According to The New York Times, most doctors have been hesitant to file patient records electronically due to the prohibitive cost and lack of confidence in customer support. Medicare, wishing to improve quality of service, has announced it will give doctors free software to create a computerized patient filing system. Installation of the electronic filing software, called Vista, will cost $10,000 to $12,000 per practice. In contrast, commercial systems generally cost $20,000 to $25,000 per doctor in a practice, which includes the cost of the software. “An office with five doctors could save more than $100,000 by choosing the Medicare software rather than buying software from a private company . . . ,” according to The New York Times. Vista has been used to file patient records for 2 decades within the Department of Veterans Affairs.
August 11, 2005
Hey, everyone:
Just remember that there is no such thing as the "free world" and free software. The launch of this software has been delayed. One can only participate as a "beta". Here is the info:
CMS delays Vista VOE until end of 2006
By Joseph Conn / September 19, 2005
The CMS again will delay the release of its Vista Office Electronic Health Record software system, this time until the end of 2006, and maybe to death, according to several observers of the project.
The announcement was made Friday during a weekly conference call hosted by WorldVistA, a not-for-profit organization that promotes the private-sector use of the clinical IT system deployed throughout the Veterans Affairs Department's Veterans Health Administration.
The Veterans Health Information Systems and Technology Architecture, or Vista, is used at about 1,300 care sites within the VA.
The CMS contracted last year to adapt Vista for use within physician offices where fewer than 13% of small group practices use electronic medical records, according to a recent study by the Medical Group Management Association. The high costs of EMR systems are oft cited as the primary barrier to adoption. VOE, like Vista itself, was to be offered free of charge under the Freedom of Information Act. Originally, the CMS was to have released VOE in July, but the release was delayed until August and then delayed again.
Daou Systems of Exton, Pa., was paid $2.5 million for software development work on VOE as a subcontractor with the Iowa Foundation for Medical Care, a Medicare quality-improvement organization that is the primary contractor with the CMS for the $4 million VOE project.
In an interview earlier this month, Kelly Cronin, a senior adviser on healthcare information technology for CMS Administrator Mark McClellan, M.D., said the delay was attributed to new leadership at HHS in Secretary Mike Leavitt and a "new, broader agenda to drive interoperable IT" that includes "a lot of focus on working with the private sector in achieving interoperability." Included in that effort are formal requests for proposals issued in June to develop an EMR certification process, a national healthcare IT network and a framework for selecting standards on IT interoperability. The CMS has yet to issue contracts for the three projects.
During last week's conference call, Capt. Cynthia Wark, deputy director of the information and systems group in the Office of Clinical Standards and Quality at the CMS and an overseer of the Vista-Office EHR project, said, in effect, the software wasn't ready.
"We have to get to the point where it has enough that everyone making the decisions are comfortable that it has to be a production 1.0 and we're not there yet," Wark said, referring to the software industry practice of calling first public product releases as version 1.0.
Instead of a full public release as planned, however, the software will be shipped to about five to 10 trial sites for what was described as "beta," or second-stage testing under CMS control. The beta testers will work with a handful of IT vendors that have been tested and deemed qualified to work on VOE by WorldVistA, which also is a CMS subcontractor with the Iowa QIO.
Four IT vendors thus far have passed muster with WorldVistA, but others have expressed an interest, according to Maury Pepper, the organization's board chairman.
Pepper said VOE has flaws, but even so, "there are a lot of people who would be ready to do something with it, and it will be frustrating for them who thought they would be able to do something in a month or so and now they'll have to wait 15 months."
One disappointed potential VOE user is veteran informaticist John Zimmer, M.D., the IT champion at the four-physician Council Bluffs (Iowa) Community Health Care Center. Zimmer said he had hoped to install VOE at the clinic and was one of several conference call listeners angered by the CMS' delay.
Zimmer said he programmed and ran a VA-based EMR in a medical clinic in Macon, Ga., for 10 years. Zimmer told Wark the challenge to getting Vista in use outside of the VA is not to launch a perfect product but to develop a community of users and programmers working on the system and continuously improving it, just as the VA did developing Vista.
"Waiting 15 months will kill the community and the community will go on without you," Zimmer told Wark.
In a telephone interview after the call, Zimmer said he needs to decide whether to try and participate in the beta testing, or go forward with installing a publicly available version of Vista from the VA, often called FOIA Vista.
"The open Vista community existed before CMS conceived of doing anything." Zimmer said. "There's absolutely no question we're going to move forward whether CMS gets off the pot or not."
Rick Marshall, president of WorldVistA, said the delay has its own blessing in that it will give the organization more time to develop what he calls a "software life cycle," that is, a system by which developers can receive and respond to requests for improving the VOE software. The VA has a well-developed system to maintain Vista, but a comparable system must be developed by VOE vendors, Marshall said.
VOE developers are "going to be finding bugs and we're going to be issued patches (software code that fixes problems). When the process feels as robust as the software, that's the time to release it properly," Marshall said"
Posted by: Bobbi Buell | October 02, 2005 at 11:25 AM