Re: Very interesting article on EMR

On May 30, 3:48 pm, bsptss <bsptss.2re...@xxxxxxxxxx> wrote:
SAN FRANCISCO

GO into almost any medical office, hospital or clinic in the United
States and your records will still be handled the old-fashioned way -
on paper. You can use a computer to pay your taxes, to program your
TiVo or to read a message from your great-aunt, but your doctor has to
practically level a forest just to examine your medical files. The
cost, however, isn't calculated in trees but in human lives: Electronic
medical records would reduce the risk of medical errors and spare
hospitals the expense of missing records and unnecessary treatment.

Health care providers have been dreaming about electronic records for
so long that the idea has begun to seem like vaporware, a
never-to-be-realized fantasy similar to flying cars and jetpacks. But
there is already a clear software standard, an open-source system
that's low-cost, easy to use and readily available. It could be the key
to the health care system we ought to have already.

The program, WorldVistA, is based on the Veterans Affairs Department's
electronic-records system, called VistA (short for Veterans Health
Information Systems and Technology Architecture - and yes, they beat
Bill Gates to the name). VistA stands as perhaps the greatest success
story for government-developed information technology since the
Internet itself.

Using the VistA record system, the veterans department has managed to
improve nearly every benchmark of quality in health care. In a decade,
the department increased its pneumonia vaccination rate among at-risk
patients to 94 percent from only 29 percent. That translates into 6,000
saved lives and $40 million saved each year from fewer pneumonia
hospitalizations. On a host of other benchmarks - beta blocker use,
cancer screening, cholesterol screening and so on - the department
outperforms the nation's best care.

Thanks to VistA, costs per patient at the Veterans Health
Administration system are 32 percent lower, using inflation-adjusted
dollars, than they were a decade ago. Over the same period, the medical
consumer price index has increased 50 percent for the country as a
whole.

The patients are happy, too. For the past eight years, the Veterans
Health Administration has outscored private-sector health care in the
independent American Customer Satisfaction Index. And because VistA is
government-developed software, we all own it - it's in the public
domain. But while the government will mail you a copy, it won't help
install it or maintain it. The Department of Veterans Affairs is, in
fact, prohibited by law to stray from its mission to serve veterans.

So in 2002, a group of former Veterans Affairs programmers and
open-source advocates formed WorldVistA. They set about making a
version of VistA that was simple for health care providers to use, and
the fruit of their effort is now ready for market. Like VistA,
WorldVistA is robust and fast. In April, the software was approved by
the Certification Commission for Healthcare Information Technology. The
certification means that WorldVistA is ready for broad adoption.

The effort to promote WorldVistA is supported by a grant from the
Centers for Medicare and Medicaid Services, the agency that sets the
prices for Medicare and Medicaid payments. The agency wants to provide
clinics and public hospitals, especially those that serve uninsured and
underserved patients, with an inexpensive system for electronic medical
records. The agency was also just getting tired of seeing another year
go by without a significant increase in the adoption of digital
records. Right now, only a quarter of office-based doctors use them.

The problem isn't a lack of software. There are hundreds of companies
hawking electronic-records systems. But they don't come cheap. The
average cost is about $33,000 per doctor, plus another $1,500 a month
per doctor for maintenance, according to a study published in the
policy journal Health Affairs. For a small clinic with one or two
doctors, that price is usually out of reach. For major hospitals,
installing a new system can quickly become a multimillion-dollar
experiment.

WorldVistA, thanks to its public-domain origins, costs about one-tenth
of what a proprietary system does for a license fee and a support
contract. And like any good open-source project, it's constantly
improving. A community of programmers fixes glitches and adds features,
just as is done for the open-source Firefox browser and the Linux
operating system.

And WorldVistA can be scaled up or down. It can work for neighborhood
clinics, small-town hospitals, hospital systems, or, well, the
Department of Veterans Affairs. WorldVistA's big promise is that it can
become the nationwide standard for electronic medical records, the
backbone of a national network of health care. Your medical records
could be read instantly and understood (perhaps less instantly) by any
provider, anywhere.

Want to see the best knee surgeon in the country? If he's using
WorldVistA, he can check out your online records at his house or
office. If you switch jobs and move to a new insurance plan, you won't
need to build a new medical history and FedEx old records around. With
your permission, your files will be accessible to your new providers
instantly. In this way, electronic medical records generate better care
and lower costs.

WorldVistA isn't perfect. It isn't as customizable as some proprietary
systems, and its graphical interface isn't as intuitive or as polished.
Worse, its back-office functions - staffing and billing - aren't all
that strong. Major hospitals and health maintenance organizations in
search of a Cadillac are free to spend the dollars to buy one.

But for the vast majority of health care providers, WorldVistA is what
they've been waiting for: a low-cost, simple-to-use system that makes
it easier to provide quality health care. If only it could upgrade the
waiting-room magazines, too.

Thomas Goetz is the deputy editor of Wired magazine and author of the
blog Epidemix.

--
bsptss

Wow, I don't know about anyone else's accounts, but $1500 per doctor
per month is more than they pay me per month to type the reports (not
even including the cost of the time they spend dictating). lol.

.

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