How Verizon Is Eating My Lunch

So I somehow ended up with Verizon as a downstream technology partner for authentication services for eRX.

They rammed the ‘new toolkit’ down our throats 2 weeks ago. The ‘new toolkit’ authentication process changed a about 3 step process into a 7 step process. That included re-entering your userid and password on EVERY eRX transaction. Yes, you have to re-login on EVERY patient EVERY time to authenticate. In 30 years of IT I have never had to do that.

Small problem: if you are supervising mid-levels like NP’s you might be doing that hundreds of times a week. That means that Verizon at minimum added 3 hours of work to my work week. Did I mention that after logging into the EHR system, then entering every time eRX 3 factors of authentication after multiple displays to check and re-check what you are doing it totally superfluously asks to the effect of do you really want to do this? Seriously? Uh yeah right after approximately 7-9 checks and re-checks I still am really not sure what I am doing. That adds up to hundreds of times a week that I have to answer do I really want to do this. They also actually hide the medication list on the authentication step. The old toolkit did not.

So let me get this straight: it adds many more steps to the process, hides the information you are approving then asks superfluously if I am sure what I am doing? The old toolkit did not hide what you are doing. The new toolkit adds a lot of work and is possibly hazardous. Yes Verizon, possibly dangerous to my care of patients.

And I told them so. Two months before it was rammed down our throats I told them in no uncertain terms that this is a disaster. That it would cost me 3 hours of time a week and that it is a user interface catastrophe.

Verizon did it any way.

Question for Verizon:

Do you really want to do this?
Do you really want to do this?
Do you really want to do this?
Do you really want to do this?

Astronaut Screenshots Advanced High Efficiency CPRS

Astronaut, LLC has circulated a screenshot of a “high throughput” Astronaut-CPRS screenshot. The screenshot exhibits:

. Two sessions open to allow for multi-chart multi-tasking (interruptions, un-scheduled patients, out of order patients, ‘pauses’ in network, etc.)
. Patient picture.
. Modeless eRX window allowing fast context switch between notes and eRX. Takes advantage of larger displays. Opens automatically on chart open to reduce keyboarding burden.
. Previous/Next chart controls for list iteration.
. Icon showing attachment present such as PDF, etc. Graphic embedding allowed.

“The VA CPRS platform has plenty of life left in it. We’ve pushed the technology further than it has ever been before. With it we’ve seen more patients more efficiently and more accurately than ever before.” says Astronaut, LLC CEO Ignacio Valdes, MD, MS

Yes, We’ve Migrated!

Since March, 30 2000 Linux Medical News has been on the Zope-based Squishdot blog before there was blogs software. After 16 years and 1963 articles (has it been that long?) we’ve finally moved to WordPress.  As always, for 16 years, your announcements your news your opinions are welcome at

Commission Wants to Throw Out VistA (Again)

A VistA commission report can be found here. Its text and conclusion are of the ‘seen it before’ variety multiple times in VistA’s long history. Maybe the bureaucrats will finally succeed this time at murdering VistA after so many past attempts.

I find the report remarkably superficial, contradictory, full of breathtaking and fundamental errors. For example that VistA is ‘monolithic’ which is totally absurd. ‘Monolithic’ while having ‘130 variations’. Which one is it? Monolithic or 130 variations? If it is monolithic then how can it have these variations? A COTS system would have no variation? Is that a good thing? It also indulges in the Interoperability Tooth Fairy/Perpetual Motion Machine (ITFPMM) Will Save Us All fantasy while admitting that it is a legislative problem and not a software one.</p>

Dysfunction and Sabotage: Why Large Hospital EHR Costs So Much

Years ago I read the cannon of the classic medical book “House of God” by Samuel Shem which reads: “…the House of God was sad and sick and cynical…like all our doings in the House…” At first, before I had worked in an actual hospital I thought the book itself was sick and cynical. After working in an actual hospital I re-read the book. I then found it hilarious for its uncomfortable truths, and did not think it was sick or cynical enough. Therein likes the crux of the matter with regard to very expensive large hospital EHR’s.

I’ve wondered for years why large hospital EHR deployments are reported to cost north of 100 million dollars. I’ve asked the question what is that software made of, Unicorn dust? I’ve also heard reports that the EHR company in question fields ‘an army’ of workers for its go-live. I’ve wondered what justifies all this and what justifies the giant budgets. In working in and around hospitals for 20 years now I’ve come to some conclusions.

As the House of God points out, the human tendency towards dysfunction, sabotage, infighting and more is alive and well. It is often exhibited in raw relief in hospitals from the lowest employee to the highest management. My theory is that’s precisely why these systems cost so much and why you have to field, maintain, and deploy an army of go-live personnel to do it.

The army is there to absorb and contain the dysfunction and tendency towards sabotage at all levels that can occur with a technology deployment. Most people resist change but they are more likely to change when the EHR stranger from afar representative is standing in their midst to be therapist through the change. People are also much less likely to sabotage, poison others, and lapse back into dysfunction with the stranger from afar representative standing right there.

Thus the hundred million dollar price tag. It isn’t the price of the hardware or software. It is the price of the change, absorption and redirection of dysfunctional tendencies while preventing sabotage.<

Open and important questions: How do you know you are not replacing one dysfunction with another? Will the new dysfunction be revealed only with time? Possibly a long time like years to decades? Who is watching the watchers, training the trainers and on what basis? Are we creating hydraulic empires and oligarchies with these proprietary systems being put in place? How long before they become the problem and not the solution?

Author: Ignacio H. Valdes, MD, MS has been thinking about and implementing EHR’s since 1985. He is managing member of Astronaut, LLC Electronic Health Record which offers a VA compatible VistA variant for the private sector.

OpenEMR 4.2.2 is released

The OpenEMR community has released version 4.2.2. This new version is 2014 ONC Certified as a Modular EHR. OpenEMR 4.2.2 has numerous new features including 30 language translations, a new modern user interface, and fully supports PHP7 and the most recent versions of MySQL and MariaDB. OpenEMR 4.2.2 can be downloaded from the OpenEMR Project website at . Thanks goes to the OpenEMR community for producing this release.

Interoperability Fears

When you get right down to it, lots of individuals and organizations fear interoperability. I am finding a great deal of resistance to the notion of the real deal of single sign-on longitudinal type record across organizations interoperability. Most want to only emit little squirts of electronic data and only under pressure to do so.

Many fear ‘their’ records and ‘their’ patients being ‘stolen’ from them by other organizations, practitioners or whomever. Because the ‘other’ organizations and practitioners will steal but they won’t. Classic Prisoner’s Dilemma thinking.

Those fears are very powerful and in my opinion not rational in the face of a nationwide doctor shortage. Convincing others to change under those emotional circumstances is very difficult. I am wrestling with that now.

My fear is that classic interoperability notions and architectures ‘work’ about as well as government ‘works’. I further fear what the government might promulgate in the name of interoperability when it isn’t a software issue.

Major Hole in eRX

Cancellation of medication orders already sent to the Pharmacy by eRX is only possible with less than 2% of pharmacies. The SCRIPT standard allows for change/cancel and you can possibly send it with the ordering software but less than 2% of pharmacies can receive the order. Therefore for most pharmacies it can only be done by laboriously calling the pharmacy, being put on hold, giving the information and waiting for them to do it. We tell the patient to not fill what was incorrect and let the order expire. It is not optimal.

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