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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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"Vendor, Thy Software is Commodity"

Commodity (kə-mŏd’ĭ-tē) n.
  1. A basic good used in commerce that is interchangeable with other commodities of the same type.
  2. A basic good that has minimal differentiation in quality between various producers of the good.
  3. Something useful that can be turned to commercial advantage or other benefit

In today’s New York Times, and op-ed piece titled “Physician, Upgrade Thyself” extolls the virtues of VistA for 80% of ambulatory clinics that does not currently use an electronic health record (EHR). The article was written by the Deputy Editor Thomas Goetz, of Wired Magazine, which recently recognized the work of WorldVista in developing an open source version of VistA. More important than the Rave 2007 recognition, as Goetz appropriately noted, was the recent announcement that the WorldVistA software achieved CCHIT Certification. While some have overstated that this would signal the “end of proprietary software”, it remains a significant milestone to have the VA software certified to be on par with a national set of standards for ambulatory EHR features, functionality, security, and performance. The original Hard Hats, WorldVistA, and the open source VistA community should be heartily congratulated for their perseverance and success.

The concept of CCHIT Certification is fairly interesting as one thinks about it. The official party line regarding the CCHIT is that it is an effort to put a “Good Housekeeping Seal of Approval” on EHR software to protect all these poor physicians from getting duped by sketchy software. Most people believe it was a scheme put together by larger vendors to force smaller vendors out of the competitive market (the $75-$100K inclusive certification costs are a significant barrier to smaller players). Interesting enough, certification can actually work in favor of the little guys because it can show that their software meets every criteria of the big boys.

Furthermore, certification accelerates commoditization of EHR software. Commoditization, as I have written before, forces you to differentiate on things other than the software. This is why Red Hat focuses so heavily on delivering value (outcomes/price). If every solution has to have the same features/functions by virtue of the certification process, what value do vendors add to support price variation between solutions? How do customer differentiate between offerings? Experience of the Vendor? Successful customer implementations? Ease of Use? Reputation in the market place? Novel business model?

In the case of open source in general and the WorldVistA software in particular, meeting the CCHIT Certification puts it on equal footing with Allscripts, NextGen, and eClinicalWorks in terms of standard features, functions, security, and performance metrics. However, VistA vendors must now differentiate themselves on the other metrics above in order to gain any market share. No ambulatory VistA vendor can (currently) hold a candle to these commercial organizations in terms of vendor experience, customer success, or ease of use.

However, this is precisely where the theory of open source and disruptive innovation should be able to converge. By definition VistA will not meet market needs (lack of scheduling/billing functionality is tantamount to death sentence in ambulatory market), but the collective resources of open source community and the targeted investment from a few key vendors could enable VistA to leapfrog current market offerings. All that is missing is a gravitational core of leadership and investment to accelerate the development of VistA-based solutions in the market.

Can you imagine the global impact of coordinated investment into the development of a standards-compliant, interoperable, VistA-based EHR? The possibilities are as endless as the software will be pervasive.

One comment on “"Vendor, Thy Software is Commodity"

  1. Fred says:

    “overstatement” me? never!

    I really do think that we we look back twenty years from now, the CCHIT certification of WorldVistA EHR will be viewed as a threshold for FOSS EHR legitimacy. That legitimacy is the first nail in the coffin for the proprietary software model.


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