search instagram arrow-down
Scott Shreeve, MD

Hey there!

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



Recent Posts

Advisory Services Change Agents Conferences Consumerism Crossover Design Direct Practice EHR Entrepreneurship Experience Full Stack Health 2.0 Healthcare Industry Innovation Insurance Interviews Irony Leadership Medical Home Open Source Primary Care Primary Health Quality Rational Choice Transparency Uncategorized Value Virtual Primary Care VistA


Ten Fold (10X): Is There Really an Order of Magnitude Difference?

Magnitude  (măg’nĭ-tūd) n.

  1. Greatness in size and extent.
  2. Greatness in significance or influence.

Two recent news items caught my attention. They follow on the heels of some of my recent writings on VistA EHR, MUMPS based systems, and the idea of virtuous cycle investments as a true stimulus in helping to lay down the health care foundation from which a National Health Information Infrastructure can truly be built.The article highlights the approach of the Have’s and the Have Not’s in dealing with transportation on the health care information technology highway:

The Mercedes

The first article is a  Go Live Announcement from West Virginia University announcing the completion of their  $90M Epic Systems Implementation (Fact Sheet).

The 2009 S600 Sedan, price $150,000

The 2009 S600 Sedan, price $150,000

The Toyota

A second article highlights the successfully implementation of life saving Bar Code Medication Administration from the West Virginia Department of Health and its seven facilities (BCMA was final segment of a comprehensive, statewide implementation of the VistA EHR for approximately $9M).

2009 Toyota Corolla, price $15,000

2009 Toyota Corolla, price $15,000

If you are trying to arrive at the same location (Stage 6), which car should you drive to get there? Well, I guess it depends on who you are. But question for the Mercedes driver, or more appropriately the people paying for you to drive the Mercedes:  is your ride really worth the 10X order of magnitude difference? Are those bells and whistle really that valuable? To the four wheels, the transportationPerhaps, but only if you can “afford” it.

But these economic times demand a little more introspection. Certainly within the health care IT world you have to ask yourself can you “really afford” it?  What could you have done with the other $81M dollars? What if you would have spent the $9M to get to the same place, and then use the balance to whack out your Toyota (Supra Size me!) and have a whole lot left over to increase access, reduce costs, and improve quality. Would it be a better decision to divert additional funds to true health delivery – additional vaccines, additional prevention screening, etc?

The Famous "Fast And Furious" Supra

The Famous "Fast And Furious" Supra

Furthermore, what if I told you your spending to improve your Supra would directly benefit others who could learn directly from you. What if every dollar you spent improving your Supra was somehow magically matched (ie, via open source collaboration) to benefit others. What if your investment somehow made it possible for more and more people to actually have a car to go to the same place as you? (OK . . . so my analogy is getting stretch a little thin, but you get my point).

I would challenge anyone at WVU (love to hear from their board, their leadership, their clinicians, etc), particularly if that organization takes public money, to justify their spend when there is a viable alternative that could be selected particular when that selection could be made better and the enhancements made available to others in the future. An “investment” in VistA is an example of the catalytic Virtuous Cycle Investment that I discussed previously.

You can make the argument to justify the extra spend, but you can’t and won’t win it, particularly when the differential fare of 10X gets you to exactly the same place.

One comment on “Ten Fold (10X): Is There Really an Order of Magnitude Difference?

Leave a Reply
Your email address will not be published. Required fields are marked *

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: