What about the VA's EHR

May 20, 2005

CMS plans to offer an adaptation of this well-regarded application, but it might cost far more than advertised.

Want free electronic health record software? That's more or less what CMS is promising when it releases the VistA-Office EHR, a version of the Veterans Health Administration's EHR designed for physician offices. For a token license fee-CMS originally told Medical Economics it would be $50, then said they haven't decided yet-you can have an EHR program that's rated among the top 10 in the country in terms of what it can do. However, you'll still have to pay for a separate database program, computers, interfaces, training, implementation, and technical support.

Created about 20 years ago, VistA is currently used throughout the VA system's 157 hospitals and 862 outpatient clinics. While VistA has been publicly available since its inception, the government began actively promoting it to the private sector in 2003 by offering an "open-source" version of the software. Several vendors have adapted the VistA EHR for hospital use, but not many hospitals have bought it so far. CMS plans to release the ambulatory care EHR in August.

CMS is interested in VistA because it fits into the agency's plans for clinical quality improvement. "The VistA-Office EHR helps us not only to assist physicians adopt health information technology, but also to collect the necessary data to measure, report on, and improve the quality of care delivered to Medicare beneficiaries," says Cynthia Wark, a CMS official.

Software is being changed to accommodate practices To tailor VistA for small and medium-sized physician practices, CMS is using a computer consulting firm named Daou Systems, which has worked with large healthcare systems as well as the VA and the Department of Defense. Daou has changed the EHR's patient registration system for private-sector use and is also adding templates for ob/gyn and pediatric conditions.

The vendor is "modifying the software to make it easier for physicians to install it in the office," says Wark. "They're also providing training materials for the lab interface and other applications." She adds that while the VA has its own labs, it has written interfaces to some reference labs from which its doctors order tests.

Daou is also installing an HL7-standard interface that can form the basis for custom interfaces between VistA and practice management systems. In other words, part of the bridge will be there, but an office's PM vendor will have to build the rest of the bridge. "We're assuming they wouldn't have to do a lot of extra programming to make it work with VistA," says Wark. But she admits that practices will probably have to pay vendors for whatever interfaces they write.

CMS is currently testing the EHR in three private practices around the country. "We'll get feedback from our users about modifications to the templates that they might want to see, and we'll make those changes," says Wark. "There's also the capability in the VistA product for physicians to create their own templates and customize those." But she's not sure how much specialty-specific material can be added to the EHR, because the CMS project is funded only through January 2006.

Private vendors trained on VistA by a CMS contractor will continue to support the product, she adds. And CMS' quality improvement organizations are expected to help physicians implement VistA, as well as other EHRs.

Outside experts have doubts about VistA Mark R. Anderson, a consultant with the AC Group in Montgomery, TX, is skeptical that the VistA-Office EHR will be as inexpensive as CMS claims. The main problem, he says, is that it uses the MUMPS programming language, rather than Windows. Even though a Windows "front end" can be grafted onto the MUMPS system, making the screens look like Windows screens, a small business computer server can't run the software, he says.