Monday, March 21, 2011

Psst, want to buy a cheap electronic medical record?

Beginning in the 70's, the Veterans Administration developed an in-house electronic medical record, (EMR), now termed VISTA, which has a number of attractive features as outlined. Notably it is free, which given the financial challenges facing this country is not to be sneezed at.


VISTA includes computerized order entering, barcode administration, electronic prescribing and clinical guidelines. UPTODATE can be accessed from within the system. It also allows (at least for the Veteran population) patients to access their own medical records, similar to the KP system. Vista Imaging allows integration of PACS, pathology, EKG etc. the VISTA system has been used in conjunction with telemedicine to provide surgical care to rural Western States.


VA claims a pharmacy prescription accuracy rate of 99.997%, and the VA outperforms the vast majority of public hospitals, supposedly based on its EMR implementation. There are only three hospital systems in the US, which have achieved HIMSS stage 7, (the highest level of IT implementation), one of which is the VA. A non-VA hospital using VISTA is one of only 42 US hospitals to achieve HIMS level 6.


Approximately 50% of US hospitals with a full EMR implementation are VA hospitals using Vista. It has also been implemented worldwide, including Finland, Germany, and Denmark as well as developing nations.


As it is open source, the license is free. Obviously there are large costs relating to localization, hardware, training, and implementation. I have found one reference to implementation of VISTA over 8 hospitals in one state costing $9 million, as compared to a commercial installation over the same number of hospitals costing $90 million.

See here and here for more information.

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