Medicare, the largest US Federal payer of medical care, has announced that it is to help speed up the adoption of electronic health records by giving away proven electronic patient record software.

In what could prove to be a watershed move Medicare – the largest source of funding for medical and health-related services for people without health insurance – has announced that it will give away a version of the Vista open-source EPR to family practitioners across the US. Although many US doctors use computers for billing and administrative purposes it is estimated that relatively few yet have computerised patient records.

The US Government has committed to developing a national health infrastructure and ensuring that every citizen has an electronic health record by 2014.

According to a report in the New York Times from next month Medicare will start to make a version of the Vista EPR software freely available to family physicians, enabling them to cost-effectively computerise their medical practices.

The NYT article says that only 20-25% per cent of the 650,000 licensed doctors in the US outside the military and Department of Veterans Affairs are yet using EPR systems.

Medicare has worked for three years on the development of a new simplified and easy to install version of Vista called VistaOffice, especially designed for small medical practices. Although the software itself is free doctors will still have to cover the costs of installation, implementation and ongoing support.

One of the major barriers to adoption is said to be the high cost of systems, which can cost tens of thousands of dollars per practice, and concerns by doctors that firms currently selling systems may go out of business and not support products long-term.

Vista is an open source system originally developed by the US veteran’s Administration, the Federal Agency that provides health and welfare services to veterans of the US armed forces and their families. The VA is one of the largest providers of healthcare services in the US.

Because Vista is not owned by any one company anyone is free to download the software and modify and enhance the source code. The NYT article quotes Joseph Dal Molin, director of World Vista, the organisation founded in 2002 to help spread use of Vista, as describing the development of new aspects of Vista as survival of the fittest.

Vista – which stands for Veterans Health Information Systems and Technology Architecture – has been in use and developed over two decades. The system is currently in use at 1,300 VA facilities in the US, ranging from small outpatient clinics to large medical centers. The system is used to maintain more than 10 million records and treat more than five million veterans a year.

In addition to the VA the software is also currently used by the Indian Health Service a number of other healthcare organisations around the world.

As part of its ongoing development of Vista the VA is in the midst of a modernisation programme, developing an enterprise-wide version of the system based on Oracle, Linux and Java technology. The goal of VA’s Vista modernisation programme is to move from an encounter-centric to a more patient-centric information system. The foundation of the new system will be the Health Data Repository (HDR), a national databank for standardised, patient-specific clinical data due to begin operation in 2005.


World Vista