Free Electronic Records System ?

What do you say when someone offers you a free lunch?

You start thinking ....




NYT
U.S. Will Offer Doctors Free Electronic Records System

By GINA KOLATA

Published: July 21, 2005

There is no one in medicine who does not consider it both crucial and long
overdue to have electronic records in doctor's offices and hospitals.

With electronic files, patient records are not stuck on pieces of paper in
endless files, but are on a screen at the touch of a key. The computers alert
doctors to do medical tests and avert errors by warning when they write a
prescription for the wrong drug or the wrong dose. Patients can often see their
own files and even make their own appointments, online, from their homes.



Benjamin Porter for The New York Times

Dr. Kevin Toppenberg and the other physicians in a medical practice in
Greeneville, Tenn., use the Vista electronic health records system.

But most doctors have balked. The systems cost tens of thousands of
dollars, and doctors worry that the companies selling them and providing support
will go out of business. Many use computers to file health insurance claims, but
only 20 percent to 25 percent of the nation's 650,000 licensed doctors
outside the military and the Department of Veterans Affairs are using electronic
patient records.

Now, however, Medicare, which says the lack of electronic records is one of
the biggest impediments to improving health care, has decided to step in. In
an unprecedented move, it said it planned to announce that it would give
doctors - free of charge - software to computerize their medical practices. An
office with five doctors could save more than $100,000 by choosing the Medicare
software rather than buying software from a private company, officials say.

The program begins next month, and the software is a version of a
well-proven electronic health record system, called Vista, that has been used for two
decades by hospitals, doctors and clinics with the Department of Veterans
Affairs. Medicare will also provide a list of companies that have been trained to
install and maintain the system.

Given Medicare's heft, the software giveaway could transform American
medicine, said Dr. John Wasson, a Dartmouth Medical School health care researcher.

But, Dr. Wasson added, it may take a while. "If you look at it from a
five-year point of view, it will make a huge difference," he said.

At first, he predicted, many doctors will bide their time, to see just how
good Vista is.

Dr. Alan Garber, a Stanford University economist and internist, said of the
Medicare plan: "It's a good idea. It's not foolproof."

But, Dr. Garber added, Medicare's investment and the program's many
appealing features "are all signals that it might be around for a long time and a
doctor in a small office would not be taking an enormous risk."

Medicare has not estimated what its software giveaway is worth. But Duncan
Pringle, chief Vista technologist at Perot Systems, said that each doctor in a
practice paid about $20,000 to $25,000 to get started with a commercial
system, including costs of software, a license fee charged to each doctor,
installation and servicing.

Installing Vista would cost $10,000 to $12,000 for an entire medical
practice. That means that a practice of five doctors might pay $100,000 to
computerize, but if the doctors used the Medicare system they might pay only $10,000
for the whole office.

The problem is that Vista has a reputation for being extremely difficult to
install. Medicare says it modified and simplified it for doctors' offices, but
it remains to be seen whether doctors will want it.

Doctors are well aware that even with free software, no system is really
free.

"Vista is a good system and it all sounds great," said Dr. Thomas Jevon, a
family physician in Wakefield, Mass. But, he added, "anyone who uses a computer
can get frustrated and waste time trying to make it work."

And for doctors, whose time is typically valued at $250 an hour, that time
adds up.

"If a program takes 10 minutes away from your hour each day, that is costing
you tens of thousands of dollars a year," Dr. Jevon said. "That's what's
bugging doctors."

There is little doubt that computerized offices can help. For instance, Dr.
Kevin Toppenberg recently saw an emergency patient who had injured his leg at
the beach and arrived at his office wincing in pain. The patient's regular
doctor, one of Dr. Toppenberg's 14 colleagues, practiced in another of the
group's three offices in Greeneville, Tenn., and was taking the day off.
In a typical medical practice, the man's records would ordinarily be in a
paper file in his own doctor's office and a colleague in another office would
have no way of getting them. Dr. Toppenberg, like many other doctors, would
rather send such a patient to an emergency room than see him without a medical
record.



"To just be working blind is scary for doctors," Dr. Toppenberg said.

But Dr. Toppenberg's newly installed computer program let him see the man's
record immediately, on a computer screen. After examining the man and
diagnosing a probable torn muscle, Dr. Toppenberg sent him to an orthopedist. Then
Dr. Toppenberg added his findings to the man's record so his colleague would
have them instantly when he needed to consult them.

The Vista project began a few years ago when Medicare officials realized
that help for small medical practices was in its own backyard. The federal
government had already paid hundreds of millions of dollars to develop Vista, and
now uses it in the Veterans Administration's 1,300 inpatient and outpatient
facilities, which maintain more than 10 million records and treat more than
five million veterans a year. Why not give Vista to doctors?

In fact, though few knew, Vista had been available all along to anyone who
submitted a Freedom of Information Act request.

Over the years, the program had accrued a passionate following and even an
organization, World Vista, founded in 2002 mostly by V.A. employees to help
spread it throughout the world. One reason for their enthusiasm was that no
company owns Vista so anyone can modify and enhance it.

It is, said Joseph Dal Molin, director of World Vista, a survival of the
fittest. "What's good survives," he said.

One feature, for example, was suggested by a V.A. nurse. Why not put a bar
code on a prescription bottle to identify the drug and its dose, put a bar code
on the patient's wristband to identify the patient's prescription, and then
scan the drug label and the patient's wristband before administering a drug?
If there was a discrepancy, Vista could catch it before an error was made.
Programmers added that feature, and V.A. drug errors plummeted by 80 percent
overnight.

Still, it is one thing to use a system that someone else installed and
someone else maintains. It is another to get a set of disks in the mail and do it
yourself.

Giving out a version of Vista is "a great idea," said Dr. David Kibbe,
director of the center for health information technology at the American Academy
of Family Physicians, a group that has been working on the project. "But at the
beginning, there was a lot of wishful thinking. They said, 'We'll just
release it.' I said, 'Where's the fairy dust?' "

Those who tried to install Vista on their own would agree.

Dr. Nancy Anthracite, a family physician in Washington, needed endless hours
of help from a group of Vista enthusiasts who call themselves the Hardhats
and volunteer their time. Getting started with Vista was so daunting, Dr.
Anthracite said, that even when the V.A. demonstrated its program at medical
meetings, almost no none of those in attendance wanted to use it on their own.

"You go to meetings and they show you things doctors can do with Vista and
everyone's going , 'Wow, wow, wow,' " Dr. Anthracite said. "But no one installs
it."

So for three years, Medicare and its contractors worked to make the program
easier to use.

They even gave it a new name, VistaOffice, to signify that was intended for
small-office practices, not the huge V.A. system.

Some, including Dr. Toppenberg, decided not to wait for the August release
of the new program. Last year, he learned that he could get the unmodified V.A.
version of Vista and decided to try it.

"I started looking around," Dr. Toppenberg said. "The newer systems tended
to be about $15,000 per doctor, not counting the ongoing support fees. Then I
found out that the Vista system was available. You just have to figure out how
to get it to work."

He did - but it took him six months.

Anyone who wants the new Vista, which is expected to require far fewer steps
to install than the V.A.'s version, must wait until August. Some, like Dr.
Meyer Cohen, an internist in Boca Raton, Fla., want to see how it works before
committing time and money to it.

But a few, like Dr. Ismet B. Kursunoglu, director of the Alaska Clinic in
Wasilla, Alaska, cannot wait.

"There are a lot of fantastic vendors," Dr. Kursunoglu said, "but,
realistically, we're in a time period where reimbursement is going down and costs are
rising. This is free."

"This," he said, "is a fantastic opportunity."