Case in point: VistA is an enterprise-wide clinical information management solution used throughout the U.S. Department of Veterans Affairs (VA) healthcare system, known as the Veterans Health Administration (VHA). Characterized by the Institute of Medicine of the National Academy of Sciences as one of the best health IT systems available, VistA is also the most widely used electronic health record in the world. It is a fully integrated EHR consisting of more than 100 software modules, including computerized provider order entry (CPOE), bar code medication administration (BCMA), clinical documentation, pharmacy, laboratory and radiology. And because it was developed by the federal government, VistA is available to the public through the Freedom of Information Act.

Using VistA as a primary clinical support tool, the VHA virtually eliminated adverse drug events and boasts rates of preventive care that exceed Medicare averages in almost every statistical category.

In addition to the VA’s healthcare system, the Indian Health Service, a division of the U.S. Department of Health and Human Services, uses a close EHR "cousin" of VistA known as the Resource and Patient Management System. Predecessor or derivative versions of VistA have been or are currently being used by the Department of Defense, state and local government health agencies, numerous private healthcare organizations and multiple foreign countries.

OpenVista, for instance, is an open source derivative of VistA that is currently deployed in numerous acute care, community-based and behavioral health hospitals across multiple states.  This platform has been successfully deployed by several hospitals, including Midland Memorial in west Texas. As demonstrated by an evaluation performed following the implementation of OpenVista, Midland Memorial reduced patient deaths by two per month and central line infection rates by 88 percent thanks to clinical reminders, alerts and real-time access to current patient information to facilitate better decision-making and patient-care processes.

Over the past three decades, the federal government has invested billions of dollars in the development of VistA, which the general healthcare community can now leverage for little to no cost. Through provisions in the American Recovery and Reinvestment Act, the Department of Health and Human Services is also spending tens of billions of dollars to promote and encourage the adoption of electronic health records throughout American healthcare. Given the prohibitive cost of so many health IT systems and the financial challenges most hospitals face, the affordability of OpenVista represents a unique opportunity for hospitals to affordably improve patient care and receive reimbursement, in most cases, for the entire cost of a comprehensive EHR solution and in many others for two or three times the cost.

We stand at a crossroads in the future of open source technology and EHRs. Indeed, we may be living through the most significant challenges American healthcare has ever faced. Building on VistA's legacy in the ways suggested in these comments offers the opportunity to improve healthcare for veterans and simultaneously, substantially and affordably improve care for millions of other Americans.

Michael J. Doyle is chairman of Medsphere, developer of OpenVista, a portfolio of clinical support products and professional services that leverages an electronic health record system created by the Department of Veterans Affairs. He can be reached at mike.doyle@medsphere.com.

Click on Open Source and EHRs to read the original article.

Users of the applications will also have a method to report back to the open source agent changes to the software.

A custodial agent is an organization that has experience in establishing and operating an open source community, its processes and resulting products.

The operational Open Source Electronic Health Record Agent (OSEHRA) is the next step in the two departments moving toward an open, modular architecture that uses non-proprietary standard open interfaces, according to Peter Levin, VA chief technology officer.

VA is developing an open source track to modernize its VistA electronic health record and will incorporate the approach with DOD in the joint system.

VA expects to launch on Aug. 30 the open source agent website where interested users can register, download code for the modules and give code back. VA has tested, certified and evaluated the modules available through the open source agent, Levin said Aug. 29 at the Military Health Systems Information Management conference.

While VA already makes its codebase available, the feedback loop is new. “You can take that codebase from us, make changes and we now have a mechanism where they can give it back to us,” he said.

“The big idea is to make it easy, transparent and accessible for anybody whether it’s a large defense contractor or a kid in a garage in Nebraska. We want everyone pulling down code and looking at it, and being able to say, I know a fix, I have an improvement, I found a bug, I can extend the capabilities,” Levin said.

For example, a CIO in a VA facility or in the Military Health System may find at the OSEHRA website an existing module that would be useful in a clinic. Currently, VA has separate instances of VistA at its hospitals.

If the user finds a bug or for some reason the software doesn’t integrate with the system version, the open agent will have someone to contact. “When you figure out how to make it work in your system, we’re going to report it back to OSEHRA, so that everyone will know how to improve, fix or repair it,” he said.

