It's been an exciting summer for the men and women whose professional world turns on the Veterans Health Information Systems and Technology Architecture, or Vista, clinical computer system.
In June, the Pacific Telehealth & Technology Hui, which fathered an open-source version of Vista, turned over further development work to WorldVista, a not-for-profit organization that counts among its members many former or current VA programmers.
Last month, a private software developer, Medsphere Systems Corp., was wrapping up its work on the installation of the VA's Vista system in seven nursing homes in Oklahoma run by the state's Veterans Affairs Department while working on the first installation of its own, modified version of Vista in a private, acute-care hospital in Midland, Texas (See story, p. 9).
But the big buzz this month -- and the biggest challenge for a part of the Vista community -- comes from the CMS. In collaboration with the Veterans Affairs Department, the CMS planned to release on Aug. 1 its Vista Office Electronic Health Record, or VOE, an electronic medical-record system based on Vista and designed for office-based physicians.
On July 21, the New York Times published a feature article about the CMS software release. The article brought to a wide audience the story of the obscure labors of thousands of programmers, physicians and nurses who've put their hearts into developing Vista for nearly three decades.
Here at HITS and our sister publications, Modern Healthcare and Modern Physician, we've been writing about Vista for years and VOE for about a year. The massive Vista clinical IT system today powers 157 VA hospitals and 800 clinics. Programmers at Daou Systems did the work on configuring Vista into VOE.
Daou was paid $2.5 million for the job under a subcontract with the Iowa Foundation for Medical Care, part of a $4 million deal between the Iowa Medicare quality-improvement organization and the CMS for VOE activities. The Iowa Foundation, for its part, will set up and operate an e-warehouse to receive clinical-quality data from primary-care physicians, including VOE users, under the Doctor's Office Quality initiative, or DOQ.
An estimated 270,000 physicians work in practices with three doctors or fewer, yet the adoption rate for EMRs in this sizable market segment remains woefully low. The chief complaint, doctors say, is that EMR systems cost too much. Software license fees are a big chunk of those costs. The CMS hopes to lower the cost barrier by adapting Vista for the small physician office. To that end, Daou was to add functions for pediatrics and OB/GYN, create interfaces for practice-management systems and make VOE easy to install and DOQ-ready.
The CMS plan calls for copies of VOE to be distributed free, just as the VA dishes out Vista, under the Freedom of Information Act. VOE runs on Windows and the Cache database, which do require license fees.
The Iowa QIO also has an $896,343 contract with WorldVista to train IT vendors to support the free VOE software. The vendors will charge doctors for this service, naturally, so VOE won't really be free, just less expensive upfront, presumably, than systems from vendors that charge for software licenses.
The WorldVista folks, a cadre of true believers in Vista, have promoted the use of Vista outside the VA and around the world. They have worked thus far largely unnoticed.
Now, they are at center stage, with taxpayers' money bet on their noses. This is their big chance to show what their software can do. It's also time to put up or shut up.
The challenge they and the future VOE vendors they train will face is to run real businesses on the service model envisioned by the CMS without the additional revenue from sales of site licenses enjoyed by most of their couple hundred competitors that sell EMR systems.
The service-only model has worked in other IT spheres and even a few EMR system developers use it. Alteer Corp., co-founded in 1996 by Frank Rhie, M.D., abandoned selling site licenses this year in favor of contracting for services that include provision of its software. Rhie says EMR software will become a commodity, but service will carry the day.
Free is a magic word, but success for VOE vendors will depend on whether they can sign up customers and keep them happy while pricing their services competitively and still charging enough to stay in business.
That's no small task. We'll see.