Electronic health records are poised to move from few-and-far-between doctors’ offices to more of a mass-market phenomenon, thanks to robust financial incentives in the 2009 economic stimulus package that kick in next year. But as doctors and hospitals look to install digital networks that talk to each other, they also have to protect doctor-patient communication, not to mention patient privacy. And given what are often significant up-front costs, everyone’s eager to avoid getting burned by EHRs that prove to be ineffective or ill-suited to real-world challenges.
There are still plenty of bugs to be worked out such as those related to work flow. Some doctors warn that the technology should adapt to the way they work and not the other way around. Dr. Pauline Chen chronicled her frustration in trying to type notes into an electronic medical record while shuttling back and forth across the room to focus on the the patient in a recent New York Times story.
Companies that produce EHRs are trying to address these concerns as they aim to help clients qualify for federal funds, which revolve around “meaningful use” of health IT. For an overview of what’s going on in the world of electronic health records, check out my Vital Signs column from April 13.
Medsphere bets on VA system
One health system that’s at least a decade ahead of most of the private sector on the EHR front is the Veterans Health Administration, whose VistA program has inspired a California company to try to build on its strengths.
This week’s Vital Signs column examines the evolution of the Veterans Health Administration, which many experts credit with delivering high-quality care after a remarkable turnaround that started in the mid-1990s.
The VA’s VistA electronic health record, created by VA workers, played a key role in allowing the agency to make crucial quality improvements. A leading architect of the VA’s turnaround, Ken Kizer, former undersecretary of health for the Department of Veterans Affairs, is now the chairman of Medsphere, a commercial open-source EHR provider in Carlsbad, Calif. The company was founded in 2002.
Medsphere has spent around $40 million in the last six years customizing and commercializing the VA’s software into its flagship product called OpenVista, the company’s Chief Operating Officer Rick Jung said in a recent interview. For example, Medsphere has significantly expanded capacity for health-care specialties such as pediatrics and obstetrics, areas in which the VA typically hasn’t had much experience.
Among a broad field of EHR contenders, the VA’s VistA program stands out, Jung argued.
“You take your car into the GM dealer and they plug it into a central computer and they tell you what’s been done to it. You can’t do that at the hospital — except for the VA,” he said. “Your physician is enabled to follow your care process whether you are admitted or at an outpatient [clinic] for every single solitary step in your care.”
Because as many as two thirds of doctors have had VA rotations as part of their training, many already are familiar with its computer system, Jung said.
“Adoption is a big problem in our industry. It’s not with VistA. It’s a trusted friend,” he said. “They’re very comfortable adopting it, and it’s a big leg up for us.”
One of Medsphere’s largest clients is the Indian Health Service. Medsphere serves 219 separate [hospital] sites, including Kern Medical Center in Bakersfield, Calif., Midland Memorial Hospital in Texas and eight hospitals in West Virginia.
“We don’t believe that software in and of itself is what people want to buy,” Jung said. “What people want to buy in health care is improvement in outcomes and ways they can better drive revenue on the operating side and decreasing operating expenses.”
Jung said as hospitals use OpenVista, boost patient safety, avoid medical errors and improve their reimbursements as a result, Medsphere benefits as well.
“Our business model is to give the software away for free and charge for the services that help the hospital go live and keep the hospital running,” he said. Since the company guarantees hospitals that implement OpenVista will qualify for stimulus funds, an average one-third of the subscription cost is tied to the risk that it won’t, which aligns both parties’ interests, Jung said.