http://www.washingtonpost.com/wp-dyn/articles/A35059-2005Mar14.html

...Patient-owned PHRs differ from electronic medical records (EMRs), which are created and controlled largely by health care providers. (It's the EMR concept that the Bush administration is trying to expand.)

PHR sponsors, which include a growing number of health plans and hospitals, are betting that more Americans -- particularly those with chronic ailments and those who care for children and aging parents -- will soon demand digital, comprehensive medical records.

"People are already in the business of managing their health information. They just don't realize it," said Andrew Barbash, chief medical and information officer of Bethesda-based Laxor. He says doctors routinely rely on patients for symptoms, medical histories, medication status and other information. PHRs can ensure the information reaches providers whether the doctor asks for it or the patient remembers to provide it.

Laxor subscribers, like those of most PHR systems, enter conditions, treatments, medications, allergies and other information via Web-based forms. Blood pressure readings, doctor visits and test results can be included, and the Laxor PHR can remind patients of appointments or screening tests.

http://www.modernphysician.com/news.cms?newsId=3236 (Registration/Login Required)

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...

...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."
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http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=109217

Three articles in this week's Federal Computer Week examine improvements being made to the Department of Veterans Affairs' VistA system.

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http://www.fcw.com/fcw/articles/2005/0221/spec-vista-02-21-05.asp

When people think of cutting-edge computerized health systems, the Department of Veterans Affairs is probably not the first organization that comes to mind. But VA officials have developed a system that many believe could be the low-cost foundation of the nationwide electronic health record (EHR) system that President Bush wants to deploy.

The Veterans Health Information Systems and Technology Architecture (VISTA) is a collection of about 100 integrated software modules that cover a wide swath of health care applications, from patient records to admissions and billing.

"VISTA is one of the few true, fully functional, fully integrated EHR systems," said Barbara Boykin, chairwoman of the VISTA Software Alliance (VSA), an association of vendors that promotes and supports the use of VISTA by health care providers outside the VA. "Personally, I think it's probably the only true one out there."

http://www.fcw.com/fcw/articles/2005/0221/spec-vahealth-02-21-05.asp

The general perception from the outside is that the massive Department of Veterans Affairs health care system is outdated. The VA's bureaucratic system is largely seen as a last resort for veterans who are too poor to afford care in better-equipped and better-staffed private hospitals, which are perceived as providing better care.

The size of the system is undisputed: The VA operates 163 hospitals and 850 clinics nationwide that treat about 4 million veterans a year.

But perceptions may not match reality, particularly in terms of the technologies the VA health care system uses, said Scott Wallace, a former lawyer and venture capitalist who is now chief executive officer of the National Alliance for Health Care Information Technology Advancement.

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http://www.fcw.com/fcw/articles/2005/0221/spec-dodhealth3-02-21-05.asp

FORT LEWIS, Wash. - Officials at Madigan Army Medical Center, south of Seattle, are in the midst of testing a program for treating Department of Veterans Affairs patients and active and retired military personnel.

Madigan officials are using both the Defense Department's Composite Health Care System (CHCS) and the VA's Veterans Health Information Systems and Technology Architecture (VISTA), said Lt. Col. Keith Salzman, chief of informatics at Madigan. They can access both systems from common terminals.

Many doctors working at Madigan appreciate the advantages of such widespread access to electronic health records compared with the paper-based practice of medicine common in many hospitals outside DOD and the VA.

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http://fcw.com/fcw/articles/2005/0214/web-va-02-16-05.asp

Information technology programs at the Department of Veterans Affairs could get a huge boost if President Bush's fiscal 2006 budget request becomes law.

The VA is one of the winners in this year's budget derby, with a request that is nearly 30 percent more than the fiscal 2005 budget for the department's IT. The administration is seeking $2.1 billion for IT in 2006, up from $1.6 billion the previous year.
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http://www.boston.com/business/technology/articles/2005/02/14/government_agencies_adopt_open_source/

State and city governments, spearheaded by Massachusetts, are becoming the newest converts to the open source software movement.

The fledgling Government Open Code Collaborative, formed last year, has set up a nationwide repository for government software applications, hosted on a server at the Massachusetts Information Technology Division data center in Chelsea. The first "deposits" into the repository will be made this month by Massachusetts and Rhode Island agencies offering software freely available for other states to use.
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http://www.washingtonmonthly.com/features/2005/0501.longman.html

Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they're producing the highest quality care in the country. Their turnaround points the way toward solving America's health-care crisis.