In June, VA awarded the Informatics Applications Group Inc. (TIAG), a management and technology services company, $5 million contract to launch and open source community.

VA believes the collaborative method will generate innovation from more sources more quickly to advance the capabilities of VistA. Moving to an open source model invites innovation from the public and private sectors. VA will be just one of the participants in the open source community, although a large one.

VA’s path is not meant “to take dollars out of vendors and turn the world of implementation upside down. This is going to cost us about the same as it would have if we kept them separate,” he assured.

“You go with open source because there is no way with a proprietary platform that you are going to stay near the cutting edge of new capabilities,” he said, noting that large IT procurements often are dated by the time they are deployed.

Click on Healthcare IT News to access the original article.

Prompted by President Obama’s push for medical facilities to adopt electronic records, hospitals may pay companies to modify the open-source code likely to power the government-developed system, rather than buying commercial systems, said Ed Meagher, former Veterans Affairs deputy chief information officer.

Veterans Affairs plans to modernize its records system using open-source software, making it likely that the VA-Defense system also will use it, said Meagher, now vice president of health-care strategy for Computer Sciences Corp. in Falls Church. Open-source software is publicly available and can be shared with other organizations at no charge.

The government agencies “are going to spend north of $4 billion turning these two systems into one new system,” said Meagher, whose company may win business modifying the government’s open-source code for other hospital systems. “And when they’re done, anybody in the world will be able to use it.’’

The Obama administration has begun distributing as much as $31.3 billion in incentive payments to encourage hospitals and doctors to adopt electronic health record systems. The federal government plans to reduce Medicare reimbursements to physicians who fail to make the transition by 2015.

‘Whole enchilada’

Companies that primarily sell “all-or-nothing” electronic health records that provide “the whole enchilada,” such as closely held Epic Systems of Verona, Wis., may suffer, said Gene Mannheimer, an analyst with Auriga USA.

“Smaller niche vendors that are good at certain aspects of electronic health records, like providing lab or pharmacy applications, could benefit,” Mannheimer said.

The VA and the Pentagon operate two of the largest health-care systems in the country. They have been criticized for running separate electronic health records networks to serve an overlapping population of U.S. military personnel and veterans.

Veterans Affairs Secretary Eric K. Shinseki and former defense secretary Robert M. Gates agreed in March to use a common platform.

The departments plan to use a common technology architecture and share data centers to cut costs and promote efficiency, said Beth McGrath, the Pentagon’s deputy chief management officer.

She said the private sector also may provide applications enabling the departments to share pharmacy information and laboratory work.

“We want to be able to take advantage of things that have already been built,” McGrath said in a June 29 interview.

The Pentagon won’t spend money on modernizing its current electronic health records system and will pay only to sustain current operations or for critical fixes, McGrath said. Companies including Science Applications International Corp., Planned Systems International and Deloitte have made more than $100 million each from contracts related to that network, and may lose work as the department phases it out.

Software contract

The VA awarded a $5 million contract in June to Reston-based Informatics Applications Group to build and manage a network of software developers to upgrade its electronic record.

Three U.S. congressmen and two U.S. senators representing Wisconsin, including Rep. Paul Ryan (R) and Sen. Herb Kohl (D), opposed the open-source decision earlier this year. The lawmakers, from the state where Epic Systems is located, urged the VA and Defense to consider using a single vendor’s commercial product instead of multiple vendors or a “homegrown development strategy.”

“While multivendor EHRs were common in the past, patient safety, workflow efficiency, and other concerns have caused the industry to move away from this model,” the lawmakers wrote.

Epic Systems provided technical information to the staff of the Wisconsin lawmakers who sent the letter, Barb Hernandez, a spokeswoman for the company, previously told Bloomberg Government. She did not respond to phone requests for comment on this story.

Michael Cherny, a New York-based analyst with Deutsche Bank, said Epic worked on VA pilot programs in the past. But “the VA is very focused on using an open-source platform to create greater connectivity and interoperability,” he said.

Allscripts Healthcare Solutions “has done a good job of creating an open architecture platform’’ in a product line for acute care software, Cherny said.

GE Healthcare IT’s Centricity products, which relay radiology images, track medications and schedule surgery, can function in an open-source environment and would be useful as the departments try to modernize their system, said David Motherway, a government account executive with Fairfield, Conn.-based General Electric, in an Aug. 1 e-mail.

