CMS unveils beta version of electronic health record

The on-again, off-again release of the Centers for Medicare and Medicaid Services' version of the VA's VistA-Office electronic health record technology for small offices is back on, but in beta format only.

Although the software itself is in the public domain, using it will incur some cost, contrary to previous news reports. The initial release will be limited to offices that meet strict requirements during an evaluation phase.

CMS will charge users $37 to put the software on a CD. To implement the software, users will have to license the Cache database program, which could cost up to $2700 for the first year, including support services and updates, said CMS spokesperson Don McLeod.

In addition to these upfront fees, physicians will have to pay the American Medical Association for the use of current procedural terminology codes. Cost of ownership will also include installation and support of the software and any hardware needed to run it, McLeod said.

During this evaluation phase, CMS has funded WorldVistA, a support organization that provides training for vendors that will install the software. CMS has chosen Document Storage System, Executive Software Systems, Medsphere Systems, and VOE Solutions to help with installation, and it plans to add a fifth vendor to the program, McLeod said. Vendor information can be found at worldvista.org.

While the software is relatively inexpensive compared with mainstream products, actually implementing it requires technological savvy and implementation personnel.

"Electronic medical record systems are complex computer programs and require a great deal of training and support for an implementation to be successful. Training and support are major issues in smaller practices, which may have to go it alone or find third parties willing to support the systems," said Dr. Jerome Carter, a clinical associate professor of medical education at the Morehouse School of Medicine in Atlanta.

VistA-Office is suited for offices with five or fewer physicians, McLeod said. The software can provide order entry functions, documentation templates, and clinical reminders. Other functions include patient registration, quality measures reporting, and printing/faxing of prescriptions.

While the VistA-Office version does not include the original Vista Imaging software, it does contain a radiology/nuclear medicine software package that allows for a variety of imaging functionality. Among these capabilities are entry of requests, registration of patients for exams, recording of reports and results, verification of reports, and displaying and printing results for clinical staff.

Implementing the software may be a complex process, but using it is generally not as difficult.

"I found it quite easy to use," said Dr. Bruce Slater, medical director of computerized decision support at the University of Wisconsin Hospitals and Clinics in Madison. "Setting it up was challenging for me, but I suspect that for people more experienced with this platform, it might not be so. I liked the templates and forms that could be customized."

Slater has tested a version of the VA software, and although his hospital is financially committed to other vendors, the attached VA hospital uses the system every day.

"The best thing about the program is the potential to become an open-source project adopted by hundreds or thousands of practicing physicians. The system could become a de facto standard for patient care," he said.

Physicians and offices interested in testing the software will have to meet a rigorous vetting process, according to McLeod. Qualified users will be small offices that have the IT infrastructure to handle the software implementation as well as the desire to function as a beta test site, receiving updates and providing feedback.

The evaluation period should last about a year. CMS expects to have about 10 participants, although there is no limit on the number of evaluation sites, McLeod said.

Physicians and clinics interested in participating in the program as an evaluation site can find more information at the vista-office.org site.

Now that the software is available in beta format, the question is whether smaller facilities will be able to adopt it.

"There's a lot more to increasing the implementation of EHRs than simply making the software available," Carter said. "Implementation takes a great deal of planning and a fair amount of project management skill in all but the smallest practices. What is really needed at this time is a large number of informatics-trained technologists who understand medical practices and electronic health records well enough to help physicians complete this very complex process."