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No Link

The Veterans Health Administration is the United States largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators. Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.
(Am J Manag Care. 2004;10(part 2):828-836)

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http://www.reuters.com

NEW YORK (Reuters Health) Dec 21 - Veterans Health Administration hospitals score better than national averages in overall quality of care, chronic disease care, and preventive care, according to a report in the December 21st Annals of Internal Medicine.

"This study showed that in major areas of care, the VA did better than the country's general health care system at providing recommended care," Dr. Steven M. Asch from West Los Angeles Veterans Affairs Medical Center, Los Angeles, California told Reuters Health. "In fact, there was no area in which the VA did worse than the general health care delivery system."

Dr. Asch and colleagues compared the overall quality of care delivered in the VHA system and in the United States, as well as the quality of acute, chronic, and preventive care across 26 conditions.

VHA patients overall were more likely than patients in the national sample to receive the recommended care for their condition (67% versus 51%, respectively), the authors report.

http://www.modernphysician.com/news.cms?newsId=2861 (Registration/Login Required)

The government is looking for a few willing office-based physicians interested in helping developers adapt the electronic health record system used by the Veterans Health Administration for use in the private sector.

Work on the Vista-Office EHR project, initiated as a joint effort of the Veterans Affairs Department and the CMS, is being performed by the Iowa Foundation for Medical Care under a contract with the CMS.

Vista powers more than 150 VA hospitals and 850 outpatient clinics, but the system needs modification for use in physician offices

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http://www.fcw.com/fcw/articles/2004/1122/news-va-11-22-04.asp

Twenty-year-old software developed by the Department of Veterans Affairs could serve as the low-cost building block of a nationwide electronic health care record (EHR) system President Bush wants officials to deploy within the next decade, according to health management experts.

This open-source software, based on the VA's Veterans Health Information Systems Technology Architecture (Vista), could also become the basis of affordable EHR systems worldwide, said Maury Pepper, a St. Louis-based computer consultant. Pepper serves as chairman of WorldVista, an rganization dedicated to making health care technology more affordable worldwide with systems based on Vista.

Officials at the Centers for Medicare and Medicaid Services (CMS) want to use Vista to stimulate the adoption of EHR systems by doctors with a new public-domain version of the software, Vista-Office EHR, developed in conjunction with VA officials.

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http://www.modernhealthcare.com/article.cms?articleId=34385 (Registration/Login Required)

At Southeast Mental Health Center, money is too tight to mention. Just ask Gene Lawrence, the chief executive officer. The facility runs lean because it has to, he says...

When Lawrence started shopping for a computerized clinical infor-mation system for his organization, he chose the Vista system developed by and used throughout the Veter-ans Affairs Department's Veterans Health Administration.

He picked Vista because the VA's highly praised, complex and powerful IT system has almost all of the functions his operation needed, and because he could get the software real cheap. The bulk of the software is available from the government under the Freedom of Information Act for just $47.16, the fees to cover copying and processing costs.

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http://www.modernphysician.com/news.cms?newsId=2842 (Registration/Login Required)

Eight technology firms, including Hewlett-Packard Co. and Perot Systems Corp., have formed the Vista Software Alliance, a trade association to promote the private-sector use of the healthcare information technology system used by the Veterans Health Administration in the Department of Veterans Affairs.

Besides Hewlett-Packard and Perot Systems, founding companies include Document Storage Systems, InterSystems Corp., Medical Alliances, Medsphere Systems Corp., Oleen Healthcare Information Management and Sea Island Systems.

The Veterans Health Information System and Technology Architecture, or Vista, system powers more than 150 VA hospitals and 850 outpatient clinics and has more than 100 modules, including an electronic health record, computerized physician order entry, lab and pharmacy systems and a picture archiving system. Copies are available from the VA under the Freedom of Information Act free of charge, not counting about $47 to cover copying expenses.

Hewlett-Packard has a service contract to help maintain the VistA system. "Most software systems have a vendor, and the vendor markets the system," said Barbara Boykin, president of Silver Spring, Md.-based Oleen. "This is an unusual model. This is free software that is incredibly good and no one knows about it. It needs marketing, but unlike a vendor software, there is no company to do it. That's why we're pooling resources to do the marketing."

Few U.S. hospitals or outpatient facilities use the VA software, in part because there is no mechanism within the VA to assist would-be users in installing and supporting the complex Vista system. Boykin said the not-for-profit Vista Software Alliance "can be the buffer between the VA and the private sector."

"When a hospital calls up the VA looking for help and says, ´I want to use your system,´ the VA can't help them," Boykin said. With the Alliance in place, "the VA can say, ´Go to this not-for-profit association. They can help you out.´"

"We're hoping that CMS with the Office Vista project will do the same thing."

