Saturday, September 26, 2009

More 'free' Things..

Health IT continues to be in the limelight of health reform. And there is a great deal of scrambling to obtain a share of the stimulus IT funding passed by congress this year.

Two cardiologists from Johns Hopkins University , David Meyerson and Sammy Zakira elaborate in the Washington Post a typical frustrating encounter for the majority of physicians who are confronted by a seriously ill patient and an unobtainable coherent medical history. Both of these physicians attend patients at the VA Hospitals in Baltimore, MD.

They write, "Most currently available electronic medical record software is unwieldy and difficult to quickly access, and there is still no vehicle for the timely exchange of critical medical data between providers and facilities." The cardiologists note that the federal stimulus package included about $50 billion for health IT, but they argue that "it will be difficult and costly to construct new systems ensuring interoperability of all current hospital software."

This does not address the issues of outpatient clinical care, which have a far greater number of clinical encounters.

The VA system has been using VISTA as their EMR. They advocate for the adoption of the VA VISTA system as the backbone for EMR in the United States. They also suggest that any other EMRs be interoperable with the VA system. Both of these suggestions enjoy considerable merit for several reasons.

1. It is a proven stable platform

2. It has been used by many or most physicians during training.

3. It is ‘free’. This is not entirely accurate. The program itself is free of charge, but does require some expertise in tweaking it for the underlying operating system. The operating system is somewhat arcane and no longer in popular demand.

4. There is a pool of IT specialists familiar with the system that can be ‘tapped’ for implementing the system and training it’s users.

5. The suggestion that other systems be interoperable with VISTA is a good one. The standard is there….and it works! This eliminates the controversy about which standard will be adopted. There are several competing certification organizations in play at this time. This will cause delays and perhaps avoid further confusion should several different regional standards emerge.

6. VISTA is scalable.

7. The taxpayers have already invested considerable ‘billions of dollars’ in this system.

The negatives are:

1. VISTA is not well designed for independent practitioners, or small group practices.

2. It bears the perhaps unwarranted ‘stigma’ of being a government computer system, with real and/or imagined prejudices against such a system. Such as the Post Office.

3. It is an ‘older system’ designed more than 15 years ago, with multiple ‘patches’.

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