Home Forums Discussions General Discussion EMRupdate.com is in Chaos

It's really a mess right now at emrupdate.com. Top posters, such as Al Borges, M.D., are being banished from the website, for talking too much about the negative aspects of CCHIT.

Also, it has come out that a representative of NextGen has been given Moderator status, on this supposedly impartial website, and many members are angry.

Physicians wonder if the information they receive there is being influenced by a pro-CCHIT EMR vendor. Competing vendors wonder if NextGen is getting preferential treatment. When they try to post about their angry feelings, however, their posts are being deleted by the Moderators.

For those that don't know, emrupdate.com has been, up to now, has been considered one of the top websites for unbiased information about various Electronic Medical Records and related issues, such as Speech Recognition, "Pay for Performance", and CCHIT certification.

For years, Al Borges, M.D. (alborg) has been one of the top ten posters at emrupdate.com. He is an oncologist who designed his own EMR, and has made available for public download, free of charge.

Yesterday, one of the moderators (Lowell Kleinman, M.D.) singled Al out for discipline, in the guise of a supposedly "Friendly Request", which was actually a public rebuke (this was basically admitted, later in the thread). He was told that his "rants have gone overboard and they hijack threads". Al requested to have the conversation moved to the "Off Topic" portion of the forum, instead of posting it at the top of the EMR Forum, like it was legitimate news.

A denial of his request came from Moderator/NextGen rep, Bob Larson:
“Reasonable request politely made - denied with prejudice. Fun ensues. Film at eleven.”

Al was justifiably angry, and reacted angrily. One of the main Moderators of the site, Nick Harrington, posted a threat of banishment, if Al didn't abide by "every word" of Lowell's "Friendly Request".

Nick further said: "Al, your continued anti-CCHIT tirade paints you as... Not balanced, not a reasonable poster and ultimately a prime candidate for a sojourn sans membership.

It is not clear what happened next. Al was apparently banned before he could post again publicly. I tried to look up his user profile, and got the message that no such user exists anymore at EMRupdate.com.

There's a lot of anger at the way Al was treated, and his banishment has brought into focus the fact that one of the moderators involved in the thread that cost him his membership, was this selfsame vendor/Moderator, Bob Larson.

This has caused physicians and other vendors to question how independent emrupdate.com really is. However, those posting their concerns are finding their posts banished. Here is one example, from a competing vendor, President of eMedRec:


Nick's reply:


This exchange was moved to the "Off Topic" forum. Dr. Borges' public rebuke remains on the front page of the "Discussion Forum for Electronic Medical Records Software."

I think the time is right now to send resolutions to our medical society and get support for protection against the bullying tactics of large CCHIT EMRs. There is need for legislation for protection of our patient data. There is a need for government to investigate CCHIT as I beleive it is now used as a way to inhibit fair and free competition. I will be submitting several resolution for the next House of Delegates (where I will meet stiff resistance from entrenched "leaders in medicine.").
Perhaps endorsement of non-CCHIT EMRs that provides fair treatment to physician users is needed to balance out the CCHIT rhetoric. Anyone interested in getting a "Stop that CCHIT" grassroot campaign? A "Bill of Rights for EMR User" resolution with electronic medical records would be helpful too.

1st step is to get AAFP to put words into action. They talk about STRONG MEDICINE to protect the practice of medicine. AAFP policy has been more a HERBICIDE to eliminate small indepedent practices with it's support of CCHIT. If there is 100 family physicians out there that will send letters of our concern that AAFP is not living out to its new identity, that would go a long way.

Brian,
Thanks for bringing this to our attention. It seems like history always repeats itself....the aggressor attempting to silence the opposition through force, particularly when they can not win on a level playing field (open debate).

Roy,
I am a member of the WSMA but have not been active. I'll second some of your suggestions.

For your reference I have replied to Al Borges last post here concerning his status (not banned). Just for the record, we neither have a pro or anti-CCHIT stance (or any other important EHR subject).

To suggest otherwise is really not true. For your information, Bob Larsen hasn't been remotely involved in any of Al Borges' temporary forum holiday. There are always a few sides to any story. Unfortunately your rendition here is grossly inaccurate and biased. Sad really.

Nick Harrington
for emrupdaate.com

Thanks, Nick, for dropping by our User Board, and offering your reassurances on these troubling issues.


Great news, if true. I just checked his user account, and found it to still be deactivated:

http://www.emrupdate.com/msgs/default.aspx?MessageID=74

I'll keep checking.


This would also be great news, if true.

In practical terms, however, I have not, so far, found a Moderator at emrupdate.com who seems sympathetic to anti-CCHIT sentiments.

