Why Aren’t You Using the VistA EMR?

For years, health IT pundits have marveled at the VA’s open source EMR, VistA, which has long had the reputation of being one of the best platforms available anywhere. Not only has it been in existence since the late 70s, making it arguably the most mature EMR anywhere, it’s, well, free.

You’d think that being able to download it gratis might make VistA a bit popular among agonized hospital CIOs, who otherwise face spending several million on systems that might not work.

Not only has VistA run with enormous success within the sprawling VA system, which includes 152 hospitals and 804 outpatient clinics, it’s also been nurtured for commercial use since 2002 by the WorldVistA project.

But no. Despite all of this effort, hospitals have been slow to adopt the VA’s wonder child. Why? Well, consider some of the commentary on the subject and see what you think.

Former Beth Israel Deaconess Medical Center CIO John Halamka, an industry tastemaker if there ever was one, was quoted once as saying that while he’s a fan of open source, VistA wouldn’t work for many settings, as it was designed for big institutions with a single payer. As much as I respect Dr. Halamkha, I’m not sure I follow why a billing issue would prevent hospitals from leveraging VistA’s excellent clinical functionality.

Other talking heads have noted that while VistA — and other open source EMR/EHR projects — are free, it can cost millions to customize and integrate such systems. (And their point is what, that it’s really cheap to implement, say, a proprietary monster like Epic?)

OK, I get it. Open source EMRs are still freaky, weird and insufficiently controlled by big, centralized vendors. They’re, well, too unpredictable for hospital organizations with rigid rules. They’re managed by hippie programmers with long beards. They don’t come in pretty packages and their developers don’t wear Dockers.

Seriously, guys, you disappoint me. I realize that even massively successful tools like Linux were strange and mysterious in 1996, but it’s been 15 years since then. I’d bet that virtually any developer on your facility’s team could jump into open source dev projects in a heartbeat.

Wait — you know that already. So it must be the doddering 75 year old traditionalists who still run some hospitals that are keeping the brakes on, long after hyperconservative industries like pharma and financial services have taken open source to their breast.

It’s sad to think that after this long, the fact that LAMP developers hate wearing ties is more important than whether WorldVista, OpenEMR or its peers can actually save money and/or do a better job. But sadly, I think that’s where we’re at. Bummer.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • As one who has used VistA, I would say that it has a long way to go in terms of functionality to be used in hospital systems. In fact, a community college is no longer exposing their ONC Workforce classes to it due to it’s rather antiquated interface and functionality. Whether free or not, the private sector offers a much better product.

    There are 300+ EHR vendors out there. Surely there is one to match everyone’s needs and price points.

  • I too am a huge fan of VistA as I used to interface with it even back when it was DHCP. I worked for HP Medical Products and we delivered the first of kind point of care systems (CareVue 9000) and implemented at VA locations like Durham, NC.

    Here is why it isn’t widely adopted: support. While a number of SMS clients of mine seriously considered VistA as an alternative (Greenville Hospital, SC) the problem nets out to who are your going to call for support, etc.

    I see state health agencies like Departments of Mental Health adopting VistA as it’s entry is affordable and will leverage consultants and integrators as the complexity isn’t nearly as it would be for a large VA Hospital provider.

    I think underserved countries around the world can adopt VistA but that is beyond my purview (perhaps someone with a WHO background).

    Besides, Epic, Cerner, etc are going to attract the brightest talent in the HIT arena. After all, how many computer scientists and/or information technologists are going to want to develop their career around MUMPS (or some derivative).

    Finally, if the VA and DOD can’t agree on an integrated health exchange, then I believe the market will be status quo for quite some time.

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