EHR War: Open vs. Proprietary

When members of a federal advisory group suggested recently that the government shouldn't be in the business of designing electronic health records, Rick Jung nearly fell out of his chair.

Apprehending his attention was a comment that appeared in a post on this blog:

"I am nervous that the government is going to get into the EHR design business," said Judy Faulkner, chief executive officer of Epic Systems and a member of the Health IT Policy Committee, which advises the Office of the National Coordinator for Health Information Technology. "We need to be careful about these committees not becoming the design committees for what the country will do."

Jung, chief operating officer at Medsphere, requested equal time. His company deploys an "open-source version of the world's most proven electronic health record system, the VistA EHR developed by the U.S. Department of Veterans Affairs over the course of two decades."

Obviously biased, Jung claims that his company's VistA derived product is a more effective solution and a better value. In West Virginia, he says, Medsphere deployed its system at a 1,200-bed facility for $9 million, a fraction of the $90 million total incurred by a similar facility of the same size that adopted Epic's proprietary system.

HIT Blog: You took exception to Ms. Faulkner's observation. Why?

Jung: It's ironic that she would be talking about the government getting into a business that they've been in for the better part of 30 years. The most widely deployed, highest-level adoption of any electronic health record system, including Epic's, is in the VA. The government built that system (VistA) to take care of our veterans. Not only have they been in the EHR business for the longest time, but VistA is used by every employee in every VA [facility], including every physician and every nurse, every clinician.

HIT Blog: How did Medsphere get into the business of adapting Vista for use in other settings? And why?

Jung: The Freedom of Information Act guarantees that anyone, any hospital anywhere, can download the VA VistA software free. We paid for it with $8 billion-plus taxpayer money.

The only reason we [Medsphere] have a reason for being is that the vast majority of proprietary systems on the market are not adoptable by physicians. They're built by technologists for technologists.

HIT Blog: So what's the difference between proprietary electronic records and the open source version?

Jung: It's great marketing to see a whole bunch of features [on a proprietary EHR]. It's a whole other thing to get physician adoption [of an EHR] and improvement of [clinical] outcomes. The VA has done that. They take care of their patients forever and a day. That [VistA] system has to make sure that it can take care of patients, cradle to grave.

Other [proprietary] systems are great at capturing information, but there is no evidence in studies of their moving the needle on care. To suggest that government not get in the business is masterful marketing.

HIT Blog: So the time for open source is now?

Jung: We are in adoption mode right now. Health care costs are out of control. If you don't have a system in place that's adoptable by physicians and clinicians, there's no way to rein in runaway costs.

If at the care giver level all you have is a bunch of slick fields that nobody uses, you've not moved the needle at all. What OpenVista is about, from Medsphere's perspective, is minimizing barriers to adoption. You don't pay for software, you pay for results. The system already works. And the government is paying 45 percent to 55 percent of [reimbursements] at every hospital in America [through Medicare and Medicaid]. Shouldn't the government have an interest in what is in the system? They absolutely have an interest.

HIT Blog: Why hasn't there been greater adoption of EHRs, particularly open source solutions?

Jung: In fairness, health care is not the most advanced industry in the world in terms of technology. Generally speaking, health care is about a decade behind every other industry. Web-based applications are just now catching on in hospitals. The challenge for health care has been compounded for three reasons: One, proprietary systems are expensive. Two, they [would-be adopters] are not aware that VistA is actually as ubiquitous as it is. Three, we're not yet an open source culture. In America, we want to have it our way. It's got to be feature- and function-focused for people to think it's high quality. In reality, you pay for bells and whistles but you still don't have adoption.

The people who have bought proprietary systems are the people with tens of millions of dollars to blow--Johns Hopkins and Kaiser. The rest of America does it on paper because there is no capital to buy a system.

Hit Blog: Now there is. How do incentives for adoption change the playing field?

Jung: The [EHR] certification process finally got some legs. In the last six months, the market has exploded. People are making purchasing decisions. They've downloaded our software. They've stood it up. People are moving rapidly.