Few hospitals have adopted a no-cost electronic health records system offered by VA

Few U.S. hospitals have taken advantage of a no-cost, open-source electronic health records system developed by the Veterans Health Administration, the Boston Globe reports (Wangsness, Boston Globe, 5/4).

The Veteran's Health Information Systems and Technology Architecture was developed over 20 years with several billions in taxpayer dollars. As a result, its source code is now part of the public domain, which means that software developers can use the code at no cost and introduce additional features without restrictions.

Although VistA still costs money to install and maintain, it frequently costs less than other options from private companies. A recent survey found that fewer than 2% of non-VA hospitals in the U.S. have a full-fledged EHR system, which many facilities say they cannot afford because of implementation costs that can range from $20 million to $100 million (Kaiser Daily Health Policy Report, 4/30).

There are several reasons for the low adoption rates of the VistA system. According to the Globe, many higher revenue hospitals have decided to purchase higher cost custom systems from private vendors, while many smaller or rural hospitals still are using paper records. The Globe reports that VistA was designed primarily for clinical use and not for billing because VA typically receives payments from only one source -- the federal government. However, experts have said that billing components can be added to the system. In addition, there are only a few consulting firms, including Medsphere, that can provide the "skilled technology workers" required to install and run VistA.

Furthermore, Edmund Billings, chief medical officer at Medsphere, said it is challenging to convince hospital executives to use the system because the company does not have a large sales force to promote it like private vendors have for their systems. Billings also said another challenge is that the administration of former President George W. Bush supported private sector development of standards for interoperability of commercial software over a government-sponsored alternative.

However, Phillip Longman, a fellow at the New America Foundation who has written a book on VA's quality-of-care system, said, "It's really insane that we have a fully developed health information technology system that is bought and paid for and free to anybody who wants it and used widely around the world by other governments running their health care systems ... and yet we don't have any take-up in the U.S., or not much to speak of."

Sen. Jay Rockefeller (D-W.Va.) has introduced a bill (S 890) that calls for open-source technology to be developed and made available to safety net and rural health care providers at low or no cost. Rockefeller said he hopes to fully fund the about $10 billion it would take to install and maintain open-source EHR systems in every safety net hospital in the U.S. (Boston Globe, 5/4).