Click on VA Goes Open Source to read the original article.

EHR Doctors developed its own platform for Health Information Exchange, which it calls Medibridge.net. Medibridge.net includes technology to generate Continuity of Care Documents from a hospitals Electronic Health Record systems and to transport those records securely over the NwHIN. Medibridge.net also allows patients to control who has access to their information over the Medibridge.net platform, keeping patient privacy at the forefront of the exchange. Medibridge.net plans to offer physicians and other clinicians to access health records over the NwHIN in the 4th quarter 2011.

EHR Doctors, Inc. leveraged Medibridge.net in establishing the link with Midland Memorial Hospital's OpenVista clinical information system. Midland Memorial Hospital's clinical document repository (CDR) is connected to EHR Doctor's record locator service in a federated manner, meaning Midland's patient records remain inside the hospital's firewall while allowing records to be located and exchanged across EHR Doctors, Inc.'s gateway to the NwHIN.

EHR Doctors, Inc.'s CEO, Gerard Reeder, stated, “We are very pleased to welcome Midland Memorial Hospital to the growing Medibridge.Net family and to the NwHIN. Midland Memorial Hospital has the distinction of being named the recipient of the 2009 CIO 100 Award for its implementation of the open source VistA electronic health records system from the United States Department of Veterans affairs, and is a proven leader in electronic health record adoption. Midland was awarded the distinguished Level 6 designation by the Healthcare Information and Management Systems Society, (HIMSS) recognizing its high level of automation in delivering patient care. Midland Memorial was also named a Top 100 Hospital by the Thomson organization and one of America's Most Connected Hospitals by US News and World Report. We have thoroughly enjoyed our collaboration with David Whiles, Midland Memorial Hospital's Director of Information Systems, and his colleagues in this collaboration.”

“This is a very important undertaking for Midland Memorial Hospital and our patients throughout Midland, and West Texas. Using EHR Doctors, Inc.'s gateway to the Nationwide Health Information Network is providing significantly faster transfer of medical records for our patients who are applying for disability benefits. We are excited to be a part of SSA's approach to expediting the disability determination process”, said David Whiles.

Click on EHR Doctors to read the original release and learn more about Medibridge.net.

When the president of the Joint Commission, the Chicago-based group that accredits the nation's hospitals, unveiled mandatory rules to prevent operations on the wrong patient or body part, he did not mince words.

"This is not quite 'Dick and Jane,' but it's pretty close," surgeon Dennis O'Leary declared in a 2004 interview about the "universal protocol" to prevent wrong-site surgery. These rules require preoperative verification of important details, marking of the surgical site and a timeout to confirm everything just before the procedure starts.

Mistakes such as amputating the wrong leg, performing the wrong operation or removing a kidney from the wrong patient can often be prevented by what O'Leary called "very simple stuff": ensuring that an X-ray isn't flipped and that the right patient is on the table, for example. Such errors are considered so egregious and avoidable that they are classified as "never events," because they should never happen.

But seven years later, some researchers and patient safety experts say the problem of wrong-site surgery has not improved and may be getting worse, although spotty reporting makes conclusions difficult. Based on state data, Joint Commission officials estimate that wrong-site surgery occurs 40 times a week in U.S. hospitals and clinics. Last year 93 cases were reported to the accrediting organization, compared with 49 in 2004. Reporting to the commission is voluntary and confidential -- to encourage doctors and hospitals to come forward and to make improvements, officials say. About half the states, including Virginia, do not require reporting. In two states that track and intensively study these errors, 48 cases were reported in Minnesota last year, up from 44 in 2009; Pennsylvania has averaged about 64 cases for the past few years.

Attention to the problem comes at a time of increased focus on the broader issue of medical errors, which a recent Health Affairs study found affected one-third of hospital patients. The federal government recently rolled out its Partnership for Patients program aimed at reducing medical mistakes. Medicare requires reporting and does not pay for wrong-site surgery, and many insurers have followed suit. Medicaid has announced a similar policy, to take effect next year.

What seemed pretty straightforward in 2004 now seems more complicated. "I'd argue that this really is rocket science," said Mark Chassin, a former New York state health commissioner and since 2008 president of the Joint Commission, which has issued refinements to the 2004 directive. Chassin said he thinks such errors are growing in part because of increased time pressures. Preventing wrong-site surgery also "turns out to be more complicated to eradicate than anybody thought," he said, because it involves changing the culture of hospitals and getting doctors -- who typically prize their autonomy, resist checklists and underestimate their propensity for error -- to follow standardized procedures and work in teams.

