No such thing as a free lunch

SAN DIEGO—The gathering of chief medical information officers and other technologically inclined clinicians here for the just-concluded Association of Medical Directors of Information Systems meeting was abuzz this morning over yesterday’s New York Times story headlined, “U.S. Will Offer Doctors Free Electronic Records System.”

The story talked about the soon-to-be-released VistA Office EHR, a “lite” version of sorts of the Veterans Health Information Systems and Technology Architecture long in use by the Department of Veterans Affairs.

According to the Times, “Medicare, which says the lack of electronic records is one of the biggest impediments to improving health care, has decided to step in. In an unprecedented move, it said it planned to announce that it would give doctors — free of charge — software to computerize their medical practices. An office with five doctors could save more than $100,000 by choosing the Medicare software rather than buying software from a private company, officials say.”

News outlets all over the country took this to mean that doctors could get free EHRs. One blog I saw, a self-described former IT consultant going by the screen name of “drsaddam,” called this news “VERY EXCITING!” (emphasis in original). “I should call the doc next week and see if he’s interested in taking advantage of this government offer. I’d like to help him set it up,” this blogger wrote last night.

The AMDIS folks, of course, know better. Yes, as something developed by the federal government, VistA Office EHR will be in the public domain — as the full-blown VistA has been for 20 years — and thus free of vendor licensing fees. However, the enterprise-class VistA is notorious for being difficult to implement in the private sector. If large health systems with their own IT departments haven’t taken advantage of free software, what makes anyone think that every physician in a small practice will simply be able to download a copy and instantly leave the paper world behind?

(Actually, I’m not sure if anyone will be able to download the software, nor is the program completely free. Some HHS folks told me that practices will have to pay a shipping fee.)

Perhaps “drsaddam” has the skills to get his physician up and running on VistA. Even so, it remains to be seen if the physician will find the system user-friendly. And what of the tens or even hundreds of thousands of other physicians out there without a “drsaddam” volunteering to set them up? Consultants don’t come cheap.

One thing that also is certain is that even if “drsaddam” calls his doc next week, he won’t be able to get VistA Office EHR right away, since the software won’t be available until at least Aug. 1.

Remember, there is no such thing as a free lunch, unless, of course, you work in journalism. A lot of reporters seem to have been sloppy eaters this week. Note the egg all over their faces.