The VA and CMS are developing a version of Vista for physician offices that is slated to be ready for release this summer.

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http://www.vistasoftware.org/about/pr/2004/launch

Bethesda, MD — A new trade association has been formed to speed the adoption of electronic health records (EHR) in private sector healthcare organizations, by leveraging proven cost-effective EHR software currently serving more than 4 million patients nationwide.

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http://www.modernphysician.com/news.cms?newsId=2817 (Registration/Login Required)

Despite plans to overhaul its Vista clinical system, the Veterans Health Administration will continue to offer copies of its multimillion-dollar software to private-sector users for a nominal fee under the Freedom of Information Act, according to the Department of Veterans Affairs' top physician informaticist.

"We have the full support of the VHA leadership to continue to keep this in the public domain," said Robert Kolodner, M.D., acting chief health informatics officer at the VHA and deputy chief information officer for health at the VA.

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http://www.eweek.com/article2/0,1759,1713278,00.asp

Health care providers are not paid for how healthy they make their patients, but by how many they care for. Since many physicians feel health IT cuts into their time to visit patients, they are understandably resistant to using it.

The solution to health IT problems is not in silicon but in accounting ledgers.

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http://www.e-health-insider.com/news/item.cfm?ID=909

The Office of Government Commerce has made recommendations that public procurement of software should consider open source solutions, citing, amongst other case studies, the experience of a Dublin-based hospital that made significant savings in transferring all its software to open source.

The report says that public sector bodies should "examine carefully the technical and business case for implementation for Open Source software and the role which OSS could play in current and future projects" as well as "review their current infrastructure and applications... well in advance of any planned procurement or renewal... and consider what steps may be necessary to prevent future 'lock in'".

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http://www.eweek.com/article2/0,1759,1698495,00.asp

An expert analysis, conducted in part by the national health IT czar, says new policy and a better business case will be necessary to sustain the adoption of health IT in physician practices.

"The current business case for the adoption of health IT systems is not sufficient," said a statement from the Markle Foundation, which initiated the analysis by a nine-member working group organized by the foundation's public-private collaborative, Connecting for Health. David Brailer, the national health IT coordinator, was one of the members.

The report concludes that financial incentives are necessary to encourage health care providers to adopt IT systems that allow for interconnectivity.

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http://www.eweek.com/article2/0,1759,1698496,00.asp

While very few practices have fully implemented electronic health records, a majority of health executives feel they will have a positive financial impact over the long term, according to a new report by Capgemini Health Practice. The survey also found support for the government taking a more active role in coordinating integration efforts.

Capgemini researched the attitudes of health industry executives toward EHRs themselves and toward the government's role in coordinating health IT.

The survey consisted of responses from 84 executives at hospitals, health insurance plans, physician groups, health technology vendors and other health organizations. Seventy percent felt EHRs would, over the long term, have a positive financial impact. Just over half had held internal discussions concerning EHRs. About a third had conducted a financial analysis or examined the business case.

The Capgemini report found that costs (58 percent), physician resistance (46 percent) and lack of technology standards (30 percent) were considered the greatest barriers to adoption. In addition, several respondents thought financial incentives for physicians would be necessary for adoption.

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http://management.silicon.com/government/0,39024677,39125359,00.htm

The UK government seems to be warming to open source. Today, the Office of Government Commerce (OGC) published a report saying open-source software is now a genuine competitor to Microsoft in the public sector.

After a running a series of pilots with government bodies, in conjunction with IBM and Sun, on the use of open-source software, the OGC's report adds weight to the argument against the idea that Linux has a long way to go before it will be considered as a serious contender and describes open source as "a viable desktop alternative for the majority of government users".

The report lists interoperability and cost as two of Linux' major advantages, saying that the former is "now not a major issue" for open source and that using open source instead of proprietary software can generate "significant" cost savings in government.

The OGC foresees the savings from an open-source switch being particularly successful when undertaken with "server consolidation and by delaying hardware replacement".

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http://software.silicon.com/os/0,39024651,39125400,00.htm

The Office of Government Commerce's report into the viability of using open-source software in the public sector was toned down in its praise of Linux security before release, silicon.com has discovered.

A copy of the report, seen by silicon.com with amendments still visible, shows changes were made to the government's stance on the particular advantages of Linux versus proprietary software when it comes to security. The Office of Government Commerce (OGC) is the Treasury office charged with improving public sector procurement and project management in the UK.

The pre-release version of the report read: "Linux would appear to offer numerous strengths in terms of security." In the final version this became: "There is no definitive answer on the relative security merits of open or closed-source software."

