Medsphere OpenVistA meaningful use certified

I am happy to mention that Medsphere has received certification for their OpenVistA EHR system.

As far as I know, this is the only meaningful use certification for Open Source software, for the in-patient setting. All of the other certifications that I have mentioned so far have been ambulatory.

Congratulations to the Medsphere team. This is an important accomplishment, and a milestone for the Open Source health software community.


HIMSS day1: Medsphere

This is the first article I am writing from HIMSS09. I am here on a press pass provided by LinuxMedNews. I am focusing on FOSS here at HIMSS.

I am, by tribal law, required to make a certain amount of Star Wars analogies when blogging and I recently categorized HIMSS as “the empire” with regards to health it. Of course the FOSS movement in health IT would be the rebel alliance in my analogy.

In reality there is a component of HIMSS that is FOSS-friendly and FOSS runs as an under current at every HIMSS conference that I have attended. It can be hard to find but it is there.

Today is a slow day at HIMSS with the notable exception of Medsphere’s presence at the health it venture fair.

Mostly the talk featured things are hardly news in our community. OpenVistA is based on FOIA VA Vista. The talk was geared to the VC crowd in the room so it was mostly focused on how many clients Medsphere has now how many Medsphere has coming… Etc. Etc.

One thing that that did surprise me was the ‘short’ version of the recent study on the improvements at Midland Memorial Hospital, an early Medsphere adopter. Two less people die every day at Midland b/c of the systems in place to handle central-line infections inside OpenVistA. Wow. That means that Medsphere clients are starting to get VA-like improved outcomes. All at a fraction of the cost of the proprietary alternatives.

The one thing that I wish VC companies ‘got’ about FOSS companies is that they must appeal to both the community as well as the market.

The problem with this kind of VC meeting is that there is simply not enough time to get into any kind of technical meat.

If I were asked to invest in FOSS EHR companies and they all would take the 100 bucks that I can afford right now. I would give 70 percent to Medsphere, 20 percent to ClearHealth and 10 percent to Tolven.


  • Medsphere has the only vista client that runs on GNU/Linux.
  • Fedora project will soon support multi-head again. It is hard to underestimate the importance of this.
  • Once this works, a Medsphere solution will be not only 5 times cheaper for software, but also 5 times cheaper for hardware!!
  • It is not clear that WebVistA (ClearHealth’s hospital product) is community friendly.
  • Tolven is not (yet) a comprehensive solution like VistA

In any case it was good to see Medsphere active and to hear rumors about the ‘Medsphere bus’….

Enjoy the pic of Medsphere CEO Mike Doyle beside the HIMSS Health IT Venture Fair sign!

Medsphere Layoffs

I have been hearing rumors that Medsphere has been laying people off. A few days ago, the rumors bubbled to Histalk, which they always do eventually.

This is a big problem. The main advantage that Medsphere has over its number one competitor, ClearHealth Inc, was its capitalization.

The idea of a funded open source medical startup is that you sell most of the company to VC’s or angels and, in exchange, you get a massive chunk of change to play with. (I have toyed with the idea of doing this myself for many years, but seeing with the Shreeves went through has always made me hesitate.)

Then with cash in hand you do three important things:

  • Build a sales force; you will need to float your sales team as they ensure the long Health IT sales cycle.
  • Invest in your technical support; supporting VistA is non-trivial, it is enterprise software and requires multiple high-payed experts to keep it running.
  • Invest in your R&D; You need to have new shiny toys that give you competitive advantages.

In a software company, all of these investments are into employees.

If Medsphere is laying off anyone it means that they are running out of capital. This makes sense. They spent  enormous amounts of money attacking the Shreeves. Money that should have gone into one of the three buckets above.

I have taken to calling the “new” Medsphere Medsphere 2.0

Medsphere 2.0, lead by solid people in the CEO, COO and CMO roles, has made some pretty smart moves. These moves have lead me, and others within the community to start giving the new company some slack. But smart moves does not undo the stupidity of the past. Most of these good moves are exactly the things the Shreeves were sued for proposing.

While I am glad to see the company come to it senses, that does not undo the harm in the past. There are two important connections with the past that Medsphere 2.0 cannot undo: The same board and the same money.

The BOD of the “new” Medsphere is the same as the old Medsphere. That BOD has done some colossally stupid things. Larry Augustine is supposed to be the money guy who understands Open Source. But he utterly failed to serve either the interests of the community or the investors with Medsphere. It was his job to explain to the BOD that the Shreeves were not a threat to Medsphere. It was his job to keep the BOD from suing the Shreeves and gutting the original company. I, along with Eric Raymond, made an offer to him personally to help him in this role. He never replied to either myself or Eric. As far as I know he never reached out to anyone in the community. In his silence he failed the community at large too.

What does all of this have to do with the “new” Medsphere? Larry is still on the BOD. That means that no matter how much Mike Doyle impresses me, I cannot fully trust Medsphere. But Mike Doyle is an position to succeed with community trust where Larry has failed. The new and releasing valuable software under the AGPL are evidence that the new leadership, if not the BOD, is trustworthy.

The other thing holding Medsphere back is the money. Medsphere spent a tremendous amount of money suing the Shreeves. This is money that Medsphere cannot afford. As an Open Source company, you cannot trap your customers using a proprietary license. That means you need to trap your customers with golden handcuffs, you need to make the service so reliable that they would never be able to consider the hassle of finding another vendor. Good service translates to “Good Employees” for an EHR company.

