I was going through some old draft posts (as I mentioned yesterday) and found a post that was started by Nate DiNiro which said “Will the VA and DoD help tip the scales on VistA adoption with OSEHRA?” Granted, this post was first started back in 2011. It’s amazing how much has changed since then.
We all know about the DoD’s selection of Cerner and Leidos to replace their EHR. In a more surprising move was the VA’s decision to sole-source their EHR selection of Cerner based on the idea that it was essential they go with Cerner after the DoD selected Cerner. Certainly a topic for another blog post.
We’ve certainly heard many complaints from those in the VA community that are going to have a really hard time giving up Vista which was basically tailored for many of their unique needs. However, there seems to be nothing stopping that ship now.
Given these events, it brings up an interesting question about the future of Vista as the VA replaces their version of Vista with Cerner. The good news for those healthcare organizations on Vista is that it’s now open source. So, the software can persist as long as there is a community of developers behind it. The core question is how much of Vista’s ongoing development came from the VA versus the community.
The two players I’ve seen using the open source Vista EHR platform are MedSphere and WorldVista. I’ll admit that I haven’t seen too much news from either of them lately, but they both seem to be humming along.
I took a look at the ONC’s latest Health IT Dashboard stats for hospitals. In 2017 (their latest data), it reported 11 “providers with certified technology” for Medsphere and 1 for WorldVistA. Of course, this is just those who have taken part in the meaningful use government program. It’s reasonable to assume that some open source EHR customers probably didn’t want to take part in meaningful use. Plus, these numbers don’t include international Vista installs which obviously can’t take part in meaningful use.
Given these numbers and the VA pulling Vista out, I have a feeling it’s going to be a hard road ahead for Vista.
I’ll never forget when it was first announced that the VA was open sourcing Vista and that anyone that wanted a free EHR could have it. What was amazing is that the HIM manager I was working with found an article talking about this announcement and brought it to me. She wondered why we were paying for an EHR if Vista was available for free. It gave me a chance to explain to her that “free software” doesn’t mean it’s free to implement and manage. Not to mention the fact that this was a small ambulatory clinic that was likely not a good fit for the hospital focused Vista software.
What have you heard or seen with Vista? Has more been happening with the open source versions of Vista that I just haven’t seen? As a big open source user myself (my blogs run on pretty much all open source software), I’d love to see an open source EHR succeed. Unfortunately, it just hasn’t seen near the adoption it needs to really create that momentum yet.
Open source software succeeds, in the same manner, like any other software – it fulfills the needs of the business and it has a flat learning curve for the end users. Many of these enterprise-level packages do not translate down to small practices or single practices. The maintenance cost alone is way to high in man hours for small practices, when I do a risk assessment, I see this first-hand time and time again. Vista and MUMPS were best fit for the VA and probably would have succeeded in large hospitals and large medical groups. It’s a shame it didn’t get the push.
In 2006, WorldVistA EHR VOE/ 1.0 was the only open source EHR that met Certification Commission for Healthcare Information Technology (CCHIT) ambulatory electronic health record (EHR) criteria, and in January 2008, it was released with full CCHIT EHR certification. So it actually works quite well in small ambulatory clinical settings.
It is true that being in the public domain and open source does not mean that it is free to implement and manage. But it costs a lot less to implement and manage than just about any other significant EHR.
Cameron,
I don’t think EHR certification is a good way to illustrate that it works for small ambulatory clinics. In fact, in many respects, it’s the opposite.
That said, do you think a small solo ambulatory practice could reasonably implement WorldVistA? Or are you talking about small clinics that are part of a larger health system?