Is VistA a viable replacement for paper records?

How is it possible that only 1.5 percent of hospitals in the United States have gone paperless? Furthermore, how is it possible that West Virginia—which is not exactly a financial or technological hotbed—is one of the few states to use fully computerized records for its state-run hospitals and nursing homes for the elderly and mentally ill?*

It's possible thanks to VistA, the Veterans Administration's open-source software. Philip Longman, a fellow with the New America Foundation and author of a book about the VA's quality-of-care revolution, believes it's a travesty that the software isn't being utilized more.

"It's really insane that we have a fully developed health information technology system that is bought and paid for and free to anybody who wants it and used widely around the world by other governments running their healthcare systems . . . and yet we don't have any take-up in the U.S., or not much to speak of," Longman said.

Despite its seemingly convenient nature, though, VistA still has several critics and some unknowns. John Halamka of Beth Israel Deaconess Medical Center in Boston, for one, points out that VistA is better suited for bigger institutions with a single payer.

"We should disseminate VistA where it's a good fit," Halamka said, but finding a single system to fit the needs of every clinician "is just not happening."

Other technology experts argue that, although VistA's software is essentially free, installation and maintenance costs--which could climb into the millions of dollars--remain a very real hurdle. "I think people are sitting back and waiting a little until they see enough momentum for it," he said.

Click on Fierce HealthIT/VistA to read more.

*Medsphere's OpenVista EHR solution.