| Is anything ever free these days? Maybe so. | | | | viable solutions have been hard to come by. |
| Instigated by the incredibly slow adoption of | | | | The healthcare system is extremely fragmented, |
| Electronic Medical Records (EMR) by doctors | | | | with thousands upon thousands of practices all |
| across the nation, Medicare is announcing it will | | | | practicing differently, using different billing |
| begin offering doctors free electronic medical | | | | systems, with different levels of computer |
| record software solutions. | | | | proficiency, and different workflows. Building a |
| Both upfront and ongoing costs have been critical | | | | one-size-fits-all system has failed in the past and |
| factors in the lagging EMR adoption rate. Medicare | | | | will likely continue to fail. The fact that over 300 |
| hopes that by providing doctors with a free or | | | | different vendors currently develop and market |
| very low-cost system, doctors will readily adopt | | | | EMR software attests to the need for |
| EMR putting healthcare providers in America on a | | | | customization. The need for pre- and post-sale |
| common system, thereby, providing Medicare and | | | | customization is a reality in every practice since |
| the general public with obvious, health, reporting | | | | every practice operates differently. Even |
| and billing benefits. | | | | practicing physicians within the exact same |
| The proposed system is VistA, (Veterans Health | | | | specialty do things differently and run their |
| Information Systems and Technology | | | | practices differently. |
| Architecture) the widely popular system built by | | | | A key challenge for systems with large installation |
| the Veterans Administration. The adoption of | | | | bases is often that the system becomes rigid |
| VistA has resulted in the VA achieving a | | | | simply due to the vendor trying to please too |
| pharmacy prescription accuracy rate of 99.997%. | | | | many different practices. Customization gets |
| Due to the implementation of VistA, the VA also | | | | repeatedly delayed or shelved altogether. Another |
| outperforms most public sector hospitals on a | | | | concern is that when medical records are stored |
| variety of criteria. The VistA system is public | | | | on servers that Medicare can access and control |
| domain software, available through the Freedom | | | | as they please practices may be hesitant to use |
| of Information Act directly from the VA website | | | | the system regardless of the benefits to the |
| or through a network of distributors. | | | | practices and their patients. |
| Installed in over 1300 inpatient and outpatient | | | | While Medicare's plan is to offer the software for |
| facilities, the system is well-established and quite | | | | free, one must ask what free is. Currently, free is |
| successful by EMR standards. But can a system | | | | software but not training, installation, and ongoing |
| designed for a large organization like the VA also | | | | support. Even if Medicare did make it 100% free, |
| work for a solo practitioner family practice office? | | | | a free EMR is not free if it fails. The costs |
| A doctor in a New York Time article writes: | | | | involved with a failed implementation can far |
| "It is one thing to use a system that someone | | | | outweigh the costs of purchasing an EMR at |
| else installed and someone else maintains. It is | | | | market price due to productivity losses, and |
| another to get a set of disks in the mail and do it | | | | hardware and implementation costs. |
| yourself." | | | | Maybe Medicare could focus more of their |
| Those who have tried to install Vista on their own | | | | resources in the development and promotion of |
| would agree. | | | | better standards for integrating already proven |
| "Giving out a version of VistA is a great idea," | | | | EMR systems and integrating EMR systems with |
| said Dr. David Kibbe, director of the Center for | | | | electronic personal health records, managed by |
| Health Information Technology at the American | | | | the patient. Why not offer patients a free |
| Academy of Family Physicians, a group that has | | | | electronic health record which can easily interface |
| been working on the project. "But at the | | | | to all the major EMR vendors in the market? |
| beginning, there was a lot of wishful thinking. They | | | | Wouldn't a record they control, that can |
| said, 'We'll just release it.' I said, 'Where's the fairy | | | | communicate with all their health providers, and be |
| dust?' " | | | | accessed by any other provider in the event of |
| The problems with the healthcare sector and its | | | | an emergency be more beneficial? |
| slow adoption of electronic medical records are | | | | After all, isn't the patient's best interest the goal |
| much deeper than some would like to admit, and | | | | of healthcare in the 21st century? |