Download VistA Free!

The Veterans Health Information Systems and Technology Architecture (VistA) software is available to the public at ftp://ftp.va.gov/vista/. VistA is one of the most advanced clinical information systems in the world. There is also a free, light-weight version of VistA under development targeted for use by small physician practices.

The 2007 VistA Community Meeting is going on this week (Jan 9th to 11th) at the National Institute of Standards and Technology (NIST) Gaithersburg, MD 20899, USA. See http://www.worldvista.org for information.

Clinical Information Systems Update

Kids today have a hard time appreciating what life was like before the computer, the internet, e-commerce, cell phones, digital cameras, iPods, and the other fruits of information technology. If you want to show them a slice of life 25, 50 or 100 years ago, all you have to do is take them to the doctor.

In recent years there have been significant advances in drugs, procedures and devices. However, in many clinical settings the information technology used is outdated or non-existant. For example, the fax machine is the last piece of clinical info tech installed at many physician practices. Computers in health care are used almost exclusively for business and administrative purposes, not clinical care.

In 2004 President Bush said: "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care," and he announced his goal for most Americans to have interoperable electronic health records (EHRs) in 10 years. In 2005, Acting under President Bush’s Vision for Health IT, the Secretary of Health and Human Services (HHS) has sought to encourage all providers to adopt interoperable, clinical, EHR systems. To date, HHS has developed and identified standards for data definition and data transmission. It has also helped develop and promote the VistA-Office EHR system.

Forces operating against the adoption of EHR systems by health care providers are:

• The cost of hardware, software and networking equipment.
• The difficulty of evaluating the many different alternatives.
• The risk that any one of the hundreds of vendors currently marketing proprietary EHR systems will not survive and their products will be orphaned.

Unless and until the Federal government mandates that providers adopt an interoperable EHR system, there is absolutely ZERO probability that a majority of physicians in practice will do so in the foreseeable future. The Feds will also have to design a mechanism to help providers pay for these systems.

The problem is that, absent government intervention, there are significant time and money costs for the physician practice associated with an EHR system which the practice is not likely to recoup. The benefits will be experienced by patients, payers and society at large, not providers.

The virtue of VistA is that it represents a viable, open, low-cost system that the government could get behind. However, the government won't mandate VistA or any other system because:

• Commercial EHR system vendors are lobbying against competition from VistA.
• Providers are lobbying against mandates that will cost them money they cannot afford.

What can you do? Ask your doctor if he/she has an EHR system in his/her practice. If not, switch to one who does. Support your local "early adopter!" (Don't be surprised if you get better care.)