Now you see why Layoffs are such a bad sign. If Medsphere is laying off employees that means that it is running out of capital. But good employees are the only thing that Medsphere has as a competitive advantage. Any layoffs have to hurt their ability to do one of the three core functions above.

If Medsphere is laying off employees then it means that the ghost of Steve and Scott Shreeve (as employees of course… they remain very much alive) are coming back to haunt the company.

Normally when a company like Medsphere needs more capital it can go for more further funding rounds, it can sell to a larger company (like IBM or EDS) or it can make a public offering. The current market state renders going public impossible. For a sale or a new round of funding, the new money will come with the simple question “What are we buying?”. For Medsphere, here is the current answer:

  • An infant community on that the Shreeves wanted to start years ago.
  • Lingering Mistrust from the larger VistA community
  • A technical support and R&D team (valuable employees)
  • A sales team (more valuable employees)
  • Several important clients
  • A massive lawsuit expense

Notice what is not on the list! Software! All of the really valuable software is already open source. The first two essentially mean that they have no community, although they will if they keep doing the same things they are now, and are given more time to earn back the trust of the community.

That means that the only really valuable things on the list are the clients and the ability to service those clients (translation: employees).

See why Layoffs are so concerning? If Medsphere is laying off people it means that it is reducing one of its few valuable assets in order to save capital. The only way that Medsphere could fully justify layoffs is if the company was profitable as a result. Otherwise they are just slowing the bleeding that will eventually kill the company.  Now the questions becomes what cards can Medsphere play, before the bleeding becomes fatal?

In any case, layoffs are not good news for Medsphere.

Please contact me through if you can confirm or deny the Medsphere layoffs.


Meeting Mike Doyle

Apparently, the people at Medsphere still read my posts.

Mike Doyle noticed my comment that I had not meet him in my last post, and he made an appointment to have a phone call with me.

I just got off the phone with him and… I was impressed. He seemed willing to reach out to the community and he seems to understand and value the Open Source process and community. This call, in combination with Medsphere’s recent press release (see last article) and their change to the AGPL for their projects, is convincing me that maybe, this “new” Medsphere might be on the right track.


Medsphere advocates for the community. Bravo!!

I have been impressed lately with “the new team” at Medsphere. I have interacted with COO Rick Jung and CMO Dr. Edmund Billings. (I am disappointed that Mike Doyle and I have not met, but he is respected by some whom I respect.)

I am happy to see that Medsphere has finally taken a stand against the current political madness regarding “phasing out” VistA.

This press release from reads:

This week, the Military Health Service is expected to decide on whether to dismantle its proven electronic health record (EHR) system, called VistA. Research demonstrates that VistA has improved VA productivity by six percent each year since 1999 and that, in a time of ever-rising healthcare costs, VA care has become 32 percent more affordable than it was in 1996. The organization has also achieved an unprecedented and unmatched prescription accuracy rate of more than 99.997 percent, making it a model for healthcare organizations everywhere. In fact, as private hospitals across the country strive to achieve the holy grail of automated, paperless environments (none has reached the mark yet), it is striking to note that every public VA hospital is already there thanks to VistA. Despite all of this, the Department of Defense (DoD) appears determined to systematically dismantle VistA and replace it with a proprietary solution that is expensive, difficult to implement and has limited interoperability with other systems. VistA advocates say the move makes little sense, economically or strategically–it is not in the best interest of our veterans, our working service men and women, or taxpayers who would have to foot the exorbitant bill. 

Over the past 30 years, a community of open source users has developed VistA into a successful health care technology solution that works with existing hardware and software and preserves legacy IT investments in more than 130 regional centers across the country. So why is the military fixing something that isn’t broken? Ironically, the military tried to do something similar by installing a proprietary EHR system, named the Armed Forces Health Longitudinal Technology Application (AHLTA), in 2005. The solution proved to be expensive, difficult to install and incapable of working well with other systems. Now, it seems the DoD is heading down the same path again towards a “vendor-locked” solution that will cost billions up front and after implementation. 

It is signed by CEO Mike Doyle, COO Rick Jung and CMO Dr. Edmund Billings.

I am relieved to see Medsphere taking a stand that benefits the whole VistA community. The long-term success of Medsphere is married to the success of VistA and the larger VistA community. Medsphere is in a great position to advocate in a way that VA employees cannot. Medsphere can reach and influence those who ignore me and the other revolutionaries who are already outspoken critics of the current VA/DOD boneheadedness. It is already getting some coverage, and it deserves more.

Bravo, Medsphere.


Medsphere so far

Medsphere could have been the “RedHat of Medical IT” that our community desperately needs. Instead they are the “Enron of Medical IT”. For those that are not aware, Medsphere sued their own founders, Scott Shreeve and Steve Shreeve for $50 Million Dollars. As it turns out evidence that at least some of Medsphere’s claims were false can be found in my inbox. After working for weeks with Eric Raymond to see if the community could negotiate a peaceful resolution, I was forced to out Medsphere for betraying the community. I was interviewed regarding Medsphere by Tony at Free Software Magazine.

Since that time, Kizer has announced that he is leaving Medsphere and Frank Pecaitis left for GE . For more Medsphere fun, you can read the entire “Medsphere” category on LinuxMedNews

You will be hearing more about Medsphere as time goes on. But I wanted to have a small blurb about what has happened so far.