On the other hand, Moderator Lowell Klineman, M.D. seems to include himself in the group of people who are pro-CCHIT in one of the links provided below. And Bob Larson, a vendor for a CCHIT-certified EMR, would hardly be expected to be neutral Moderator on the subject, whatever his protestations.


This is mystifying to read, as Mr. Larson has posted all over the thread where Al Borges gets the sack, as anyone can easily verify. He is the first moderator to gang up with Lowell against Al. He is the one who denies Al's request to move the offending thread "with prejudice".


As to whether my rendition of events is grossly inaccurate, readers can read the posts, and judge for themselves:

Here's the thread where Al gets the sack:
http://www.emrupdate.com/forums/t/11907.aspx

Here's the thread where dissent is stifled:
http://www.emrupdate.com/forums/t/11926.aspx

bcmd,

I think the link you're refreshing is just a message ID, not Al Borges identity. Just rechecked and I can download from his files area using a John Doe user. Could be a cache thing.

This is the URL to Al AlBorg profile at emrupdate http://www.emrupdate.com/members/alborg.aspx

CCHIT biased? On the contrary I have personally tried to help Al get his message across helping him with a number of forums, blogs, sites. That he chooses to ignore these places is clearly a waste of my time and effort.

I don't have to respond in any detail on moderator discussions, you shouldn't expect me to; this forum wouldn't either. All I note is that Bob hasn't cast any vote for or against any temporary ban on Al Borges, and has not replied on that moderator thread. You're still using the phrase "Al gets the sack". I'm mystified why, when he's simply had a short-break from posting.

I think you may be using a bit of "spin" here. Don't know why.

Nick Harrington
for emrupdate.com

Thanks again for posting here, Nick, and for your clarifications and further reassurances.

You absolutely don't have to answer to us about your choice of moderators. This is our Amazing Charts forum, and we were talking among ourselves.

What you do over there is your personal responsibility, certainly, but onlookers are going to talk about the choices you make.

As to the "spin" issue, I think that my phrase, "sacking", was more accurate than your euphemism, which was that he was "on holiday from posting". My phrase expressed the meaning that someone was pushed out, and turned to find the door locked, and yours did not.

Now that Al's account has been restored, I will say that he was "temporarily banned from posting."

Hey what about free speech and letting the reader do the editorial weeding out? Was that not the beauty and the downside of the web verses large corporate mass media. It kind of gave back the printing press to the masses. Are we now going to allow those of corporate interest to again be the editorial filter for all of us???

I have a suggestion because I'm very concerned that those inside an industry, even just technicians at large hospitals, TV stations and so on do have some amount of inherent bias to maintain and grow certain types of technology even if they try to have a neutral stance. Having CCHIT and ERMupdate board membered and moderatored by those who are industry insiders can "appear" to be biased even when not, althought I do feel that many are while a few are not; this is very frightening and wrong. Perhaps if EMRupdate and CCHIT had moderators and board members who were from mostly small and medium sized practices, both those that have adopted some amount of tech and those that have not (why not include the nay sayers, perhaps we could all learn where the road blocks really are?) we could get a more fair and balanced perspective. Even us Non-CCHIT but EMR adopters are some what biased already towards the technology, right? We do agree with the basics, just have a different spin on how to get there and why. We have already cut off half the conversation by not including those that are totally against EMR's and the like.

This is how the conservatives cut off half the conversation in the 80's and 90's by redefining the extreme left as "Liberal". The proper original edfinition of a liberal really was for a waffeling, sit on the fence, middle of the road, person who you couldn't easily tell if they were right or left of center. They were for the most part the center. To be as extremely left of center to counter the exterme right side that is, big corporate, free market, hawkish, military industrial complex, one would need to include the Yippies, Anarcists, Full Socialists and Communists and the like... That puts the Liberial right back where he belongs, sitting on that fence sort of playing both sides. Get it??? But by redefining the center as the extreme left side, that entire side of the argument no longer has to be dealt with or acknologed, no less incorporated into the conversation. It's simply GONE!!!

For the most part those of us who are discussing EMR's have kind of done the same thing. I like EMR's in my office, not connected to the large world wide web, with citizens' and their health records in anyone's, no less government's centralized servers. Have none of you read your required Orwell back in college and HS??? Did none of you get it??? But even I at this extreme conservative side of EMR's am still an EMR'er and I am smart enough to understand that there are others who don't even want to go there and perhaps it is my conservative perspective that has many of them scared off and worried, and wanting to aviod the entire thing??? Did that ever cross your minds.

So how about have NO corporate board members or moderators, even if they are good people of decent character, because they are by their very nature, on the extreme side of one of the sides of this conversation??? Those who are the CEO of tech intergration at a major teaching hospital, are by their very nature very biased. So is the corporate COO, CFO, CEO and what have you of an EMR vendor, even if they are great people who studied a whole lot of philosophy back in undergraduate school. What we need is to have people who come to this as average, small practice docs and practice managers (like myself) who are the ones that have to live and work with the final choices of this ivory tower committees. Have the committee hire folks to help them understand the tech side, but have regular folks make the choices. It is their offices that are going to get banged by this CCHIT.

