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Catching up, asking for your thoughts

It’s been more than a month since my critical response to all the news reports suggesting that the forthcoming release of VistA Office EHR from CMS and the VA would mean free electronic health records for all physicians.

Among the target of my written wrath was a blog from a former IT consultant calling himself — for reasons I have not ascertained — “drsaddam.” Said blogger then responded that he was thrilled that a journalist like myself would talk about his post. (Imagine that, someone not bashing the media!)

He also had a few questions for me:

So are you saying, Mr. Versel, that installing VistA is as tough as doing some kind of enterprise ERP installation that takes months and lots of expertise to do?

Interesting that the full version of VistA has been free and available for 20 years, but private practices don’t use it.

So Mr. Versel, what do you recommend a primary care doctor with a small office, who doesn’t have much money to throw around, should do instead? Any better, cheap, and easier alternatives?

Thanks for writing your blog. As a former engineer who’s now entering health care, I’m really interested in how to increase the efficiency of the way health care people and patients share and exchange data. … What are the barriers to getting that implemented, and are there any likely candidates for practical use right now?

I’ll take a partial stab at those questions.

First of all, let me state for the record that VistA Office EHR had been due out Aug. 1. In true government fashion, it’s late. Just don’t use this fact next year as an excuse not to pay your taxes until May 15. I hear the feds don’t like that sort of behavior.

As for the existing software, private practices don’t use the Veterans Health Information Systems and Technology Architecture (VistA) because it’s an enterprise-wide application that requires the IT support that only a large health system has. Only a few private practices — think Mayo or the Cleveland Clinic — are large enough. That’s why CMS was working with the VA to develop a scaled-down version of VistA more suited to medical practices.

Remember also that the Department of Veterans Affairs runs the largest health system in the country, with something like 14,000 physicians, and 7.4 million enrolled patients. (Those with serious service-related disabilities and recent wounded military discharges do not have to enroll, so the actual patient population is hard to calculate.)

It’s also a “closed” system, as close as you are going to get to single payer in the United States. Britain’s National Health Service, which has undertaken the mammoth task of automating records for England’s 52 million people, has turned to the VA for guidance.

Health systems in other countries have had success with VistA. I’ve heard of hospitals in Germany, Singapore and Egypt that have taken advantage of the open-source software.

If you want to get in touch with some people who know about VistA applications outside of the U.S. government, check out the VistA Software Alliance and World VistA, two private-sector groups of VistA users and advocates. A nitpicky note of caution: The VistA Software Alliance repeatedly refers to the “Veterans Administration.” I cannot say enough that VA has stood for “Department of Veterans Affairs” since 1989. Old habits die hard!

I wish I could recommend an EMR to a primary care practice, but I’m an objective journalist, not someone in the business of rating software or implementing technology. I’d say, keep reading the health IT press (insert shameless plug for myself here), call some consultants specializing in ambulatory EMRs and show up at the industry meetings. I’ll be at the Medical Group Management Association conference in October and at HIMSS next February, and there is a good chance those will not be the only business trips I take in the next six months.

I invite other readers of this blog to add their two cents. Just click on the “comments” link below. It’s free and painless.

August 29, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

New safety reference site

It’s been a while since I’ve updated this site. Blame it on the slow nature of August? I do owe a response to “drsaddam,” who commented on my comments on his comments (still following?) regarding VistA Office EHR. (By the way, in a teleconference last Friday regarding the formalizing of the structure of the Office of the National Coordinator for Health Information Technology, Dr. David Brailer declined to comment on the status of VistA Office EHR, which was supposed to have been ready by Aug. 1.)

With that apology out of the way, it’s time for me to get to my point: There’s a new patient safety resource for clinicians called Safer Healthcare. It’s a joint effort of the Britain’s National Patient Safety Agency and the BMJ Publishing Group, with input from the U.S.-based Institute for Healthcare Improvement.

I’m not a clinician, so I can’t offer an endorsement. Check it out and decide for yourself.

And now to digress a bit more.

I just returned from a road trip to a wedding in Toronto. I took some prescriptions with me to see if I could save some money by filling them in Canada, knowing full well that Canadian pharmacies can only fill prescriptions written by Canadian doctors. The pharmacist at a Wal-Mart in Cambridge, Ontario, who clearly has dealt with American customers before, suggested I go to a walk-in clinic to get the proper scripts.

As usual, I got a late start on the 9-hour drive home, so I passed on waiting in line at a clinic to save a few bucks. I did, however, discover that Allegra and Allegra-D are available without a prescription in Canada.

That’s it for the international pharma update. I promise I’ll stick to IT in the future.

August 23, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

It’s about time!

It’s taken nearly two years, but CMS finally is going to stop accepting Medicare claims that are not in HIPAA-standard format.

Administrator Mark McClellan, M.D., announced yesterday that, starting Oct. 1, CMS will no longer process fee-for-service electronic claims that do not conform to the HIPAA transaction standards that took effect on Oct. 16, 2003.

For 21 months now, CMS has been operating under a contingency plan to give covered entities more time to comply with the HIPAA rules, and was to end the leniency as soon as the healthcare industry reached an unspecified threshold of compliance. (For most of that time, however, CMS has treated nonstandard electronic claims the same as paper claims, meaning that providers have had to wait an extra two weeks for their money.)

Apparently, the CMS threshold was 99.5 percent, since the agency says that only 0.5 percent of claims from Medicare fee-for-service providers had not been in standard format as of June. Interestingly, physicians, with a 0.45 percent rate of noncompliant claims, were doing better than hospitals, for which 1.45 percent of electronic claims were submitted in a nonstandard format.

This most recent development does not affect Medicare managed care, nor does it account for the fact that individual payers in the private sector are allowed to have their own special addenda to HIPAA code sets, all but defeating the purpose of standardization in the first place.

The HIPAA transaction rule eventually may actually accomplish what it was intended to — namely, increase the efficiency of healthcare administration and reduce costs for all — if and when private-sector payers follow Medicare’s lead and refuse to pay nonstandard claims.

And people wonder why nearly a quarter of all U.S. healthcare spending goes to administrative expenses.

August 5, 2005 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.