(I see Nancy's name
in there...)
Docs
to begin testing electronic health record adapted from VA
system
By
Joseph Conn
/ March
2, 2005
A physician in
Maryland, another in New Jersey and four offices of a community health network
in West Virginia will be the first test users of the newly minted Vista-Office
Electronic Health Record.
"I just think it's wonderful," said Njide
Udochi, M.D., a solo family practitioner who opened her own office in October
in Catonsville, Md., and is scheduled to have the Vista Office EHR system
installed March 16.
Udochi already has in her office electronic access
to lab results and an electronic billing system, both of which will be
interfaced to Vista-Office EHR at installation, she said.
Udochi said
she'd shopped for an electronic medical records system, but was discouraged by
the price tags ranging "anywhere from $30,000 to $55,000 to have everything
installed. That's a lot of money for someone in solo practice. Instead of
borrowing, my plan was to practice for a year or two and get some income
first."
But then Udochi heard about the joint effort by the Veterans
Health Administration and the CMS to adapt the Veterans Health Information
Systems and Technology Architecture, or Vista system, to small physician
offices.
Vista provides clinical IT to 170 VA hospitals and 850
outpatient clinics nationwide. Udochi said she had used Vista during her
fellowship in geriatrics at George Washington Hospital in Washington, D.C., in
1999 and liked it. She said she then yearned for an EHR in her subsequent
years of practice at the paper-based Baltimore Healthcare for the Homeless
program.
A colleague introduced Udochi to Nancy Anthracite, M.D., a
Maryland physician working with WorldVistA, an organization developing another
version of the program, who provided Udochi with a contact in the Vista-Office
EHR project. Udochi, who says her office is within walking distance of CMS
headquarters, applied and was accepted as a beta tester.
She said her
office already was wired with one computer in one of her three exam rooms, but
now she expects to use a tablet PC supplied by the project to document patient
encounters. Her two clinical assistants and a part-time billing clerk are all
computer savvy, she said, so, with her previous Vista experience, she expects
the four hours of training on the system they'll all receive March 16 will be
enough to get them going.
Recent surveys of information technology
usage by the Commonwealth Fund and Modern
Physician show a digital divide is opening up between large-group
practices and solo and small physician offices due to the high cost of buying
and maintaining EHR systems.
The VA/CMS Vista-Office EHR project aims
to help close that gap and is part of a larger quality-improvement program at
the CMS called the Physician Focused Quality Initiative.
Installation
of the Vista-Office EHR already is under way at four of the 20 community
health centers in the West Virginia Primary Care Network, based in Huntington,
according to Capt. Cynthia Wark of the Public Health Service. Wark is deputy
director of the information and systems group in the Office of Clinical
Standards and Quality at the CMS and is an overseer of the Vista-Office EHR
project. The target date for public distribution of the software is Aug. 1.
"We're right in the midst of getting these pilots up and working,"
Wark said. "Right now, we're at all trains running on full speed to meet our
deadlines."
The installation process includes an analysis of the
technical infrastructure and training needs at each site, Wark said. Daou, an
IT contractor based in Chevy Chase, Md., that converted Vista into the
Vista-Office EHR, is working with the beta testers on the installations, she
said.
Vista, which comprises more than 100 modules from radiology
archiving to physician-order entry, is available from the VA for about $47 in
copying costs under the Freedom of Information Act. Vista-Office EHR also will
be available at little to no costs under FOIA, according to government
officials. Who will distribute the final versions of the Vista-Office EHR
software is unresolved, however, Wark said.
"We are, in fact, this
week trying to finalize our plans with the VA on that," she said.
In
addition, the Vista-Office EHR must be reviewed by the VA to make sure it
remains compatible with core elements of the VA's main Vista system. That way,
any future changes to the Vista system can be readily integrated into the
Vista-Office EHR.
"That work is going on right now," Wark said.
The Iowa Foundation for Medical Care, the primary contractor working
for the CMS on the Vista-Office EHR project, is also seeking proposals on
identifying a "buffer organization" to provide training to IT consulting firms
wishing to install and maintain the Vista-Office EHR. Once trained, these
firms would provide training on the system and installation help to physicians
and other end users. Neither the VA nor the CMS will supply those support
services themselves.
"It is our collective, federal thinking between
the VA and the CMS (that) it would be helpful to provide some training to
vendors who would provide the training on installation," Wark said. "To not
provide this training would undermine our goal to drive IT adoption. It would
enable the vendors to gain a level of expertise in the software."
David Campbell is the chief executive officer of the West Virginia
Primary Care Network in a state where 62% of the population lives in rural
communities. More than 200 clinicians, including an average of three to five
physicians per care site, as well as dentists and nurse practitioners, work in
the system, he said.
"We take care of about 150,000 (people)
throughout the state in rural areas," Campbell said. "As we've looked at this
from a health-improvement standpoint, it's pretty important to have an
integrated approach. This (Vista-Office EHR) gives us a chance to begin to
build an electronic information system and telehealth system."
Campbell said his network is adapting the Vista-Office EHR to run in
the application service provider mode, which means, during the testing phase,
at least, the software being used in the four rural West Virginia test sites
will be running on a server at a data center in Florida.
"We start
testing this next week," Campbell said. "We hope by this summer to be using it
in a controlled environment and start rolling it up in late summer."
Campbell said he expects to install the system in all 20 clinics.
Failure is not an option.
"It's going to work," he said. "It has
proven technology. There are a lot of strong clinicians here."
Barbara
Boykin is president of Oleen Healthcare Information Management of Silver
Spring, Md., and chairman of the VistA Software Alliance, a not-for-profit
trade association of about 20 companies and individual software developers and
consultants supporting the deployment of both Vista and the Vista-Office EHR.
Boykin said the alliance is interested in becoming the project's
"buffer organization" to provide vendor training, adding that she expects the
alliance will add more members as the Vista-Office EHR release date draws
near.
"We hope to have a nice long list we can give (to physicians) of
people who are capable of installing and maintaining it," said Boykin.
She predicts a physician should be able to load the Vista-Office EHR
onto a computer and fire it up without hiring an outside expert, but she
advises against it.
"While it may be simple enough to install on your
own, medical records systems are very complex," she says. "It's re-engineering
your practice and it requires someone to look at how the work is flowing and
how an EHR fits into that scheme."
Udochi is chairman of the education
committee of the Maryland Academy of Family Physicians, a chapter of the
American Academy of Family Physicians, which is working closely with the CMS
on other aspects of the Physician Focused Quality Initiative. She said she is
looking forward to being a guinea pig for Vista Office EHR.
"Hopefully, if I learn, maybe the other members will be willing to
invest in the technology, too."
David Sommers,
Architect
Dialog Medical
p> 800.482.7963
x46
p> 770.982.7851
x46
f>
770.736.5725
e> [EMAIL PROTECTED]
w> www.dialogmedical.com