In engineering there is a great basic idea to live by when designing something and CCHIT has totally lost sight of this which is why I think most of us here are AC users. "Remember your end user." If a piece of equipment or software, a car, a VCR, and phone, whatever, is properly designed then the intended end user should be able to take the darn thing out of the box, run if through at least half if not 3/4's of it's paces without ever opening up the user manual. The steering wheel is the steering wheel, the gas is the gas, the brake is the brake; get it???

This is the reason for AC's continued success and frankly I think that many of the larger CCHIT like vendors are really scared of this little upstart that could. And even here at AC I and a few others have to try and remind AC central not to forget this most important and basic of principles. That one basic concept should be handed down on stone tablets to what ever commitee be it CCHIT or hopefully something else that replaces it, to be tatooed on eveyone's forehead, never to be forgotten uder penalty of death. This is where EMR's and any other technology has to go if it will ever be successfully adopted.

"Hi, I'm a PC", "and I'm a MAC". MAC baby, MAC... If you can not accept or understand this most important concept then it is true, you are too much to one biased side, too involved. This is perfectly understandable and it is very human. Most software writers have this myopic perspective. Have you noticed how many of the larger vendors keep trying to use the AC marketing idea of "designed by a regular doctor just like you". They do understand that their products are not intuitive or they have not desinged then for the average, not computer science major, front end receptionist, MA, Nurse, Practice Manager and the like. Even half the docs don't want to get this detailed. They need a good old Auto trannied, MPFI, basic EMR to get them from point A to point B. Something they can just put their key in and it turns over every morning and drives... Get it? Imitation is the greatest form of flattery.

So let's give the design and creation of these most important tools back to the folks who have to live with the consquences and the costs. And there should be no unfunded mandates here. Either put up or shut up, plain and simple. Are you really game to do this the proper and fair way????

Good Night and Good Luck,
Paul

Funny,
I would have thought that there would have been something here from one or two of the interested parties by now. At least one or two of the other AC based, regular gang. Everybody here OK? Out X-mas shopping??? Have a good night.
Paul

Here's the post where emrupdate posters ask for Bob Larsen and Lowell Kleinman to step down as moderators:

"A friendly request for Bob and Dr.K." http://www.emrupdate.com/forums/t/11946.aspx

Here is the post where Kleinman now is "demoing" NextGen:
http://www.emrupdate.com/forums/t/11956.aspx

Some of us had wondered if Bob/Lowell had this planned all along; i.e. a free NextGen license to help Bob kick me out. I predicted it in a prior post here- I wouldn't have thought that he would be dumb enough to do that NOW! But then, I never did find him that bright to begin with.

Oh my- the power of money and greed...

Hi,

My name is Lowell Kleinman and this is my first time here. I wish it were under different circumstances.

As you know, there are often 2 sides to a story. Our perspective is that Al was asked on multiple occasions and by multiple people to tone down his posts. While we all appreciate his views the path to expressing them had become to paved with disparaging comments and mocking commentary. Recently he posted commentary and pictures of me and nazi outfits...the last straw for me.

So, he was publicly asked to cease and he decided to disregard the rules of our forum. The moderators as a group decided to ban him for 24 hours so as to make a point. There seemed to be no other option short of banning him permanently.

For the record, I have no relationship with NextGen or eCW or any other vendor other than that I use eCW as my EMR and I communicate in emrupdate regularly. I think it is inappropriate for Al to make statements about me in a public forum and I wish he would stop and perhaps take time to see his role in how things ended up this way.

Also for the record, I am still undecided about CCHIT. I am not a fan of governmental involvement with EMRs. I also worry about docs being tricked into buying EMRs that do not do as advertised. I am on the fence regarding CCHIT but were I forced to vote today I would probably opt for a free market approach given the track record of governmental involvement with health care.

Sincerely,

Lowell Kleinman, MD

Lowell, Al, and Nick,

Welcome to ACville.

ACville is a peaceful community where we consider ourselves a sangha. A community of hardworking honest physicians who seek shelter from the glitzy, high-powered, fast-paced, impersonal, corporate environment that permeates our daily lives.

It appears that there was a time where the three of you coexisted on another userboard, perhaps far far away, before finding yourselves in our neighborhood. Each of you appear to have passion, which is wonderful, until there was a misunderstanding and this passion led to flames of anger and hatred.

I hope that you will use our userboard and community to find some reconciliation so that you can return to emrupdate with to continue your discussions. I think I am speaking for the community in that we want to see you three make some peace with each other as it is quite painful to watch this discussion unfold.

