core of the EHR part is free for the taking.
The VistA system, developed by the VA, apparently works well and is
not only open source but public domain. Some commercial enterprises
have been built around it. Perhaps a partnership with one of them would be a good idea.
EHR, Inc. is a
prospective QE Enterprise whose product combines VistA with the
identities and privacy protections that are inherent in QEI. It will
also need to add analytical and reporting tools to its product.
Health Link EHR system, which was cleared by the FDA
in 2004, incorporates implantable RFID microchips (VeriChips),
handheld scanners for emergency room personnel and online electronic
personal health records. So far the company has enrolled a total of
536 patients in the Health Link EHR system.
The system hit
a snag in July 2008 after VeriChip sold a
significant portion of its assets to The Stanley Works and diminished
its marketing efforts for Health Link, but in November 2008
VeriChip’s former Chairman and CEO, Scott R. Silverman, purchased a
majority ownership position and has since pushed for the re-launch of
VeriChip, EHR systems like Health Link offer a number
of advantages over previous record keeping methods, including
decreased medical errors and reduced costs for providers and
Memorial Hospital in Texas, nurse William Winslett used to spend hours
deciphering physician's scribbled notes, filling out forms and
retrieving misplaced patient charts. Worst of all was the pneumatic
tube system used to shoot orders and other documents between floors --
or, at least, that was the idea.
tube system was down or got stuck," recalls Mr. Winslett. As for
patient charts, "sometimes we couldn't find them at all."
Wilson reviews the new system at Midland Memorial.
In the push to
digitize America's hospitals, Midland Memorial faced an all-too-common
dilemma: a crying need for information technology to replace archaic
paper records, but a shortage of funds to pay for it. Midland Chief
Executive Russell Meyers found an unexpected freebie of sorts: the
software used to power the electronic medical-record system of the
Veterans Health Administration.
several billion dollars in taxpayer funds over two decades and used in
more than 1,400 VA facilities, the source code is in the public domain,
meaning software developers around the world can freely build features
into it. Add the cost of hardware and the services of a company that
has adapted the VA software for commercial use, and Midland paid less
than $7 million for a full electronic medical-record system.
At a time when
the administration will penalize hospitals for not bringing their
information technology out of the dark ages, a bright spot has emerged:
free software created by the VA that still costs money to install and
maintain, but often less than the offerings from private vendors.
Still, the number of hospitals that have modernized is frightfully low
as a host of obstacles threaten adoption of technology that could
significantly reduce human error and improve care. It may also reduce
costs once an initial investment -- albeit a daunting one -- is made.
technologies have revolutionized banking and retailing. But even after
a decade-long effort to modernize health care, fewer than 2% of the
nation's 5,000 non-VA hospitals have what could be considered a
comparable full-fledged system, according to a recent survey in the New
England Journal of Medicine. Hospitals say they haven't been able to
afford the cost of the systems, which range from $20 million to $100
million, and the current economic crisis isn't helping.
government has offered both a carrot and a stick, neither of which,
some fear, will make modernization more affordable. It has earmarked
nearly $20 billion in stimulus funds as an incentive for hospitals to
use electronic records by 2011. And it will penalize those who don't
use them, cutting a percentage of their Medicare payments starting in
2015. Once fully phased in, the penalties could amount to a loss of
$3.2 million annually in Medicare funding for the average 500-bed
hospital, according to a new report from PriceWaterHouseCoopers. But
the incentive payments for using health information technology -- about
$6 million by the fourth year for the same hospital -- are "a small
carrot compared to the amount of resources it will take to deploy this
technology over the next five years," the report says.
To help speed
adoption, Sen. John D. Rockefeller (D., W.Va) last week introduced
legislation calling for the government to create an open-source
electronic health-records solution, and offer it at little or no cost
to safety-net hospitals and small rural providers.
The benefits of
electronic medical-record systems, regardless of their makers, are
widely touted. In addition to gathering each patient's medical history
in a single database, they include bar-code systems that can reduce
medication errors. They use reminder and alert systems that check when
a new drug is prescribed to make sure there are no allergies or unsafe
interactions with another drug. They offer clinical guidelines to
remind doctors to follow recommendations like making sure heart-attack
patients are given a beta-blocker to prevent a second heart attack.
Computerized order-entry systems can also eliminate mistakes from
illegible doctor's handwriting. And they can save costs by suggesting
cheaper generics when an expensive medication is prescribed.
system, dubbed VistA for the Veteran's Health Information Systems and
Technology Architecture, includes those benefits and another that
private commercial vendors don't have: standardization that allows
hospitals to share information seamlessly. So when you break your leg
in Vail, Colo., doctors there can easily retrieve your complete medical
biography from your doctor in Minneapolis if both are using an open
Note: Your complete medical biography available online by anyone
anywhere who claims to be a physician? How long before ex-spouses and
plaintiffs' lawyers and medical ID thieves etc. etc. etc. start helping
themselves to that rich trove of information?|
1. Measurably reliable cert-based identities
2. Authorization certificates (ie professional licensing) based upon those reliable identities.
We now return you to your regular programming...
