Gold Rush Redux?

The Boston Globe's story this weekend on Athenahealth CEO Jonathan Bush confirms what is becoming increasingly apparent: the EMR revolution is indeed a gold rush and federal incentives will define the agenda in Healthcare IT for the foreseeable future. A survey of news items in HIStalk also lists several stories supporting this conclusion.

If you compare the current environment to the pre-bubble days of the internet, you could assume we are in 1994. Netscape has not been launched yet, but there's a wide expectation of a revolution to come. Web 2.0 proponents will claim that the first wave of the internet did not produce productivity improvements comparable to those from Web 2.0 technologies. Similarly, skeptics might believe this gold rush will not truly transform healthcare IT, but it will set the stage for an eventual revolution in technology, patient engagement, and evidence-based medicine.

Whichever way you look at it, participants in the market will adapt their strategies in order to profit from this environment. News satire site, The Onion had a memorable headline a few years ago:  "Recession Plagued Nation Demands New Bubble to Invest In." I think that call is being answered.

The Best Care Anywhere?

I'm reading the second edition of Philip Longman's classic: "Best Care Anywhere". The book is a fascinating read into the story behind the VA's transformation from a case study in Government mismanagement to a model of modern medicine with manageable costs and outstanding outcomes.

The book offers some surprises, and I need to research them more.

• One story concerns Beth Israel New York and Duke Medical giving up promising studies into better patient outcomes because the programs were not profitable. This highlights the disconnect between incentives and goals that everyone talks about. I imagine other hospitals aren't any different and these two should be lauded for at least trying outcomes-based programs.
• The other bigger story for me was the apparent success of the VistA EMR system which is Open Source. There are emerging companies like WorldVistA, vxVista, and others following a "Red Hat strategy" of wrapping maintenance, enhancements, and support around VistA. Could this be an alternate world to the commercial EMR vendors?

See also the RAND Corporation's research brief on quality of care at the VA from 2005. Apparently, the VA's success isn't new.