Peace be with you all.

Thanks! I am a solo fp as well. Frankly, I don't even have the time for this sort of thing as I have enough on my plate keeping my office running.

Do you guys have an area where you discuss solo doc issues?

Lowell
We took a survey of the people on the userboard. We find that 80% of the members responding were solo-physicians/practitioner. On this board, if you find a two person group, that would be considered a LARGE practice. I think you'll find most of the issues brought up here are related to solo-practice.
There are so few solo-physicians in our community that during a recent fundraiser, I asked my state senator to consider passing legislation in which Solo-Family Practice can be placed on the Endangered Species Act so that we will receive protection from predators and environmental encroachment.

In my neighborhood we have a retail clinic opening up (sponsored by a fp!) and we have a large group buying practices. I have been ok because we are very focussed on service. Open access scheduling since opening, I take my own call, we do house calls and I do my own admits. It's a crazy lifestyle that I will never trade away for more income.

I actually came close last year. 6 weeks vacation (what's that like?), same salary...all very tempting but I felt like I would lose my reason for practicing.

I was wondering where everybody went! Nice to see you all, and please feel free to stop by EMR Update and post about AC. I have never done an interview with an AC user or CEO, and I am "jonesing" for one!!!

If you would like to read my EMR interviews, please see http://www.emrupdate.com/blogs/emrinterviews/default.aspx

(Yes, it's true. I'll do anything to get a new reader.)

I set up that survey as I recall. This is the extent of my moderator powers I wish I had the power to ban... J/K

To emrupdate.com:

Have you seen our cool Wikis?

Moderators: Nick has requested that all of the emrupdate threads be deleted for privacy matters. Bert- I've emailed you; can you guys close the threads? Thanks and I'm sorry for the problem.

Sincerely,
Al

They're at it again! It's great to now be looking at it from the sidelines- although my name is still being dragged through the mud...

Nick kind of hid the banter here: http://www.emrupdate.com/forums/6.aspx

David Winn of e-MDs quit and brought down his advertisement.

Al,

Here's the funny part.

I don't think any one of us here has the ability to destroy threads. They don't degrade. They're not eco-friendly.

I know Bert gets a stash of pixie dust. I'm not sure if Pixie dust can erase threads.

Actually, emrupdate is the only place where they delete messages, and that has only been a phenomenon recently. It's nice, though, not to be part of the "excitement".


(The ACers enjoying the emrupdate weekend festivities!)

The best part of the last rumble is that I met you guys!

I sure hope for the best for emrupdate...

.

Yes, as Roy says, I do have Pixie dust. But, I save it for something more important than Nick, lol.

I think the only two who could delete posts would be Vinny and Jon. But, I doubt they would delete them. Besides, once he posted over here, that's it basically. I didn't see anything that private anyway.

Good to have you around Al.

Interesting. I wonder how your forum would react if a poster (regular or drive-by) posts something that may be libel, fake, untrue or unfair? There has never been/never will be censorship at emrupdate.com, but there will be the rare times* when a post just has to be moderated. In truth this becomes a no-win situation. (Not many, I think 4 posts deleted Dec/Jan)

To moderate (say, at the request of a vendor) is someone else's censorship. This is a true Catch 22. It may be legitimate to allow a controversial post to remain, but may be equally risky (legally) to take no action. Of course both sides are "in the right", but neither are walking that tightrope of moderation or holding the can when an attorney calls!

To attempt the impossible, to please all the protagonists, we're now moving non-EMR discussions to a "Water Cooler" forum.

Tricky job this. Any experts out there?

With kind regards,
Nick Harrington @ emrupdate.com

I like the "Water Cooler" area idea...

Nick- why don't you and Robert hold moderator ELECTIONS! Let the public decide who's in (reasonable chaps) and who's out (you know who I'd vote for). It would be a first on the 'net! It would surely be an interesting feat. Then they can't blame you when the moderators act up. You'll sleep better, yet you still will be in ultimate control. The generalisimo, the commandante.


(The 2 emrupdate leaders plan elections of future moderators.)*

The legal risk seems a bit more blown up than what it really is. If a vendor threatens too much, then by all means cut THEM off. Ban them! Don't do that to posters, though. They are emrupdate's best resource.

Cheers, Al

* These are NOT the actual Nick or Robert chaps (N&R are much younger and better looking). Since I'm Cuban born, I like to use Cuban themes occasionally in my parodies. aab

We actually had a pretty neat talk, and I'll begin posting real soon. Robert likes the idea of the vote for moderators- might be a big breakthru in blogosphere concepts!

I haven't heard from Dr. Winn yet after the blowup. His last notes mentioned something about going to a beach...