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July 22, 2005

TECH: Here comes VistA and eRx update

This week CMS announced that the oft-touted VistA system -- the EMR developed by the VA -- would be made available for free. Given that similar EMR systems are sold for up to $15,000 a seat, this might appear to be a boon to the computerization of the physician practice, while simultaneously destroying the prospects of commercial software companies in that market. But there are many uncertainties.

VistA was built for government hospitals and has been converted to the private small office environment. It doesn't really have a billing function integrated, nor yet does it link well with other clinical systems. Plus it's apparently tricky to install, there's at least one rival EMR system based on it and there's only a nascent open-source support movement surrounding it -- albeit one CMS is trying to encourage. In addition small office practices may do better with an ASP system rather than setting up their own technology. However, what VistA's availability will likely do is reduce the price of EMR systems for physicians, even if that price is only a small component of the overall "cost" of EMR adoption. And it's good to see the government realizing that the most crucial part of automating health care is computerizing the physician's clinical workflow.

I hope to have more on open-source IT in EMRs and the fate of the small office shortly.

Meanwhile, I got this update from Manhattan Research about ePrescribing.  The number of doctors using eRx is now at 14%, 80% of whom are in big groups (and probably using eRx as part of a total EMR solution).  The number using eRx on handhelds is up 300% since last year (although it's a much smaller proportion of that total and they wouldn't tell me exactly what it was --after all they are trying to sell this research!)

Finally the piece I've been working on about prescribing, including eRx, is being put into editorial today and should be out in the Fall.  I'll let you all know about that when it comes out.

July 22, 2005 in Technology | Permalink


Free won't be cheap enough for small physician offices to cross the tipping point in adoption EHRs.

I think I read that 65% of physician offices are under 3 docs.

EHR adoption will need to be incented, encouraged, and resourced (or gov't mandated) before the average 1-3 doc office is going to invest the time, energy, and money to install something that 1) will - initially at least - not save them time and 2) will not make them more $$$.

Posted by: matt | Jul 22, 2005 12:24:58 PM

Anyone who understands the "cottage industry" nature of physician practices knows this is going to be a train wreck.

A cobbled up hospital system being offered to docs is a prime example of how bureaucrats think - badly.

Any really useless EMR needs to link to billing systems, and billing systems are there own nightmare.

Sorry, this won't work.

Posted by: healthcarethinktank | Jul 25, 2005 6:10:26 AM

So, I talked to the VA- we found out that in order to use the VA system- doctors had to see 30 percent less patients- to work with the VA system. Thuis would bankrupt any private physician.

Moreover- not only do VA doctors seem to hate the system- their patients seem to resent the fact that the doctor pays so much attention to the computer.

I downloaded the VA program- it locked up my computer. Saying that the VA ssytem will take over American medicine is tantamount to saying that government cheese will take over the dairy industry.

Posted by: randy lipscher | Aug 6, 2005 12:51:32 PM

There is no customer support for the "free" ERx Now. Several months into it, it does not function, but freezes each and every time. I keep getting, "We're working on it". I'm sure the paying customers get more attention. You get what you pay for.

Posted by: Len | Aug 29, 2007 6:16:56 AM

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