"It's disheartening that we haven't moved the needle on this," said Peter Pronovost, a prominent safety expert and medical director of the Johns Hopkins Center for Innovation in Quality Patient Care. "I think we made national policy with a relatively superficial understanding of the problem." Pronovost suggests that doctors' lip service to the rules, which he calls "ritualized compliance," may be a key factor. Studies of wrong-site errors have consistently revealed a failure by physicians to participate in a timeout.

Some recent cases: In April an ophthalmologist in Portland, Ore., operated on the wrong eye of a 4-year-old boy. In December 2010, Beth Israel Deaconess Medical Center in Boston reported that neurosurgeons had performed three wrong-site spinal surgeries in a two-month period. And after five wrong-site operations in less than three years, state officials in 2009 ordered that video cameras be installed in the operating rooms of Rhode Island Hospital in Providence, which was fined $150,000.

Wrong-site mistakes have multiple causes, experts say: mixing up the left and right sides; operating on a patient who was accidentally given test results belonging to someone else; marking the incorrect vertebrae in spinal surgery; neglecting to mark the site at all. Some occur even though a member of the surgical team thinks something might be wrong but fails to speak up, fearful of slowing the process or challenging the surgeon in charge.

Reported cases are "clearly the tip of the iceberg," said Philip F. Stahel, director of orthopedic surgery at Denver Health Medical Center.

Stahel was lead author of a 2010 study of 132 wrong-site and wrong-patient cases reported by doctors to a large malpractice insurer in Colorado between 2002 and 2008, one-third of which resulted in death or serious injury. Among them were three men who underwent prostate cancer surgery although they were cancer-free. In 72 percent of cases there was no timeout.

Stahel says many doctors resent the rules, even though orthopedists have a 25 percent chance of making a wrong-site error during their career, according to the American Academy of Orthopaedic Surgeons, which launched a voluntary "Sign Your Site" campaign in 1997.

"It's very frustrating," said surgeon John Clarke, clinical director of the Pennsylvania Patient Safety Authority. "If you can't solve the wrong-site-surgery problem, what can you solve?"

Ritualized Compliance

The legal system typically offers little recourse: One study found that only a third of wrong-site cases result in a malpractice suit. Stahel's team found that the average payment was less than $81,000 in cases resulting in a lawsuit and $47,000 in those resolved without legal action.

While some wrong-site errors inflict little or no injury, either because they are corrected early or did not involve major surgery, others are devastating. Last year a jury returned a $20 million negligence verdict against Arkansas Children's Hospital for surgery on the wrong side of the brain of a 15-year-old boy who was left psychotic and severely brain-damaged. Testimony showed that the error was not disclosed to his parents for more than a year. The hospital issued a statement saying it deeply regretted the error and had "redoubled our efforts to prevent" a recurrence.

"I felt violated," said Lexie Fincher, 39, of Fredericksburg, whose Virginia surgeon in 2008 failed to mark the site of a benign tumor, then misinterpreted her MRI scan and operated on the wrong part of her shoulder, causing continued pain and leaving a scar. "It was absolutely avoidable."

Clarke said researchers have discovered that the way a timeout is done and where it is performed make a difference, details that the protocol initially did not specify. Doctors who verify the site and procedure with patients before they are wheeled into surgery are less likely to make a mistake, as are those who explictly ask everyone on the team to speak up if they have concerns. "There's a big difference between hospitals that take care of patients and those that take care of doctors," Clarke said. "The staff needs to believe the hospital will back them against even the biggest surgeon."

'They Will All Die'

Many experts say that medicine needs standardized rules similar to those in aviation, which bar takeoff until a pilot and co-pilot complete a prescribed checklist without interruption. Airlines have a vested interest in a culture of safety that Stahel says medicine lacks. In surgery "sometimes people say, 'Well, this isn't quite right, but someone else will address it.' In aviation they don't do that, because the plane will crash and they will all die," he said.

"Health care has far too little accountability for results. ... All the pressures are on the side of production; that's how you get paid," said Hopkins's Pronovost, who adds that increased pressure to turn over operating rooms quickly has trumped patient safety, increasing the chance of error.

