Free EMR by Medicare?

I’ve been working with John Deutsch of EMR Experts, Inc. and I invited him to be a guest blogger on my blog. Here’s an article John sent me about the Free Vista EMR offered by the government. While I think the news about Vista being free came out about 2.5 years ago, the information about adopting it is still VERY relevant. Probably because the EMR adoption level is so low.

Enjoy John’s take on the government’s “Free EMR.”

Is anything ever free these days? Maybe so.

Instigated by the incredibly slow adoption of Electronic Medical Records (EMR) by doctors across the nation, Medicare is announcing it will begin offering doctors free electronic medical record software solutions.

Both upfront and ongoing costs have been critical factors in the lagging EMR adoption rate. Medicare hopes that by providing doctors with a free or very low-cost system, doctors will readily adopt EMR putting healthcare providers in America on a common system, thereby, providing Medicare and the general public with obvious, health, reporting and billing benefits.

The proposed system is VistA, (Veterans Health Information Systems and Technology Architecture) the widely popular system built by the Veterans Administration.

The adoption of VistA has resulted in the VA achieving a pharmacy prescription accuracy rate of 99.997%. Due to the implementation of VistA, the VA also outperforms most public sector hospitals on a variety of criteria.
The VistA system is public domain software, available through the Freedom of Information Act directly from the VA website or through a network of distributors.

Installed in over 1300 inpatient and outpatient facilities, the system is well-established and quite successful by EMR standards.

But can a system designed for a large organization like the VA also work for a solo practitioner family practice office?

A doctor in a New York Time article writes:

“It is one thing to use a system that someone else installed and someone else maintains. It is another to get a set of disks in the mail and do it yourself.”

Those who have tried to install VistA on their own would agree.

“Giving out a version of VistA is a great idea,” said Dr. David Kibbe, director of the Center for Health Information Technology at the American Academy of Family Physicians, a group that has been working on the project. “But at the beginning, there was a lot of wishful thinking. They said, ‘We’ll just release it.’ I said, ‘Where’s the fairy dust?’ ”

The problems with the healthcare sector and its slow adoption of electronic medical records are much deeper than some would like to admit, and viable solutions have been hard to come by.

The healthcare system is extremely fragmented, with thousands upon thousands of practices all practicing differently, using different billing systems, with different levels of computer proficiency, and different workflows.

Building a one-size-fits-all system has failed in the past and will likely continue to fail. The fact that over 300 different vendors currently develop and market EMR software attests to the need for customization.

The need for pre- and post-sale customization is a reality in every practice since every practice operates differently. Even practicing physicians within the exact same specialty do things differently and run their practices differently.

A key challenge for systems with large installation bases is often that the system becomes rigid simply due to the vendor trying to please too many different practices. Customization gets repeatedly delayed or shelved altogether.

Another concern is that when medical records are stored on servers that Medicare can access and control as they please practices may be hesitant to use the system regardless of the benefits to the practices and their patients.

While Medicare’s plan is to offer the software for free, one must ask what free is. Currently, free is software but not training, installation, and ongoing support.

Even if Medicare did make it 100% free, a free EMR is not free if it fails. The costs involved with a failed implementation can far outweigh the costs of purchasing an EMR at market price due to productivity losses, and hardware and implementation costs.

Maybe Medicare could focus more of their resources in the development and promotion of better standards for integrating already proven EMR systems and integrating EMR systems with electronic personal health records, managed by the patient

Why not offer patients a free electronic health record which can easily interface to all the major EMR vendors in the market? Wouldn’t a record they control, that can communicate with all their health providers, and be accessed by any other provider in the event of an emergency be more beneficial?

After all, isn’t the patient’s best interest the goal of healthcare in the 21st century?

For more information about EMR Experts, Inc. and their Medical Software solutions, please visit

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Interesting development.

    The issue with support and adoption rates are key, and intertwined.

    If you want an EMR to do several, fairly high-level tasks, it is going to be a relatively complex beast, and you will HAVE to have IT/customer support. That’s as much a given as water being wet.

    At a minimum, an EMR will need a database to organize patient data, and enable data actions like checking to see how certain populations are doing by certain criteria, for just one example of tons (the exception being a word processor, which is not what I’d consider an EMR). Most docs want it to also do prescriptions, which means a fax or electronic prescribing capacity, another drug database (constantly updated), ideally with formulary checking, and interactions alerts.

    EMR’s should, in my opinion, enable phone messaging and intra-office tasking, notifications of when patients are due or overdue for key health maintenance tasks, forward looking reminders on past tasks not yet confirmed to be done, remote log-on/work from home capability, airtight data backup, and incorporation of paper info (old chart and new notes from outside).

    ANY of these tasks will require tech support. ANY combination of these, to function smoothly…it’s mind boggling to think it even possible to work smoothly without tech support and maintenance — which the physicians cannot possibly do on their own, unless they become full time IT folks, at which point they’re not practicing medicine anymore.

