick read, I
                          don't see anything that specifically excludes the
                          information that I was given. But, in any case, my
                          point was that if CMS wants to control release of VOE,
                          I would assume that they would find some way of making
                          the FOIA process not apply. As an approved vendor, we
                          already have access to the code, so it's not an issue
                          for us.

                          I'm afraid I don't understand your second point.

                          Mike

                          --- Rod Roark <rod@...> wrote:

                          > Well... I would respectfully suggest that the
                          > information told to
                          > you is raw horse manure.
                          >
                          > A good source of information about the FOIA,
                          > including the text of
                          > the statute (which by the way does not include the
                          > phrases
                          > "in progress" or "beta") and sample requests, may be
                          > found at:
                          >
                          > http://www.gwu.edu/~nsarchiv/nsa/foia.html
                          >
                          > Frankly I don't think it would be very good
                          > publicity for OpenVista,
                          > CMS or your company to see the FOIA used to force
                          > release of VOE to
                          > the parties who have an understandably high degree
                          > of interest in
                          > seeing its current state. Many of us are making
                          > important decisions
                          > based on claims made about VOE which can only be
                          > verified by
                          > independent inspection and testing of the code.
                          >
                          > Regards,
                          >
                          > -- Rod
                          >
                          > On Tuesday 04 October 2005 11:37 am, Mike wrote:
                          > > No. I can only tell you what was told to me, that
                          > FOIA
                          > > only applies to completed works, not works in
                          > > progress. Calling the current release a beta puts
                          > it
                          > > into the "works in progress" category.
                          > >
                          > > Mike Ginsburg
                          > >
                          > > --- Rod Roark <rod@...> wrote:
                          > >
                          > > > On Monday 03 October 2005 04:54 am, Mike
                          > > > <galaynta@...> rote:
                          > > > > Until VOE comes out of beta, FOIA doesn't
                          > apply.
                          > > >
                          > > > Would you please quote the FOIA section that
                          > > > justifies this statement?
                          > > >
                          > > > Regards,
                          > > >
                          > > > -- Rod
                          >




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