[Medsphere chairman] Kenneth W. Kizer, who coined the term "never event" nearly a decade ago when he headed the National Quality Forum, a leading patient safety organization, said he believes reducing the number of errors will require tougher reporting rules and increased transparency. Kizer, California's former chief health officer, advocates mandatory reporting of wrong-site errors to a federal agency so cases can be investigated and the results publicly reported.

"How can you say these things should not be reported?" asked Kizer, director of the Institute for Population Health Improvement at the University of California at Davis. "These are the health-care equivalent" of plane crashes.

Shepard Hurwitz, director of the American Board of Orthopaedic Surgery, said he believes withholding payment for errors may prod hospitals fearful of offending their medical staffs to enforce safety rules and take action against recalcitrant doctors. "I think before it was thought to be the cost of doing business," Hurwitz said. "I think the first time it happens, the person should be taken out of circulation until they understand what they did wrong. And if it happens again, they're finished."

One Surgeon's Mea Culpa

Hand surgeon David C. Ring was in his office at Massachusetts General Hospital dictating notes when the sickening realization hit him: The carpal tunnel release he had just completed was the wrong surgery.

"It was the worst feeling of my life: The ground literally falls beneath you," Ring recalled in an interview. He returned to the operating room and informed the staff, then apologized to the 65-year-old patient, who spoke only Spanish and agreed to let him perform the correct surgery, a trigger finger release.

Several factors contributed to Ring's mistake, which he wrote about last year in the New England Journal of Medicine; chief among them was the failure to perform a timeout because of various distractions.

The patient did not file a lawsuit, and Ring said the hospital paid her a modest amount in compensation. As a result of the case, safety monitors were assigned to the hospital's operating rooms, and nurses were instructed not to hand the knife to the surgeon until the timeout is completed.

"I was an advocate before, but now I really believe in safety systems," said Ring, who speaks to medical groups and says he still "tears up" when discussing the error. "I don't want any patient or doctor to feel like I felt."

Click on Never Events to access the original Kaiser Health News article.

A prototype interface already has been developed, Gould told the Senate Committee on Veterans Affairs on May 18.

The user interface provides the front end and a point-of-entry for physicians to interact with the digital medical record system, he said.

The VA-DOD program to develop a common electronic health record system has kicked into high gear in recent weeks, following a February 2011 critical report from the Government Accountability Office that suggested the two departments did not have an effective joint strategy.

The GAO concerns were legitimate, Gould said, and as a result the VA and DOD secretaries met and committed to a joint electronic platform for health records.

The prototype development should “give this committee confidence that we are heading down the right road,” Gould said. Once it is fully tested and implemented, the user interface will provide to both VA and DOD doctors that ability to optimize their use off the system to treat patients, he added.

Other milestones for the joint system in the coming months include instituting a single computer sign-on for VA and DOD staffers utilizing the digital medical records system at the James Lovell Federal Health Center in North Chicago. That facility opened in November 2010 as the first in the country that has been established as a joint VA and DOD medical center.

Overall, by June 2012 there will be “significant functionality shared between VA and DOD,” Gould added.

William Lynn III, deputy secretary of defense, who also testified, said the joint development approach will utilize commercial components whenever possible. It will be led by a program executive and deputy director selected by both VA and DOD secretaries and overseen by an advisory board co-chaired by the DOD deputy chief management officer and the VA assistant secretary for information and technology.

“Developing large-scale IT systems is difficult for any organization, public or private," Lynn said in his testimony. "Jointly developing an interoperable system across two major federal departments is more difficult still. To the extent that other large joint IT systems have succeeded, they have based on a common data foundation, common service bus, and common service broker."

Click on VA and DoD Interface to access the original article.

He directed the VA Health Care System during its metamorphosis; led the California health department during the early years of HIV, spearheaded a blunt anti-tobacco campaign that politicians tried to quash, and coined the term "never events."

Perhaps most significant, in 1999 this former emergency room physician founded and directed the National Quality Forum, an independent group of stakeholders who develop reliable, accurate ways for hospitals and other providers to measure, report, and improve quality. That's a tough set of issues from which to draw consensus.

Last Friday, the NQF became an even more significant player in healthcare reform.  That's when the Obama Administration released the final rules for Value-Based Purchasing.

