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There's been plenty of silence about the VistA-Office EHR-a private-sector version of the VA's VistA clinical information system-since CMS beta-tested it last year in private practices. But VistA-Office and other private-sector varieties of VistA (which has nothing to do with the new Windows operating system, by the way) are very much alive. Some private practices and public clinics have installed these EHRs, or are in the process of adopting them, in Alaska, Arizona, Florida, Hawaii, Louisiana, Texas, and West Virginia. Whether commercial vendors can implement and support the free, open-source software in small practices at an affordable price is still a question.
Internist and pulmonologist Ismet B. Kursunoglu, a soloist in Wasilla, AK, near Anchorage, has been using VistA-Office since May. Kursunoglu, a self-confessed techie, worked through the challenges of implementation over the Internet with the help of Sequence Managers Software, the Raleigh, NC-based vendor that installed the system.
"It's a very difficult system to set up and configure," he admits. "It requires expertise to manage and implement. But it mirrors the complexity of medicine like nothing else out there." Overall, he says, he's very satisfied with the EHR. He doesn't even mind the cost, although he laid out $20,000 for hardware, training, and implementation and pays Sequence Managers between $300 and $400 a month for software support.
Some vendors will soon offer WorldVistA's product at a support cost of $200 to $300 a month, says Joseph Dal Molin, interim president of WorldVistA, the nonprofit organization that ran the CMS pilot and now maintains the core VistA-Office software. And FP Matthew M. King, medical director of a six-office community health center headquartered in Surprise, AZ, says that his group has hired an overseas software company to provide technical support for its new VistA-Office system for about $3,000 a month. Divided over 22 physicians and midlevel clinicians, that's $136 per provider per month. The system was scheduled to go live at one site in August.
Customizing the system
King's clinic has hired outside programmers to write an interface to the group's GE Centricity practice management software. It has also hired a trainer who was coached by VistA experts. And the group plans to do the end-user support itself. King figures VistA will cost the clinic only a third to half of what a comparable commercial EHR would cost.
Having worked closely with WorldVista on development, King is confident that he and his colleagues will be able to use VistA-Office. But some outside observers are less optimistic. Fayetteville, NC, gastroenterologist Bryan D. Uslick-although he's had no experience with VistA-Office-says that the VA's original VistA program is antiquated and cumbersome. He finds it "painful" and time-consuming to document visits and procedures in the system.
King replies that the VistA-Office program, unlike the VA technology, allows users to build their own templates. (Uslick confirms that in the VA system, physicians must submit formal requests to have technical staff customize their templates.) Also, King points out, the VA VistA doesn't permit "charting by exclusion," a method that greatly speeds up documentation in commercial EHRs. VistA-Office does have this feature.