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Tuesday, February 26, 2013

Could VistA solve the eHealth problems in Ontario?

Recently I posted a piece answering the question, "Will boomers bankrupt the medical system?" In that post I fell prey to many of the same demons that haunt those in the main stream media. A reader called me on my position and brought me down with a few politely delivered, well reasoned comments. (That blog has become another example of my need, and the need of all writers, for a good editor. I thank anonymous for his/her comments. Anonymous took on the role of editor.)

My position was that seniors will not bankrupt the system. It will be expensive new technologies and drugs teamed with higher wages for health professionals (physicians in particular) that will drive increasing costs.

Anonymous argued, and quite accurately, "Guess who is using the majority of new expensive drugs... yes you guessed it, seniors." And, seniors are living longer thanks to their expensive medical care. Anonymous told me that health care costs in the last year of life are huge. More seniors means more costs, "simple math really," wrote anonymous.

Now, stepping sideways out of this brouhaha of my own making, I'd like to take a quick look at our eHeath debacle here in Ontario, Canada possibly an example of the thinking that is running up costs independent of the boomer driven health demands.  

Screen grab of of one take on a VistA electronic health record.
While touring the American Northwest, I met a retired software developer who told me about VistA (Veterans Health Information Systems and Technology Architecture) used by the VA in the States.

He called VistA an excellent electronic health record system, and because it was paid for by the American taxpayer, VistA is written in open source code. This means that VistA offers the tantalizing promise of being adaptable to use not only throughout the States but the throughout the world and for very little cost.

When I got home, I googled VistA and confirmed that the chap was right. Although not everyone agrees VistA is the answer to all electronic healthcare record problems, it is being discussed worldwide as one possible solution.

Today, The New York Times ran an article A Digital Shift on Health Data Swells Profits in an Industry. I commented on the article asking, "Whatever happened to the idea of using VistA?" I got a number of replies plus 22 readers giving me the thumbs-up.

Here are the first comments:

The VA program is the best, most intuitive, easiest EMR to use, however, it was supposedly built on an ancient platform and so difficult to adopt. I have used Cerner (crap), Eclipsys (more crap), and the GE one (too awful to remember) and now a college program Pyramed 5. They all have issues. I miss the VA software and want to return to work there -- that's how good it is!
  — bucketomeat - Castleton-on-Hudson, NY

This was my first thought too. I've used the version of this system (CPRS) in research I've done in the VHA, and it is really well designed and already paid for to boot. . . .
  — Alice Olson - Bronxville, NY

What ever happened to the idea of using VistA?
In the US we believe that the government should do NOTHING that, left to the private sector, might turn a profit and a huge salary for some corporation and its CEO.
   — john strass - Delray Beach, FL\

This would be an excellent solution. I'm surprised that a consortium of hospitals has not gone on board with this. . . ?
  — athens area - pennslyvania

Let's give some of the other comments a quick look:
  • The scandal is the VA apparently has a very good EMR (hopefully someone from the VA can chime in with their experience) that was available as open source free software. [This got 109 recommendations.]
  • A doctor, Jan B. Newman, wrote the VA system is time tested, physician friendly and free . . . [compared to the other systems that] are set up to maximize profits for the IT companies, cost the physicians huge amounts to install, cost the hospitals huge amounts . . . [This got 53 recommendations.]
  • The ironic thing is that the government has already paid to create the VA EMR system, allowing all VA providers 24/7 access to patient records as patients travel around the US. . . . [34 recommendations.]
  • The government has a great EMR (the VA system). All commercial ones should be forced to be able to export data in a way that is 100% compatible with that. As such, they would then be 100% compatible with each other. [33 recommendations.]

There were more comments but you get the idea. The retired software fellow I met in the American Northwest has a lot of company when it comes to seeing VistA as a relatively inexpensive and very efficient answer to the electronic healthcare boondoggle.

Are there any hospitals, other than VA facilities, using VistA? I learned from an article in Forbes the answer is "yes". It seems the CEO of Oroville Hospital in California needed to digitalize the hospital's patient records. He turned to VistA, which Forbes calls "one of the oldest and most reliable electronic health records, in use at 163 VA hospitals as well as hospitals around the world."

Canadian Press (CP) reported in January that PC Leader Tim Hudak claimed eHealth spent $2 billion “with nothing to show for it." Hudak is championing open source software as the answer to Ontario's EHR mess. The news service quotes Hudak as saying Ontario must stop "reinventing the wheel." Has Hudak heard of VistA?

I fired off an e-mail to eHealth Ontario asking, "Why has eHealth Ontario not considered VistA or (WorldVistA) EHR software with its open source code and solid history going back decades in the U.S.? Thank you."

So far I've heard nothing back.

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