The Department of Veterans Affairs, working with the CMS, will begin distributing copies of the VA's electronic medical-records system to office-based physicians at nominal cost in 2005.
The system, launched in 1996 as the Veterans Health Information Systems and Technology Architecture, or Vista, was built on client-server architecture and links computers at VA facilities across the country. It's been hailed as a model of connectivity and interoperability that could be emulated by the private sector. (See "Wired and ready," Modern Physician, August 2003, p. 12 [purchase required].)
The Veterans Health Administration healthcare system has 14,200 physicians, 36,000 registered nurses, 4,700 pharmacists and 172 hospital and handles 47 million patient visits each year, making it the largest healthcare system in the U.S.
A version of the EMR, Vista-Office Electronic Health Record, is used at more than 1,300 VA facilities throughout the country to maintain records on 5 million veterans who receive their health care from VA.
The system performs preventive healthcare reminders and handles e-prescribing, lab results, referral requests, X-rays and pathology slides.
It is currently used by the Department of Health for the District of Columbia as well as by health care systems in Finland, Germany, Egypt and Nigeria.
"VA is proud to lead the healthcare industry in the use of information technology," said Jonathan Perlin, M.D., the VA's acting undersecretary for health. "The expertise we have gained, however, belongs to the American public. With our federal partners, we're making it easier for the private-sector healthcare industry to make use of this electronic system for healthcare records."
Lewis Coulson, M.D., an internist and cardiologist, is associate chief of staff and chairman of the information management committee at the 209-bed Jesse Brown VA Medical Center in Chicago. He helped write the software for the Vista system.
Coulson said the software would be readily adaptable to private-sector hospitals as well as medical-group offices.
What would be needed is a hospital, large group, HMO or service organizations to host the database and server at the heart of the system, which fits into the regional data-sharing scheme proposed by David Brailer, M.D., the national health information coordinator at HHS, who delivered his national IT plan Wednesday in Washington, D.C.
"A group could do that, but I don't think a solo doc or two docs would be practical," he said. "To have each individual physician site run this system would be cumbersome. It would work, but you couldn't share the data."
For example, servers at Jesse Brown on Chicago's west side handle data at the VA's Adam Benjamin outpatient clinic in Crown Point, Ind., about 60 miles away.
"We developed it to be very site-configurable," he said. "You don't have to use it as it comes out of the box. That's the good thing."
In fact, the system must be configured for individual facilities for level of access and other local issues, as well as for clinical usage, he said. "But you would have to do that with a commercial system anyway."
Coulson said the takeaway from Wednesday's announcement for those looking for an EMR system is "there is this great program that does work very, very well, and the price for buying this is $15 or $20, the cost of the disks."
Actually, the cost to implement a system will run a bit more. Someone from the VA will probably need to come out and assist with the setup and training, "but it would be far, far less than the costs of these multimillion dollar programs that are out there," Coulson said.
In addition, the Department of Defense will join with the Department of Veterans Affairs and HHS in developing standards for public-sector application of healthcare data interconnectivity and data storage.