[LINK] VistA open source EHR software

stephen at melbpc.org.au stephen at melbpc.org.au
Mon May 4 17:17:07 AEST 2009

A classic/textbook battle between open source and proprietry software:


 http://www.vistasoftware.org  What is VistA?

VistA is a trusted, proven, & economical electronic health record system.

VistA is an (open source) enterprise-wide, fully integrated, fully 
functional information system built around an electronic health record. 

It is easily customizable and can be configured to fit any type of 
healthcare organization, from clinics and medical practices to nursing 
homes and large hospitals. VistA has been named one of the best 
healthcare information systems in the nation by the Institute of 

Developed by the Department of Veterans Affairs, the VistA healthcare 
information system supports the hospitals and clinics serving veterans 
throughout the US. VistA has been deployed in thousands of healthcare 
facilities, both domestic and international. 

Because VistA is available in the public domain, there are no license 
fees to use the software.  

and ...

'Few hospitals go paperless using free VA software'

By Lisa Wangsness, The Boston Globe, May 4, 2009 

WASHINGTON - In a country where just 1.5 percent of US hospitals have 
fully computerized records, one of the poorest and least technologically 
advanced states has created a paperless records system for its state-run 
hospitals and nursing homes.

West Virginia did it by using an electronic medical records system built 
by the Veterans Administration with taxpayer dollars, saving millions in 
software licensing fees charged by commercial software vendors. 

The VA software, known as VistA, is open-source software - its code is 
freely available to the public and is constantly being improved by users,
and it includes important features, such as a bar-coding system to track 
drug dispensations, to help improve patient safety.

But very few US hospitals have taken advantage of it. Wealthier hospitals 
have opted to buy more expensive, custom systems from private vendors, 
while smaller and more rural hospitals often stick with paper records.

"I would think there would be a tremendous opportunity for using this as 
a platform, particularly for smaller hospitals that have a real challenge 
in coming up with the money for electronic medical records," said Dr. 
William Weeks, an associate professor at Dartmouth Institute for Health 
Policy and Clinical Practice, and a psychiatrist in Vermont.

Phillip Longman, a fellow at the New America Foundation and author 
of "Best Care Anywhere," a book about the Veterans Administration's 
quality-of-care revolution, said VistA is an unrecognized national 

"It's really insane that we have a fully developed health information 
technology system that is bought and paid for and free to anybody who 
wants it and used widely around the world by other governments running 
their healthcare systems . . . and yet we don't have any take-up in the 
US, or not much to speak of," he said.

Some policy makers are working to change that. Senator Jay Rockefeller, a 
West Virginia Democrat who chairs the Finance Committee's health 
subcommittee, is introducing legislation that would promote the 
widespread adoption of VistA and other open-source systems among 
hospitals that serve the poor. He also successfully pushed to include 
provisions in the stimulus bill to make VistA more accessible.

Massachusetts' well-known hospitals have been pioneers in health-
information technology - the doctors and technicians across the country 
who collaborated to build VistA piece by piece in the 1970s and 1980s 
used programming language first developed by Massachusetts General 
Hospital, Longman said.

VistA was designed mainly for clinical use, not for billing - the VA gets 
most of its money from the government, not from insurance reimbursements. 

But billing components can be added on, specialists say.

John Halamka, the chief information officer for Beth Israel, which has a 
custom electronic records system, is a fan of open source, and called 
VistA "one piece of the puzzle," but cautioned that it was designed for 
large institutions with a single payer, and would not work well in, say, 
small doctors' practices with a large array of payers.

"We should disseminate VistA where it's a good fit," he said, but finding 
a single system to fit the needs of every clinician "is just not 

Michael Siegel, a professor at MIT's Sloan School of Management, said he 
thought small rural hospitals in western Massachusetts "could very much 
benefit from an open-source system, but they're not."

Technology experts cite a number of reasons why: The software itself is 
free, but as Siegel noted it still costs millions to install and 
maintain, so money remains a barrier. 

There is also another problem - installing and running VistA requires 
skilled technology workers, a resource lacking in many hospitals, 
particularly smaller and more rural institutions. 

But because so few hospitals have adopted the technology, only a few 
consulting firms - like Medsphere, which brought VistA to West Virginia - 
provide that expertise.

"I think people are sitting back and waiting a little until they see 
enough momentum for it," Siegel said.

The system also looks clunkier than commercial software, and its 
capacities are less honed for medical specialties that the Veterans 
Administration has not traditionally offered or focused on, such as 

But companies like Medsphere say VistA is highly adaptable and those 
capabilities can be built.

Edmund Billings, Medsphere's chief medical officer, said it can be 
difficult to persuade hospital executives to buy into a system that does 
not have a large sales force to promote it. The private vendors, he 
added, have deployed a significant lobbying force in Washington, and the 
Bush administration's pro-private sector leanings put the focus on 
developing standards to try to get different brands of commercial 
software to communicate - not on promoting a government-sponsored 

"The business software alliance lobbies against any open-source 
provisions," he said. "And that's a hard thing to beat when they have 
more capital."

Rockefeller said he hopes to change that by fully underwriting the 
roughly $10 billion cost of installing and maintaining open-source 
electronic records systems in all of the country's safety-net hospitals, 
removing a barrier that he fears could lead to a deepening divide between 
health information haves and have-nots. 

Even with generous subsidies from the Obama administration's $19 billion 
health technology investment in the stimulus bill, many hospitals still 
can't afford an electronic records system.

"This legislation does not replace commercial software; instead, it 
complements the private industry in this field by making health 
information technology a realistic option for all providers," Rockefeller 
said in a statement.

Rockefeller's legislation would also create a federal public utility 
board to coordinate upgrades to a national open-source system and build a 
standard child-specific electronic health record for the Medicaid program.

Rick Peters, an emergency room doctor and technology consultant from San 
Diego, said ideally the federal government would fund an open-source 
project to create a more sophisticated and user-friendly VistA that could 
serve as a kind of national canvas for experimentation and innovation.

"VistA is fantastic and should be used, but the energy should be on 
updating and rearchitecting VistA over time," he said.

© Copyright 2009 Globe Newspaper Company.



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