Over the past several years I have tried many EHR (Electronic Health Records) systems and a lot of pseudo-EHR schemes. I have practiced as a general, vascular, and trauma surgeon at large referral centers and small community hospitals. I have worked for Kaiser Permanente, which tried over the course of years to implement the EPIC EHR. I experienced the conversion of a very large VA hospital from paper charts to an electronic EHR in a matter of months.
My current community hospital basically scans in paper records and makes them available via PDF files through ChartMaxx (a similar version of which is available for the small practitioner or group). It is similar in many ways to the popular PaperPort program, an inexpensive, basic document manager bundled free with many scanners.
I have set up three different offices with a different medical records plan each time. I also listen carefully to other physicians' needs and fears in the community about their medical records needs. One 3 physician group recently spent $30,000 for an EHR system, only to end up spending another $45,000 over the next year for extra modules and training. Another group spent even more for their somewhat larger group practice, only to find out soon after their system had been implemented that the EHR company they selected was planning to pull out of their state.
After all these experiences, I decided that VistA-based electronic medical records (such as VistA Office) were the best, most integrated, and least expensive medical reecrods system for use by the average practitioner.Other EMRs have many problems; some are detailed below.
In one huge facility, the EHR had improperly implemented CPT and ICD-9 codes in their system, and the giant group could not bill properly for at about a year, losing nearly 10% of its revenue.
One hospital chain struggled for at least a decade to co-ordinate medical records between its affiliate hospitals. It never really succeeded, to my knowledge.
In contrast, the transition I witnessed at the VA at which I trained for a year progressed smoothly and transformed the efficiency of the entire hospital. Now, this VA was not the first to implement VistA, and it benefited from experience gained at the many other many VA hospitals that had implemented VistA before it.
But, that's the whole idea: an EHR system that has had the bugs worked out, for the most part. The system is successful enough that the US government wants its Department of Defense hospitals to implement VistA as well.
Furthermore, the US government has fast-tracked the ability of VA facilities to exchange records between each other, as well as the ability of DOD hospitals to exchange records with the VA hospitals. This program is very successful and is in its third and final stages. This medical record exchange capability may already be the most extensive in the world.
Furthermore, the VistA system (which is accessed for many users via a CPRS GUI, or graphical user interface, that works in Windows) is intuitive, robust, and sensible (unlike many extremely cryptic EHRs I have seen). It is also quite customizable, if desired.
Lastly, there are now several companies dedicated to customizing VistA to the needs of non-government hospitals, where a larger priority on billing is usually placed.
The best feature about open source VistA EHR (the version of VistA available publicly) is that it is largely free for most of its components, under the Freedom of Information Act (FOIA) that dictates that certain US government-generated documents (including software) should be made available to the US public freely.
VistA is a scalable EHR that has recently been available to hospitals, large clinics, and physician groups in the form of open source Vista. It is now also available to smaller physician groups or individuals in a somewhat modified format as Vista Office EHR.
The latter is being packaged and presented by an extremely dedicated group of physicians and individuals.
This web site attempts to help an inexperienced user understand the implementation of both a new Linux server and a Vista Office EHR system. I have enjoyed setting up fully functional demo versions of these on my computers, with the intent of their incorporation into daily practice.
Along the way, I have discovered the Ubuntu Linux operating system, and have now transitioned my entire practice into an Ubuntu based system, keeping Windows available on the dual-boot computers only for occasional backwards compatibility needs.
Since doing so, I have also converted my house into a smarthouse using Linux programs (and X10 modules), and have set up a Linux-based surveillance system for both my home and office that writes both to a hard drive and sends images over the Internet.
All these projects, while time consuming initially, were very inexpensive. I also now have the support of an operating system (Ubuntu Linux) which is upgraded continually without requiring me to pay $200 to $400 per computer every few years. It also has a support system to be found either through online support forums or through commercial vendor support.
Open source VistA likewise has rapidly developed similar upgrade paths and support avenues.
Lastly, the financial risk to me of implementing both Ubuntu Linux and VistA has been small, and the gain tremendous.
I am a strong believer in an affordable, integratable EHR for the entire country, and VistA is the only thing close.
Hopefully some of my experiences recounted on this site will make setup for future users much quicker and equally enjoyable.
Vincent Mazzarella, MD
Chico, CA
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