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.