Few hospitals go paperless using free VA software
Electronic record system helps W. Va.
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 serving the indigent elderly and mentally ill.
"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 Veterans Administration 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
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
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
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.
Michael Siegel, a professor at MIT's Sloan School of Management,
said he thought small rural hospitals in western
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
"I think people are sitting back and waiting a little until they see enough momentum for it," Siegel said.
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 obstetrics. But companies like Medsphere say
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
"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.
Peters, an emergency room doctor and technology consultant from
is fantastic and should be used, but the energy should be on
updating and rearchitecting