Reinventing EHR

Computerworld - How would you reinvent part of the software industry? Back in March, I suggested that Medicare -- the 800-pound gorilla of health care - could break the logjam in electronic health records by requiring EHR for all doctors who do business with it, much like Wal-Mart is forcing its suppliers to adopt RFID [QuickLink 52932].

This month, Medicare is doing something even more dramatic: It's giving away free EHR software that's customized for private medical practices. In a single stroke, Medicare is setting de facto standards for EHR and making EHR more affordable.

And shaking up the whole EHR software business in the process.

If you've been following the nonprogress of EHR, you already know that individual doctors are the ones who haven't converted patient health records from paper to computerized systems. Hospitals have made the transition over the past decade, spurred by laws such as HIPAA.

But doctors in private practice have dragged their feet, mainly grumbling about cost. And at a typical price tag of $20,000 per doctor for commercial EHR systems, that's no surprise.

Medicare's solution? Take an existing EHR system called VistA, scale it down and make it easier to install, then rename it VistA-Office EHR and give it away to anyone who wants it.

But wait, you ask, where does Medicare get off giving away free software and undercutting EHR vendors? And where did Medicare get this software it's giving away, anyhow?

Hang on -- this gets complicated. VistA comes from the Department of Veterans Affairs, which developed it in 1996 and has been running VA health care facilities with it ever since. And VistA is actually just the client/server version of the VA's Decentralized Hospital Computer Program, which the agency has been using since 1985 in 1,300 VA facilities to maintain health records of 5 million veterans. That's what we call "mature."

And because it's software developed with taxpayer dollars, it's in the public domain. Anyone can get a copy of VistA under the Freedom of Information Act and then make as many copies as he likes. It's sort of like open-source software, but without any open-source license.

Wait, there's more. VistA was built on a database engine named MUMPS (now called just M). VistA is free, but M requires a license fee. VistA has also been rewritten as an open-source version called OpenVista, which runs on Linux and uses its own open-source version of MUMPS, so there's no license fee.

Medicare's VistA-Office is also in the public domain, requires M and runs on Windows. That's what doctors can get their hands on starting this month. They'll have to pay license fees for M and a few other modules, but that's only about one-tenth of the cost of a commercial EHR license.