Much in the
same way Microsoft guards its proprietary software, commercial systems
made by vendors including McKesson
Corp. and Cerner
Corp. are proprietary technology that don't always allow them to easily
talk to other vendors' systems. By contrast, open source providers can
share information freely and a worldwide network of software
developers, WorldVistA, has emerged to offer new features, much like
the community that supports the free Linux computer operating system.
vendors, noting a common complaint against open-source software that is
developed by engineers here and there, say that they can provide a more
reliable soup-to-nuts system and offer many features that users of the
VA system have to tack on, notably billing and financial programs that
commercial hospitals need to run their business.
consultant Dan Garrett says that while the VA software holds promise
for some hospitals, it has not been widely commercially proven, unlike
vendor systems. The challenge for vendors, he adds, is to offer
solutions tailored to smaller hospitals or those with financial
senior vice president of government and industry relations at McKesson,
says once hospitals pay companies to deploy the VA software and the
necessary service, training and upgrades it requires, the cost won't be
much different than that of a commercial electronic medical- record
system. Big vendors can work with hospitals to provide more reliable
systems within their budget, he adds.
companies adapting VistA for commercial use, including Blue Cliff Inc.,
MELE Associates Inc., Sequence Managers Software and Medsphere Inc.,
say their systems will still be less expensive for hospitals to deploy.
Medsphere, which put together the system for Midland Hospital, says
OpenVistA enables hospitals to run system checks for security problems
and bugs. And Chief Executive Mike Doyle says the open-source software
community can quickly share information and patches to fix or correct
Chairman Kenneth Kizer, the former undersecretary for health at the VA
who oversaw the development of VistA before joining the company, says
its enhanced version of the software, called OpenVistA, "can be
installed in one-third the time and for about one-third the cost of the
big-name proprietary systems."
Memorial, doctors and nurses can retrieve patient records, lab results
and X-ray images instantly. In the past, it could take hours and even
days to gather them all. The system helped the hospital catch up on a
$16.7 million coding and billing backlog for about 4,500 patient
records in four weeks, which might have taken five or six months to do.
In the 18
months after the system went live hospital-wide in June 2006, the
hospital reduced medication errors and patient deaths. Infection rates
dropped 88% thanks to guidelines in the record system that prompted
nurses to follow infection-control procedures, such as changing a
dressing or following correct procedures when inserting a new IV.
Bed sores were
also reduced as the system prompted nurses to turn patients in their
beds at a set number of hours depending on their condition to prevent
the sores. And Midland was able to increase by 77% its staff compliance
with guidelines to care for patients on ventilators, which, if not
followed, can lead to pneumonia.
bumps along the way. Doctors were resistant to changing the way they
practiced medicine and taking the time to learn the new systems. Nurses
found that entering data in the system often took more time because
they couldn't skip over things they could come back to while filling
out paper charts. And some employees weren't used to computers. Mr.
Winslett, the nurse, says he was never much of a typist.
learning the new system, he has grown used to it. Most importantly, he
says, "I can spend much more time with the patients."
Write to Laura
Landro at email@example.com
in The Wall Street Journal, page A11
Health Administration's open-source electronic health record system
could be an effective and low-cost option for non-Veterans Affairs
hospitals that are seeking to implement such a system but have been
held back by the cost, the Wall Street Journal
A recent survey
in the New England Journal of Medicine found
that fewer than 2% of the 5,000 non-VA hospitals in the U.S. have a
full-fledged EHR system. Many facilities have said they cannot afford
such a system, which can cost between $20 million and $100 million to
implement, according to the Journal.
As a result,
although the software still costs money to install and maintain, it
frequently costs less than other options from private companies.
VistA offers a standardized program that facilitates seamless transfer
of patients' records between different hospitals and facilities, a
benefit that private commercial vendors of EHR systems do not provide.
standardized software also reduces implementation costs and potential
errors for users, according to the Journal.
-- chair of Medsphere and former undersecretary for health at VA, who
oversaw the development of VistA -- said his company can implement its
OpenVistA system "in one-third the time and for about one-third the
cost" of other private companies that offer proprietary systems.
Medsphere is one of several startups that has begun using VistA's
Garrett, a PricewaterhouseCoopers consultant, said that while VistA
could be beneficial for some hospitals, the system's advantages have
not been widely proven commercially like those offered by private
companies (Landro, Wall Street Journal,
is the key word here. It could be cheap if you happen to have staff
that know MUMPS and have lots of time to attempt to get the system up
and running. Also it could be useful assuming you do not ever need to
get the data you put in, back out. VistA has no analytic software, for
data to be analyzed, it must be extracted and transferred to a
different platform. You want to know how many male patients with high
A1C levels were seen at your hospital? Good luck!