And if the health care blogging world wasn’t specialized enough for you, here are two new ones taking deep dives into very specific subjects. One on the Ethics of Vaccines from the Bioethics guys at UPenn, and the other on bio-medical informatics called FutureHealthcareIT from uber-nerd Dale Hunscher at Univ Michigan.

At HIMSS I had a quick chat with Scott Shreeve, the Chief Medical Officer at Medsphere. Medsphere’s product OpenVista, as you all know, is built on the VA Vista product — which is the main “open source” EMR code out there. To get it ready for the commercial market they had to remove the VA- centric features, rewrite the user interface and re-architect the middleware layer using open source technology. For commercial hopsitals they had to enhance the charge capture features for patient billing. They also had to enhance features in the ancillary department systems, and leverage and extend the current data base (which is written in MUMPS).

Their first client, Midland Memorial Texas, has 425 beds in 3 sites. They were facing approximately a $20m price tag for to upgrade their McKesson clinical system. Going with Medsphere is 1/3 the price of a new system but Medsphere had to interface with the McKesson billing system to get the gig.

Are they able to compete with Medtiech in the smaller hospital world? The business model is that they get paid for services and an ongoing subscription for managing it. So they have to provide the open source code, but ideally they want to get the subscription to manage it and so need to do a good job there. Aside from hospitals, they are going to stay in the bigger (i.e. medium-sized) ambulatory clinic market, but do have groups of small physician practices coming together to buy the system — so they do have some opportunity in other parts of the market. They think that they can do move that process down to small hospitals.

What are they doing to address that? They’re developing deployment models that work very quickly setting up systems. They’ve done it with pharmacy, lab & radiology and have have some tools to extend the system. But the software is thin-client but not web-based so there is stuff they have to do in terms of services and installs, and it’s hard to see them moving to a very small hospital market or ASP solution just yet. (They are, after all, waiting to show their first hospital client site fully live!)

And that "open sourceness"? They are changing some of the code and adding some of the new code set back to GPL, but they are keeping some of the code proprietarily for the interfaces and the GUI that they’ve built. So the open source purists may not think that Medsphere is pure open source, but the rest of health care IT will be watching with a great deal of interest to see if they can make a real business selling "free" software and undercutting the bigger guys.

BTW MrHISTalk had a nice interview with Scott a while back

Writing in his blog from PC Forum, Esther Dyson’s technology conference that Dave Winer says is apparently is back “in” these days, here are some parts of what Michael Miller had to say.

Esther Dyson talking about how the health care industry showed extreme versions of many of the issues discussed earlier in the day: more information than ever, with users having to make more decisions themselves.

Scott Cook talked about the difficulty of tracking medical expenses and figuring out how much an individual owes.    He talked about Intuit’s Quicken Medical Expense Manager, and how institutions are wanting to get more data into it.  There are lots of issues about understanding the information, who owns the information etc. 

Jeffrey Rideout of Cisco talked about the problem of trying to get his employees information about their medical plans, expenses and other information.  We have a lot of problems to solve with the health care system, he said.  He said Cisco is looking on how to use its influence as major employer to help its employees navigate the system and get better care.

J.D. Kleinke of Omnimedix Institute talked about how looking at data is improving health care, and how it was important to gather more information about the health care process.  His company wants to give people personal health care records.  They want information that is private and portable.  He also operates Healthgrades – a site for getting the grades of your doctor and hospital. (Matthew’s note—not sure how JD ended up Vice Chairman there but he has been since the dark days of 2002!)

Gina Glantz from Service Employees International Union talked about how many of their members don’t have good health coverage; and how health care costs are an increasingly large issue in negotiations with employers.

The discussion talked about the need to deliver the technology in lots of places, perhaps by mobile phone.  But all seem to agree that technology has a way to help the system.

Scott Cook said “we don’t have time to wait” for a complex solution.  More people die because of medical errors caused by bad systems than from Diabetes or car accidents. We need to go after the root causes of the complex work systems and use best practices to improve this. We can’t wait for an all-encompassing technology solution, he said.

Rideout thought the personal health record was the first and easiest way to make an improvement; by getting a core set of information to people.We don’t spend enough money on IT for health care, he said. (Matthew’s retort—Well at least they’ve taught him something about marketing IT since he went to Cisco!)

People in the audience seemed particularly interested in the concept of a personal health record that you could carry around with you electronically. Both Intuit and Omnimedix said they were working on the problem.  Rideout said many doctors don’t trust this information though. Kleinke said the problem was not primarily technological, but instead was getting political agreement

I’ve remarked before how it’s incredible that really bright people from outside the industry just have no comprehension of how this business works. I can forgive Esther (and I was relatively nice about her before). Cook is selling a software program, and so if he can create a consumer market for PHRs, good luck to him — although I hope it’s a whole lot more transparent that the baffling TurboTax.But if this is reported accurately JD and Jeff Rideout, who both know plenty more about health care than the rest of the people in that room, need a good paddling if they seriously believe that portable PHRs are the best we can do as a solution for anyone apart from Quicken’s shareholders.

The only person who even appeared to be in the ball-park of defining what was wrong is the rep from the SEIU who’s noticed that health care costs are going up too fast and have been for years. No one (unless JD was transcribed wrongly about what was political) seems to have mentioned the overall access/cost/quality/practice variation problem.  Couldn’t they have got tech guru Len Schaeffer in there? At least he understands that part of the problem.

Of course as has been discussed many times by the crowd over here on THCB who do know something about this business, the broad problems with health care are a) the insurance market, b) the structure of the delivery system, c) the quality of the care delivered by that system and very lastly d) customer service. Well the portable PHR might solve some of the last issue, but that’s eventually being dealt with by the plans and providers starting to use decent CRM. So by glomming onto the portable PHR as a solution because it looks like a piece of technology that they vaguely understand, the PC Forum crowd is imitating the drunk looking for his keys under the street lamp because it was dark where he dropped them.

And unless the major issues of the health system are changed by some type of reform, all the technology and information in the world won’t make much difference.

OK. I have two requests for people in slightly different parts of health care IT. Both are based on the west coast.

One is for a senior level marketing Director at a large technology company to build a health care marketing group. Needs 10+ years experience knowing health care, technology and marketing.

The other is a 9 month full-time contract as an IDX implementation consultant/manager for their enterprise wide scheduling system. If you don’t know what that means, it’s not for you!

Please email me with your details (resume/bio/experience) if you think that it might be you. And as I’ve said before feel free to write if you’re just looking but not for these in particular as I get asked a lot. Obviously everything is treated in total confidence,