Look, gkfahnbulleh, let's agree to disagree on certain issues, but let's not turn this into yet another disagreeable argumentative "discussion". What pisses me off the most about your style is how you immediately go for the jugulars and begin to attack your opponent, rather than discuss the topic at hand. Phrases like: "Every IT professional WORTH HIS SALT..." really intend to demean and intimidate your opponents and ends up making yourself look like a jerk, a bully. 'nuff said...
>>> It has already been established that MS-Access is not scalable...If it has an SQL backend, it could be an excellent front-end platform in a large hospital environment. In a small office, a Jet backend would be not only be workable but inexpensive and easy to program. It still works well in my office. If you end up using the SQL Server Express things would even be even better.
>>> [about the "Vista" VAMC EMR] That would stiffle competition, restrict innovation, and be anti-capitalist...CCHIT and universal health care would end up forcing folks to use only a handful of EMRs. The British NHS, for example, lets one choose between Cerner and some generic Brit EMR. Same situation is seen in many of the Canadian provinces. If I had to choose between one anti-capitalist schenario or another, I'd choose the free big government route anytime than having the likes of GE act like a big mafia, with uncontrollable EMR inflation due to loss of true competition.
>>> Nothing I have read about CCHIT "controls" how a physician practices medicine. What Obama and his group of health care pinheads want to do is to mandate the use c-EHR systems to control the way health care is delivered, from patient denial of care to denial of physician payments based on data mining. They want to force all physicians to use eRx, CPOE, etc. through the use of CCHIT c-EHR systems. The catch word of the day now is "significant use", which means that if a physician is to make a profit with Medicare, he/she will have to do all the above using a c-EHR.
>>> CCHIT's goal is to ensure the interoperability of multiple systems from multiple vendors by providing the standards.I'll discuss CCHIT and interoperability when finally CCHIT c-EHR systems do become inoperable. CCHIT started in 2006, and here we are 3 years later with a bunch of standards most of which have absolutely nothing to do with interoperability. The only really interoperable systems usually are based on one platform, s.a. the VAMC and to some degree, Kaiser.
It is interesting that Kaiser, after installing EPIC at a cost of more than $4 billion is still unable to make their whole program from "sea to shining sea" interoperable. My next article in the
MD Net Guide magazine will be on HIT and universal healthcare systems in the USA, BTW. Don't miss it.
CCHIT was formed to "cull the heard" by forcing EMR vendors to pay a large amount of money up front and on-going then making the standards onerous enough to force EMR vendors to exert a vast amount of money in becoming compliant.
By itself, the idea would be a good one, and would have joined the list of many prior health standards that have been lost to obscurity. Then HIMSS got the HHS to go back them up as an "official accreditation agency" and at the same time CMS/MEdicare has been trying to force EMR use by contracting physicians through the use of certified EHR systems (c-EHR) as a way to get paid appropriately. The feeling is that this one-two punch will finally get more than 4% of doctors to buy c-EHR systems.
HHS, a government body is essentially insulating HIMSS, and the CCHIT certification process, to bypass Federal RICO anti-racketeering laws which has resulted in killing off much of the competition. What HIMSS/CCHIT does is no different than a mobster extorting money from businesses which in this case would be vendors to allow them to compete in society.
I discussed this further here:
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http://www.emrupdate.com/forums/p/7953/60493.aspx --
http://www.emrupdate.com/forums/p/11551/75582.aspx#75582 >>> How do you suggest ensuring INTEROPERABILITY without a standards body to set the standards?CMS/Medicare could have simply asked for providers to follow certain medical parameters (eg- smoking cessation, HgbA1c levels, PAP smears, etc) and let it up to the physician to use whatever "tool" (paper, EMR, hybrid system) he wanted to use to deliver the results. They could have set up a simple RIO-like system by which any EMR could hook up to for "interoperability" without having to resort to an "enterprise" level CCHIT c-EHR.
Al
