By Christina Orlovsky, contributor
With cost a constant concern for health care administrators, the adoption of new technology—including electronic health records (EHRs)—often takes a backseat to a facility’s immediate needs already accounted for in the budget. In fact, cost is perhaps the greatest barrier to a widespread adoption of EHRs in hospitals across the country.
A recent survey published in the New England Journal of Medicine reported that only 1.5 percent of hospitals surveyed had a comprehensive electronic health record system in place. The report concluded that there are significant obstacles that must be addressed, with the study authors recommending that "a policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic records systems in U.S. hospitals."
One potential answer to the authors’ call for a new strategy may not be new at all, but rather the adoption of a tried-and-true strategy employed for decades by the U.S. Department of Veterans Affairs (VA).
Long before most hospitals had heard of EHRs, the VA deployed a comprehensive electronic record system called VistA in the 1980s. Thanks to the Freedom of Information Act, VistA is available for use as what is called open source software, which is free to the public, including non-VA hospitals, and constantly improved by users.
Medsphere is one company that has leveraged the VA’s VistA electronic health record system to create a commercial version called OpenVista, which it calls "a feature-rich EHR designed to meet the needs of hospitals, clinics, integrated delivery networks and regional health information organizations."
Edmund Billings, chief medical officer for Carlsbad, California-based Medsphere, explains that OpenVista, and open source technology in general, is a very useful tool in a multidimensional health care environment. It can be used in all health care settings—acute, ambulatory and long-term care—as well as in large health systems with multiple facilities and multiple specialties.
"Health care is collaborative—when it’s done right, your doctors and your consultants all work in collaborative way, and the more they can share information and leverage their learning, the better," Billings said. "When you put in a proprietary EHR, the hospital may have one system and the physician offices may have another, vendor-locked system, which creates islands of data."
"What open source does is allow systems to be much more interoperable and it allows for collaboration. It’s a great match for health care," he pointed out
With its OpenVista product, Medsphere has successfully used VistA’s open source code and packaged it to meet the different needs of mainstream hospitals.
"What we’ve done is taken VistA—which has been tried and proven in VA hospitals for decades—and helped improve it and package it for commercial hospitals, which handle different types of patients and different billing issues," Billings added. "What’s really exciting is that we can charge a subscription fee that’s equivalent to the maintenance fee of the proprietor vendors, whose products can be afforded by big health care groups and academic centers, but mainstream hospitals cannot afford them. This has allowed the affordability of a proven system."
While Medsphere’s OpenVista product may offer one potential solution to the cost challenge many hospitals face, open source is not seen as the answer to all the problems associated with the implementation of EHRs.
"Open source technology is certainly a viable technology, but the barrier today is that it’s not currently certified technology by the Certification Commission for Healthcare Information Technology [CCHIT]," explained Patricia Wise, vice president of the Healthcare Information and Management Systems Society (HIMSS).
"The recent economic stimulus legislation says hospitals need to be using certified electronic health records to quality for incentives," she continued. "Having said that, CCHIT recognizes that open source software is something they need to address. They don’t want the fact that a technology is open source to be a barrier for adoption."
Both Billings and Wise acknowledge that, while new government legislation and cost incentives are a boon to the business of health care technology, the true key to widespread implementation of EHRs in health care facilities is getting people to use them.
"Cost is a tremendous barrier, but deriving a successful implementation is also a significant barrier," Wise concluded. "Implementation is hard; it’s hard to get it right and to implement it in such a fashion that encourages provider use."
Still, when asked if she feels the benefits of implementing an EHR—open source or not—will eventually outweigh all the challenges, Wise was certain: "I absolutely do," she said.
After all, as Billings concluded, "Paper doesn’t work."
© 2009. AMN Healthcare, Inc. All Rights Reserved