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The HIT Realist Column

Congress Must Fully Fund Health Information Technology (HIT) and Make it Freely Available

 June, 2009

On 2/17/09, the HITECH law was signed by President Obama which is an investment of more than $19 billion towards HIT related initiatives. Unfortunately, physicians still can’t afford to use electronic health records (EHR). Congress needs to make available a free EHR interconnected in a nationwide network which has a usable interface.

Below I report on 2 of the biggest governmental EHR implimentations. One is having numerous problems (AHLTA), and the other, which has been around for 30 years seems to be not only the biggest, but possibly the best and most tested EHR system in the world. I’ll discuss both, to learn not only from their strengths, but from their weaknesses.

Department of Defense’s (DoD) EHR System AHLTA

The DoD rolled out its first EHR system, AHLTA, in 2005 with a $5 billion price tag to date which may eventually cost as much as $20 billion.1,2 AHLTA is currently deployed worldwide to 70 hospitals, 410 clinics and 6 dental clinics. In addition, the system is used in 14 theater hospitals and 208 forward resuscitative sites.3

Yet top military health leaders reported to the House Armed Services subcommittee hearing last March that they continue to have numerous problems, including:

·        It is difficult to use, some calling the situation “intolerable”, causing numerous health care workers to leave.

·        It’s slow interface decreases the number of patients that can be seen each day.

·        The EHR is still not fully interoperable with patient data from military treatment facilities on the battlefield, with the VAMC’s VistA EHR, and with private health care provider EHR systems.

·        It is open to cyber attacks, s.a. from the use of thumb drives.

·        AHLTA has suffered from poorly written software contracts with vendors leading to poor performance and delays and a lack of a clear cut strategy.

Veteran’s Administration Medical Center (VAMC) EHR

The successful VAMC’s EHR, VistA, available since the late 1970’s, has actually been shown to decrease costs, improve quality, decrease errors and has made the VAMC medical record system completely paperless.4  VistA is one of the most widely used EMR systems in the world.5

VistA supports both ambulatory and inpatient care, and includes a computerized order entry (CPOE), a bar code medication administration system, eprescribing and clinical guidelines. An updated version of VistA, WorldVistA, is now certified in the 2006 CCHIT criteria.6 The VistA software is open source and public domain, and has been interfaced with various commercial off-the-shelf products.

Complaints/problems with VistA/WorldVistA include:

·        The Linux platform and the “database” that Vista uses, MUMPS, which makes it more difficult to impliment and support.

·        Many of the cost savings in the VAMC include the increased use of non-physician allied personnel, as well as the use of bar coding, robotics, and other technology outside of the EHR software, which may not be reproducible in a physician private office.7

·        Physicians still complain about the difficult to use interface as well as the loss of  physician-patient interaction.8

·        It is still not interoperable with external systems.

·        It is unknown whether the VA will work to improve VISTA, redesign it with AHLTA, or scrap it for some other proprietary EHR software.

·        While VistA could be beneficial for some hospitals, the system's advantages have not been widely proven commercially like those offered by private companies.9

·        There are still issues with the safety and confidentiality of patient data.

Summary Statements

Congress continues to be very interested in promoting open source and VistA on a national level:

·        On 11/2005, the U.S. Senate passed the Wired for Health Care Quality Act which would require the government to use the VA's technology standards as a basis for national standards for interoperability as part of a nationwide HIT exchange.

·        In late 2008, Congressman Pete Stark (D-CA) introduced the HIT Act of 2008 (H.R. 6898) that calls for the creation of a low-cost public HIT system for those providers who do not want to invest in a proprietary one.10

·        On 4/2009, Sen. John D. Rockefeller introduced the HIT Public Utility Act of 2009 calling for the government to create an open-source EHR solution and offer it at little or no cost. If passed, the bill would establish grants to fully cover the cost of developing the software and its maintenance for 5 years, at which time the grant could be renewed if the project has proved useful.11,12

The idea of having Congress fully fund HIT, such as through VistA is gaining momentum and should be made the law of the land. Congress should make VistA a multi-platform system, including the popular Windows operating system and should reconfigure VistA with a common programming language s.a. Visual Basic. The cost would be small, as was the cost of rolling out the certified WorldVistA totalled only $6 million, and Sweden’s recent nationwide EHR rollout cost about $19 million.13,14

Al Borges, MD

Bibliography

  1. http://medsphere.org/blogs/inthenews/2008/09/15/ahlta-textbook-bush-administration
  2. http://www.usmedicine.com/article.cfm?articleID=1906&issueID=123
  3. http://www.usmedicine.com/article.cfm?articleID=1906&issueID=123
  4. http://www.washingtonpost.com/wp-dyn/content/article/2007/04/06/AR2007040601911.html
  5. http://en.wikipedia.org/wiki/VistA
  6. http://worldvista.org/World_VistA_EHR
  7. http://www.dailykos.com/story/2009/5/19/733050/-How-VA-can-Transform-Healthcare-  
  8. http://www.dillingerkovach.com/accusourcecareers/?p=7650
  9. http://blogs.wsj.com/health/2009/04/30/free-from-uncle-sam-va-software-for-hospital-ehs-systems/
  10. http://en.wikipedia.org/wiki/VistA
  11. http://arstechnica.com/open-source/news/2009/04/senator-opens-source-software-needed-for-medical-records.ars
  12. http://blogs.zdnet.com/open-source/?cat=54
  13. http://www.modernhealthcare.com/article/20070809/FREE/308090001
  14. http://www.emrupdate.com/forums/t/19915.aspx


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 Alberto Borges, MD
Alberto Borges, MD, is in private practice and is an assistant clinical professor of medicine at The George Washington University School of Medicine and Health Sciences in Washington, DC. Check out his website at http://msofficeemrproject.com. The opinions expressed in this blog do not necessarily reflect those of HCPLive. If you like what Dr. Borges has to say, make sure to read his print column of The HIT Realist published in MDNG.

 


 
   

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