Electronic records are one of those everybody-agrees ideas that sane people are begging doctors to implement and medical offices are dragging their feet on. Medicare, though, is trying to change that.
With electronic files, patient records are not stuck on pieces of paper in endless files, but are on a screen at the touch of a key. The computers alert doctors to do medical tests and avert errors by warning when they write a prescription for the wrong drug or the wrong dose. Patients can often see their own files and even make their own appointments, online, from their homes.
But most doctors have balked. The systems cost tens of thousands of dollars, and doctors worry that the companies selling them and providing support will go out of business. Many use computers to file health insurance claims, but only 20 percent to 25 percent of the nation's 650,000 licensed doctors outside the military and the Department of Veterans Affairs are using electronic patient records.
Now, however, Medicare, which says the lack of electronic records is one of the biggest impediments to improving health care, has decided to step in. In an unprecedented move, it said it planned to announce that it would give doctors - free of charge - software to computerize their medical practices. An office with five doctors could save more than $100,000 by choosing the Medicare software rather than buying software from a private company, officials say.
The program begins next month, and the software is a version of a well-proven electronic health record system, called Vista, that has been used for two decades by hospitals, doctors and clinics with the Department of Veterans Affairs. Medicare will also provide a list of companies that have been trained to install and maintain the system.
Given Medicare's heft, the software giveaway could transform American medicine, said Dr. John Wasson, a Dartmouth Medical School health care researcher.
So what does Vista do?
The Vista project began a few years ago when Medicare officials realized that help for small medical practices was in its own backyard. The federal government had already paid hundreds of millions of dollars to develop Vista, and now uses it in the Veterans Administration's 1,300 inpatient and outpatient facilities, which maintain more than 10 million records and treat more than five million veterans a year. Why not give Vista to doctors?
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Over the years, the program had accrued a passionate following and even an organization, World Vista, founded in 2002 mostly by V.A. employees to help spread it throughout the world. One reason for their enthusiasm was that no company owns Vista so anyone can modify and enhance it.
It is, said Joseph Dal Molin, director of World Vista, a survival of the fittest. "What's good survives," he said.
One feature, for example, was suggested by a V.A. nurse. Why not put a bar code on a prescription bottle to identify the drug and its dose, put a bar code on the patient's wristband to identify the patient's prescription, and then scan the drug label and the patient's wristband before administering a drug? If there was a discrepancy, Vista could catch it before an error was made. Programmers added that feature, and V.A. drug errors plummeted by 80 percent overnight.
So it's a partially-open source software system that's worked to create the absurdly efficient VA system we enjoy and is now coming, for no-cost, to doctor's offices everywhere. Now be honest, who ever thought that one of the most impressive and effective disseminations of open source software on record would be done by the federal government? Anyone?
Update: Matt Holt's less optimistic, but actually knows what he's talking about, so you should probably read his analysis of this.