Set to take effect July 1, the rules establish specific measurements—nearly all of them researched and endorsed by the NQF—that will financially reward or penalize hospitals on the basis of care quality. With 1% or 2% of a hospital's entire Medicare DRG payments at stake in the coming years, quality now makes a business case for itself.

Moreover, next year there will be many more measures added, and more still the year after that.

Just before the VBP release, Kizer found some time for a telephone interview with me about where the quality field has been, and more importantly where it's headed.

"Now everyone is talking about measuring quality," he said, "But that wasn't how it was 11 or 12 years ago when I started NQF. No one really wanted to engage in measurement. Now, it's in a different place, but it clearly is not being used as much as it should be. There are many areas of medicine where there simply are no measures—or there are, but they aren't as good as they should be."

He added, "This is a very young and immature science, and that statement's probably more significantly true for outcome measures than for process measures."

Kizer says that for all of the work being done to link such process measures with improved survival, mobility and function, like giving patients serum glucose at 6 a.m. after their cardiac surgery, quality metrics today overlook one enormous ingredient that makes what doctors and hospitals and nurses provide pale in comparison.

"We have to remember that the healthcare that hospitals and doctors provide is only a small piece of what makes people healthy, perhaps only 10%," he says.  The rest has to do with family, food, diet, environment, education, lifestyle, and so forth.

And to focus on that, without looking at the other 90%, "creates misperceptions about a lot of other things that we should be looking at," Kizer says.

But unfortunately, we're only at the beginning of our search to find quality measures to improve that other 90%, he says.

Take, for example, let's look at veterans and smoking, two of his favorite topics.

The military tries to reduce smoking among its personnel, and does a good job offering nicotine replacement therapy to active duty members or veterans. But, Kizer says, "They don't offer it—it has been expressly forbidden—to give it to their families.

"So here you have veterans who got off the smoking habit, and we send them back to their families where everyone else is smoking. What's the likelihood they're going to continue to not smoke?  Here's a huge cause of morbidity in this country, and a great example of why we cannot treat patients in isolation."

The physician takes care of the hospitalized CHF patient, prescribes medications and sends him home. "But the patient doesn't take the medications, goes out and eats French fries and loads up on salt, and ends up back in the ER within 30 days. Whose responsibility is that?" Kizer asks.

What can be done, then, to change the situation? "I take the perspective that there's much more that healthcare could do to prevent these kinds of things than some people would agree with," Kizer explains. "Did they [the care provider(s)] try to have contact with the patient every day to measure their weight?"

The way to manage this increased intensity on quality, Kizer says, requires providers to adopt "a team activity."

• Does the health provider have teams in place to support the patient at home so he doesn't end up back in the hospital?
  
• Is anyone calling the patient to see if they took their medications? And ask if they are okay?
  
• Is anyone asking how the patients are doing on their diets?

"It's unrealistic that the doctor should be doing that, as nice as that might be," he says.

Back in February, Kizer, 59, was tapped to direct the new Institute for Population Health Improvement at University of California at Davis Health System, an entity that will tackle pressing issues dealing with how we find strategies to improve health in the community, including how to measure them.  That's a whole new field of science.

Kizer says he's happy that hospital care is finally being measured in a meaningful way, though he realizes that many providers think the science isn't quite there yet. Still, he believes the most important revelations about quality of care are still to come.

"One way of keeping measurements from being good is to not use them, which some people would like to see," he acknowledges. "But we have a saying: 'Nothing makes a performance measure better than when it starts being used.'

"Because once it is used in the real world, you find out all the little nuances;  the real world situations that may not have been thought about when it was being designed.

Kizer believes that for those who think value based purchasing is a bad idea that can't last, and have the attitude that "this too shall pass,' are very mistaken. "It may not make some people very happy, but a few years from now, we'll be talking about amounts of money that are much higher than 1% to 2%."

I think he's absolutely correct.

Click on Measuring Quality to read the original article.

Thus, the IHS becomes the first federal agency whose EHR system has achieved certification under the incentive program, according to a news release (PDF). The IHS provides healthcare services to 2 million American Indians and Alaska natives in 35 states.

RPMS, which derives from and remains closely related to the Veterans Affairs Department's VistA EHR system, is used at more than 280 IHS, tribal and urban Indian healthcare sites, according to the IHS.

