Open-source software may unify the medical-records realm

VistA and its derivatives, in particular, could prove helpful

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The other VistA

One EHR system, however, does have a proven record, since its introduction in 1982: VistA (Veterans Health Information Systems and Technology Architecture), the U.S. Veterans Administration's public-domain EHR. VistA has become the foundation for over a dozen proprietary and open-source medical record software suites.

What's important about VistA is that it works for doctors instead of for only IT staffers. As Dr. Cara B. Litvin wrote in the New England Journal of Medicine, "Since the early 1990s, the VA has been a pioneer in adopting information technology, using an integrated electronic health record system to promote high quality care. The VA now outperforms Medicare and most private health plans on many quality measures. Prescriptions, lab tests, studies, consults, reports, and progress notes from all visits by patients to any VA hospital are stored in EHRs."

VistA has nothing to do with Microsoft's operating system of the same name. VistA's core, open-source code is called WorldVistA and can be found on the SourceForge site.

Like Canonical and Novell's Linux iterations, WorldVistA has been commercialized by independent software vendors such as Blue Cliff, Sequence Managers Software, and Medsphere Systems, whose product Medsphere OpenVista is perhaps the best known of these suites.

Products based on VistA are used in many facilities. Midland Memorial Hospital in Midland, Tex., Brooklyn, NY-based Lutheran Healthcare and West Virginia's state hospitals are all using Medsphere's OpenVistA.

An OpenVista software stack is made up of a minimum of Linux, GT.M (an open-source implementation of the MUMPS language), EsiObjects (a MUMPs objects extension) and VistA.

Medsphere's CEO, Mike Doyle, sees HITECH as being a "perfect storm" for VistA. Doyle said, "Open source is the only way that the administration can drive health care IT adoption. Health care is collaborative by its very nature, but health care IT is not. The old proprietary business model is of siloed applications that can't share data."

The down sides of open-source medical software

On the front-lines of medical practice, though, open-source software isn't perfect. Paul Abramson, a primary care doctor and hospitalist in San Francisco with a master's degree in electrical engineering from Stanford, saw both sides of the open-source medical-technology discussion when he checked out WorldVistA last year for his solo private medical practice.

At the time, he was hoping to find something comprehensive that "I could implement myself, given my background as a computer programmer and engineer. WorldVistA also appealed to my open-source roots, and seemed like it might offer a cheaper and more flexible way to implement an electronic medical record system."

Unfortunately, "There were a number of issues that caused me to look elsewhere for a cost-effective, practical solution for my medical practice. WorldVistA just didn't seem ready for prime time," Abramson wrote.

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