A physician in Maryland, another in New Jersey and four offices of a community health network in West Virginia will be the first test users of the newly minted Vista-Office Electronic Health Record.
"I just think it's wonderful," said Njide Udochi, M.D., a solo family practitioner who opened her own office in October in Catonsville, Md., and is scheduled to have the Vista-Office EHR system installed March 16.
Udochi already has in her office electronic access to lab results and an electronic billing system, both of which will be interfaced to Vista-Office EHR at installation, she said.
Udochi said she'd shopped for an electronic medical records system, but was discouraged by the price tags ranging "anywhere from $30,000 to $55,000 to have everything installed. That's a lot of money for someone in solo practice. Instead of borrowing, my plan was to practice for a year or two and get some income first."
But then Udochi heard about the joint effort by the Veterans Health Administration and the CMS to adapt the Veterans Health Information Systems and Technology Architecture, or Vista system, to small physician offices.
Vista provides clinical IT to 170 VA hospitals and 850 outpatient clinics nationwide. Udochi said she had used Vista during her fellowship in geriatrics at George Washington Hospital in Washington, D.C., in 1999 and liked it. She said she then yearned for an EHR in her subsequent years of practice at the paper-based Baltimore Healthcare for the Homeless program.
A colleague introduced Udochi to Nancy Anthracite, M.D., a Maryland physician working with WorldVistA, an organization developing another version of the program, who provided Udochi with a contact in the Vista-Office EHR project. Udochi, who says her office is within walking distance of CMS headquarters, applied and was accepted as a beta tester.
She said her office already was wired with one computer in one of her three exam rooms, but now she expects to use a tablet PC supplied by the project to document patient encounters. Her two clinical assistants and a part-time billing clerk are all computer savvy, she said, so, with her previous Vista experience, she expects the four hours of training on the system they'll all receive March 16 will be enough to get them going.
Recent surveys of information technology usage by the Commonwealth Fund and Modern Physician show a digital divide is opening up between large-group practices and solo and small physician offices due to the high cost of buying and maintaining EHR systems.
The VA/CMS Vista-Office EHR project aims to help close that gap and is part of a larger quality-improvement program at the CMS called the Physician Focused Quality Initiative.
Installation of the Vista-Office EHR already is under way at four of the 20 community health centers in the West Virginia Primary Care Network, based in Huntington, according to Capt. Cynthia Wark of the Public Health Service. Wark is deputy director of the information and systems group in the Office of Clinical Standards and Quality at the CMS and is an overseer of the Vista-Office EHR project. The target date for public distribution of the software is Aug. 1.
"We're right in the midst of getting these pilots up and working," Wark said. "Right now, we're at all trains running on full speed to meet our deadlines."
The installation process includes an analysis of the technical infrastructure and training needs at each site, Wark said. Daou, an IT contractor based in Chevy Chase, Md., that converted Vista into the Vista-Office EHR, is working with the beta testers on the installations, she said.
Vista, which comprises more than 100 modules from radiology archiving to physician-order entry, is available from the VA for about $47 in copying costs under the Freedom of Information Act. Vista-Office EHR also will be available at little to no costs under FOIA, according to government officials. Who will distribute the final versions of the Vista-Office EHR software is unresolved, however, Wark said.
"We are, in fact, this week trying to finalize our plans with the VA on that," she said.
In addition, the Vista-Office EHR must be reviewed by the VA to make sure it remains compatible with core elements of the VA's main Vista system. That way, any future changes to the Vista system can be readily integrated into the Vista-Office EHR.
"That work is going on right now," Wark said.
The Iowa Foundation for Medical Care, the primary contractor working for the CMS on the Vista-Office EHR project, is also seeking proposals on identifying a "buffer organization" to provide training to IT consulting firms wishing to install and maintain the Vista-Office EHR. Once trained, these firms would provide training on the system and installation help to physicians and other end users. Neither the VA nor the CMS will supply those support services themselves.
"It is our collective, federal thinking between the VA and the CMS (that) it would be helpful to provide some training to vendors who would provide the training on installation," Wark said. "To not provide this training would undermine our goal to drive IT adoption. It would enable the vendors to gain a level of expertise in the software."
David Campbell is the chief executive officer of the West Virginia Primary Care Network in a state where 62% of the population lives in rural communities. More than 200 clinicians, including an average of three to five physicians per care site, as well as dentists and nurse practitioners, work in the system, he said.
"We take care of about 150,000 (people) throughout the state in rural areas," Campbell said. "As we've looked at this from a health-improvement standpoint, it's pretty important to have an integrated approach. This (Vista-Office EHR) gives us a chance to begin to build an electronic information system and telehealth system."
Campbell said his network is adapting the Vista-Office EHR to run in the application service provider mode, which means, during the testing phase, at least, the software being used in the four rural West Virginia test sites will be running on a server at a data center in Florida.
"We start testing this next week," Campbell said. "We hope by this summer to be using it in a controlled environment and start rolling it up in late summer."
Campbell said he expects to install the system in all 20 clinics. Failure is not an option.
"It's going to work," he said. "It has proven technology. There are a lot of strong clinicians here."
Barbara Boykin is president of Oleen Healthcare Information Management of Silver Spring, Md., and chairman of the VistA Software Alliance, a not-for-profit trade association of about 20 companies and individual software developers and consultants supporting the deployment of both Vista and the Vista-Office EHR.
Boykin said the alliance is interested in becoming the project's "buffer organization" to provide vendor training, adding that she expects the alliance will add more members as the Vista-Office EHR release date draws near.
"We hope to have a nice long list we can give (to physicians) of people who are capable of installing and maintaining it," said Boykin.
She predicts a physician should be able to load the Vista-Office EHR onto a computer and fire it up without hiring an outside expert, but she advises against it.
"While it may be simple enough to install on your own, medical records systems are very complex," she says. "It's re-engineering your practice and it requires someone to look at how the work is flowing and how an EHR fits into that scheme."
Udochi is chairman of the education committee of the Maryland Academy of Family Physicians, a chapter of the American Academy of Family Physicians, which is working closely with the CMS on other aspects of the Physician Focused Quality Initiative. She said she is looking forward to being a guinea pig for Vista-Office EHR.
"Hopefully, if I learn, maybe the other members will be willing to invest in the technology, too."