Keeping an open mind…



Benoit Essiambre is a Moncton-based software developer with a keen interest in seeing an end to the Velante monopoly.   His vision of the future of electronic medical records in New Brunswick stands in stark contrast to the exclusionary “take it or leave it” philosophy of the New Brunswick Medical Society and their wealthy business associate Accreon.   Essiambre would like to dismantle the information silos that have been cobbled together for private profit, and foresees a day when we are free from barriers to open, yet secure, exchange of health care information.

Here’s what he has to say:

As a software developer, there is one aspect I feel qualified to comment on which didn’t get much attention and may explain NBMS’s mistakes with Velante.

To software guys like me, it is obvious that when choosing software, one of the most important aspect to look at is vendor lock-in. This has been well known in the software world for a long time. Non technical organisations are starting to realize it too. For example, the UK government has a guide ( warning of lock-in when choosing software.

In the private world companies are quite averse to lock-in from other companies. That is why open source is gaining so much popularity in the tech business world. One area where it is particularly critical to not bestow control is core data infrastructure. By this I mean the systems that holds the most important data and that controls how and what other systems interface and communicate with it.

Medical records are one of the most important documents in the medical world, so it makes absolutely no sense to stash them in a single system controlled by a single private company and let them charge for access.

This doesn’t mean that proprietary software is always bad. I have created many closed source applications myself. But these systems are better as addon components or for tasks that require special and unique proprietary technology, not to hold and process your core data. The risk that your data will be held hostage and that you will have to pay inflated prices for continued proper access is too high. 

You can add clauses to contracts to try to keep access rights to your data however this ignores technological limitations. Information and data complexity is a fundamental, even mathematical, property of software systems. It is nearly impossible to make independent and closed systems data formats compatible with each others in changing and evolving applications. At the very least, if you have to migrate to a different system, you will have high costs, a difficult transition period and a situation where you will require help from the company you are leaving which will have no incentives make things easier in your departure.

There are better alternatives. Some people have suggested allowing multiple EMR systems and thus some competition which is certainly an improvement over a monopoly. However, even better, some type of systems are developed under the “open source” model. This means that companies working on the system are required to make public the source code used to build the system. It means multiple companies can work on the system, improve it and compete on offering support and services for it. Developers usually cooperate publicly on forums as you can see here ( for the Oscar EMR used by thousands of doctors accross the country.

I was recently part of the implantation of Oscar EMR in a new clinic in Moncton for five doctors. The installation was easy and took less than a day, the cost for support is about $100 month per doctor and I estimated that our 5 year cost for the clinic will be about $30 000. Had we signed up for the Intrahealth system, in the same time frame we would have paid $40 000 upfront, $120 000 in monthly fees and the government would have put up $80 000 for a total of $240 000 or 8 times the price of our current, more open and more compatible and in my opinion more future proof system.  You can clearly see the effect that competition amongst multiple companies has on price.

Sure you can find vendors charging high prices but that is usually because they already have a large user base locked-in their legacy system and they wouldn’t want to set a lower price precedent for these users.

Here are some important questions that need answers:

Has NBMS properly evaluated the risk of letting a single private company’s closed software, Intrahealth, control every New-Brunswicker’s medical record?

If the exclusivity contract was necessary to lower prices, why is the price 8 times that of a competing, leading edge system? Shouldn’t the price be lower not higher?

If it is so difficult and costly to make multiple systems connect to hospital data, why did Velante have to contractually forbid others from this connectivity to prevent it? I personally talked to developers and got very reasonable prices to do the work, a few tens of thousands of dollars, lower than the price difference between just a few installation of Intrahealth and Oscar. It’s not as if you have to provide different connection protocols for each system. You only need to provide a single type of connection based on the secure standards defined by Canada Health Infoway and make it the responsibility of the different EMRs to adhere to this standard. The standardization work on this communication channel has already been performed by other provinces.

Why has Velante been trying to push our small clinic into a $240 000 system when we were able to get a better one for $30 000?


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