    The answer to adopting an EMR isn’t to make it cheaper.

    The key is educating physicians and their offices: this can absolutely be done, but it WILL be the toughest transition a practicing doctor will ever make. It is NOT about a training session or two to get acquainted with a fancier word processing program, tied to a snazzier billing software for the front desk.

    In tech terms, EMR is not a “kludge”; it is a fundamentally different way of doing what a doctor used to do, that will enable doing 10 times more eye-popping and productivity enhancing and patient safety increasing activities than ever before.

    A vague sense of it being an new wrinkle on an old way of documenting…will result in the emotional equivalent of walking into a harvesting machine. An hour or two with the manual — like what you might do with a new word processing program — is nowhere near enough. 10-12 sessions, about an hour each, of progressively more challenging practice cases, is more like it.

    Until doctors and their offices realize this isn’t a step up from a Ford Focus to a Mercedes, it’s a leap up from driving a car to flying a jet, successful adoption rates will remain low. And price of the product will have very little to do with it.

  • Ironically enough, Bostwick is also talking about paying for up to 80% of EMR costs for companies that are looking at going that route.

    The interesting thing is how it will be legal for them to do so under the anti-kickback laws and stark laws.

  • There are new medicare plans for 2008. I would strongly recommend reviewing your current plan each year as there are sometimes dramatic differences. If you think outside the box you will find some great health plans. The big companies such as Blue Cross will charge whatever they want because they assume people will just go with the name and they spend a ton of money on advertising which reflects in the premiums and benefits. If you look at some other companies you may be pleasantly surprised with the benefits you will find.

  • “The healthcare system is extremely fragmented, with thousands upon thousands of practices all practicing differently, using different billing systems, with different levels of computer proficiency, and different workflows.”

    I believe this problem will persist as long as office managers use interpret coding in inconsistent ways. While nice to have a common records system, the real problem is interpreting the billing method consistently.

  • Anyone using Vista at the VA can tell you how incomplete Vista is. Most depts at the VA that use it, have shadow systems of some sort. One dept has an MS Access database they use. You enter in all your comments into Access, then run a report and copy and paste that into Vista. Seems ridiculous doesn’t it. Unfortunatly that is the norm. Now if you want data out of Vista – good luck. The VA is spending millions on shadow cache systems, custom FileMan extracts, Oracle and SQL Servers – you name it, to try and get data back out of Vista. And most of those processes are years behind. Word to the wise, get an EMR with a real database behind it – not MUMPS/Cache.

  • DBAguy,
    Thanks for the perspective on Vista at the VA. I’ve heard so many people rave about how wonderful the VA system is and that they have a unified system. Nice to hear that it’s not all perfect.

    My usual response to someone who talks about the VA system is that it’s much easier for them since they have a very well defined patient base with specific insurance requirements and a unique identifier they can use across all the VAs.

  • Being in the software industry for years, I know how much development dollars go into a “give away” application. Very little. I have found with free software, you can save now, but end up paying later.

    To me, it makes better sense to find the best solution for your practice, then negotiate a price everyone can live with.

  • Mike,
    This isn’t actually true with Vista. They’ve actually spent a ton of dollars on development of it. The problem is that the dollars weren’t spent wisely and with good methodologies behind it. It wasn’t designed with open source in mind from the beginning and so it uses the lovely mumps database among other challenges.

    Your point about free software saving you now, but will end up costing later is dead on. Free doesn’t mean you won’t have to pay for other things like customizations.

    I don’t personally see Vista as the best “free emr” out there and I have yet to see any of the other “free emr” being amazingly good yet. I’m hopeful that in the next couple years they reach that point and become a great alternative.

  • I totally agree with Mike its always to get the best service not compromising on the quality.

  • After the HiTech act of 2009, 400 EMR’s started up to compete in the new incentivized market, most if not all focusing on billing and e-prescriptions. We found a niche that most did not even think about, Referral Management, over 200,000 people die just in the United States due to improper communication. We at ERM, plan to change that with electronic referral management for physicians. Let us know what you think of our progress.

  • ERM,
    Interesting approach. How many users do you have now? I’ll be interested to see how well this will do as a stand alone product and not part of an EMR itself. Some EMR vendors do offer these types of features.

  • Hello John,

    We are currently in beta, and will be launching in a few months. From my understanding most ERM’s are strictly internal only and do not talk with each other across practices. We plan to partner with those ERM’s so that our platform can be used with any ERM, and so doctor’s can stick with what they know best, but still send referrals more efficiently.

  • Nice discussion and would include my interruptions as being <a href'="; MD consultant in the USA, what we have observed is, the EMR systems are less popular and we all need to make them as much as flexible that everyone in the niche could get that as a necessity on it. Currently, we could adopt the available survey polls and could find the gist of it!!!

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