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http://politics.guardian.co.uk/egovernment/story/0,12767,1337817,00.html

With today's announcement of a significant shift in IT policy, is the government warming to open-source software? Michael Cross investigates

The government is set to clear the way for the use of open source software on hundreds of thousands of government desktops - but plans to keep the door open to Microsoft, too. The announcement, the first significant shift in policy on open source for more than two years, is likely to follow the publication of results from trials showing that "free" software works and saves money.

However, the new policy is unlikely to quell critics of the close relationship between Microsoft and the British government, its largest customer outside the US. Microsoft, meanwhile, will continue to argue that its software works out cheaper than "free" programs when measured by total cost of ownership.

The Treasury's Office of Government Commerce (OGC), set up to get better value from government procurements, will today announce that open source is a "viable desktop alternative for the majority of users" and that it can generate "significant savings". Interoperability with other systems is "not now a major issue". The report also found potential "green" benefits because open source software can prolong the life of computer hardware.

The announcement is significant because open source had previously been seen as an option only for consolidating servers and other "back-room" systems.

The pilots, carried out with IBM and Sun, two firms committed to open source systems, tested technology in central government departments such as the Cabinet Office and other organisations including central Scottish police.

They were conceived following lobbying by the open source industry, which says that the UK government lags behind commercial firms and other European administrations in picking open source.

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http://www.healthcareitnews.com/NewsArticleView.aspx?ContentID=1800

WASHINGTON — Free is not cheap enough.

If there appears to be one point that healthcare payers, providers and policymakers appear to agree on at the Health Information Technology Summit in Washington, D.C., it’s that free hardware and software will not be enough to drive IT adoption among the nation’s cadre of physicians, nurses and other clinicians.

Today, a public-private collaborative of more than 100 stakeholders, Connecting For Health, released a groundbreaking report that argues payers – including the federal government – ought to provide incentives of $3 to $6 per patient visit, or up to $1 per patient per month in a capitated system, to physicians who adopt electronic health records.

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http://www.modernphysician.com/news.cms?newsId=2718 (Registration/Login Required)

Four federal healthcare agencies will create a change control board to keep up to date the proposed free Vista Office Electronic Health Record system, an adaptation for physician offices of the EHR used at more than 1,300 care sites operated by the Department of Veterans Affairs, a leader of the federal development team said.

Capt. Cynthia Wark, an officer in the U.S. Public Health Service, said the VA, the CMS, the Health Resources and Services Administration and the Indian Health Service will form the core group for the entity. "We don't want to imply that it's formed or decided upon," Wark said. "We're just putting together a draft charter, but there is an agreement of how we want to operate with each other."

Wark is deputy director of the information and systems group in the office of clinical standards at CMS, which is the lead agency handling the Vista Office adaptation.

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http://news.zdnet.co.uk/business/0,39020645,39169940,00.htm

The UK government admitted on Monday evening that the cost of upgrading the National Health Service's IT system would be much greater than previously forecast.

The 10-year scheme, which is the largest IT project in Britain, had been priced at just over £6bn. But the Department of Health has now said that it will actually cost between three and five times as much - - suggesting the final bill could top £30bn, according to reports.

The revelation has led to concern that money could be diverted from patient care to cover this additional cost.

The NHS National Programme for IT will create an electronic booking system for patients, followed by an electronic patient record scheme. This will allow doctors to access a patient's records from anywhere within the NHS - - be it their local surgery or a hospital.

The Department of Health was prompted into its revelation by a report in Tuesday's Computer Weekly, which claimed that the IT-led modernisation of the NHS would cost at least £18.6bn, and that local health trusts would have to carry much of the financial burden.

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http://federaltimes.com/index.php?S=360236

Earlier this year, President Bush outlined an ambitious plan to ensure most Americans have electronic health records (EHRs) in 10 years. He noted that expanded use of information technology could improve the quality, safety, efficacy, delivery and security of health care. In July, the strategic framework for this initiative was released at the National Health Information Infrastructure Summit in Washington.

For decades, the Veterans Affairs Department has developed innovative IT solutions to support health care for veterans, creating what today is known as VistA, or the Veterans Health Information Systems and Technology Architecture. In the past several years, VA has initiated or joined in efforts with federal, state and industry partners that lay the groundwork for the president's initiative. VA's evolving strategy addresses four key IT components: EHRs; personal health records; and two pieces critical to the exchange of health information between them - namely, data and communications standards and information exchange infrastructure.

Today, VistA supports a comprehensive EHR system. Its Computerized Patient Record System provides a single, integrated application used by health care providers in all VA medical centers, nursing homes and clinics. Providers can update a patient's medical history, review test results, submit orders and access patient health information from any VA medical center or clinic.

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