In addition, an open-source version of RPMS was installed in several dozen federally qualified healthcare clinics in West Virginia, with plans for its use in a nursing informatics program and at a student clinic at Shepherd University in Shepherdstown, W.Va.

“Our certified electronic health record will help us provide quality healthcare delivery to patients in the Indian health system," said IHS Director Dr. Yvette Roubideaux. "The monetary incentives made available by this certification will also benefit IHS, tribal and urban Indian health facilities."

Click in IHS and Meaningful Use to access the original article (basic registration required).

Decision makers would do well to study the health care delivery system of the Department of Veterans Affairs. To meet the challenges of the nation’s largest integrated health system, VA has developed strategic public-private partnerships that are crucial to its mission.

These relationships, using sophisticated information technology and supply-management systems, allow VA to drive innovation throughout its health care system. This has made VA more productive and better equipped to deliver the highest level of care to a group our nation has always honored: men and women who have served and sacrificed for our freedom.

Indeed, one thing that distinguishes America is its sense of responsibility to those who have served in uniform. We believe strongly in standing up for those who stood for us. Our promises to them are important, and we understand they bear a strong relationship to our freedom. These obligations are met through both public and private institutions that have professionals who understand values that make our country strong.

I am a product of both the Army’s and VA’s health care systems. They had a profound effect on my life — and the lives of millions of others. I know these organizations and their people well.

While neither system is perfect, those working in the Department of Defense and VA systems are talented, creative people who dedicate their lives to delivering the best care and services.

Private partners, such as The Center for the Intrepid in San Antonio, Texas, a state-of-the-art facility linked to Brooke Army Medical Center and funded privately by more than 600,000 donors, inspire our wounded warriors while offering expert physical rehabilitation.

Fisher House Foundation is another partner. It provides free housing near DoD and VA medical facilities to injured service members’ families so they can be close to their loved ones and participate in their recovery.

Most recently, VA has joined with the Paralympics to use sports as a platform for healing. Our soldiers, sailors, airmen and Marines can now train and compete as world-class athletes.

Seventy-five years ago, at age 12, I worked at Dawson’s Drugstore in my hometown of Russell, Kan. I can still hear the creaking of the pine floors, see the smiles around the soda fountain and remember the medicinal smells of the pharmaceutical products. Behind the counter were hundreds of bottles containing compounds, many supplied by a company named McKesson, now VA’s partner in managing its award-winning mail-order centers that deliver pharmaceuticals to all VA medical facilities using technologies none of us could have imagined then.

VA is now considered 10 years to 15 years ahead of the private health care system when it comes to technology. Its success has largely been because of its commitment to innovation. This model for government action is possible because of its unique purpose, as well as its successful public-private collaboration. These efficiencies are significant for patients and taxpayers.

One reason our nation is resilient and strong is that we understand, in our finest public and private institutions, the values and commitments that make an enduring legacy. While our nation faces great economic challenges, our spirit is forged in the abiding desire to press the limits of discovery and persist through the greatest difficulties.

The contributions of private initiatives and ingenuity — and our nation’s ability to apply them to government functions — have been a vital component to fulfilling America’s solemn obligations. It is certainly true of the high quality of care delivered to our veterans.

Policy leaders looking for examples of proven efficiencies that can stretch the dollar can learn from VA.

Bob Dole, a member of the 10th Mountain Division during World War II, is a former Senate majority leader and the 1996 Republican nominee for president. He is now special counsel at Alston & Bird LLP, which represents McKesson.

Click here to access Senator Dole's original comments.

WASHINGTON--(BUSINESS WIRE)--The Department of Veterans Affairs (VA) today released a draft Request for Proposal (RFP) aimed at forming an Open Source community around its ground-breaking VistA (Veterans Integrated System Technology Architecture) electronic health record (EHR) system. When award is made under a planned RFP for a custodial agent, VA will commit to deploy the Open Source version of VistA to all of its facilities, and will contribute all non-security essential modifications to the product it makes or pays for directly to the Open Source custodian. VA will also commit to participate in Open Source VistA with other public and private sector participants.

"VistA is an important asset for VA, and for the Nation,” said Secretary of Veterans Affairs Eric K. Shinseki. “As we work to ensure that we provide Veterans with the best in health care, modernization of VistA is absolutely critical. This move towards Open Source welcomes private sector partners to work with us to improve VistA, and is an important part of our strategy to ensure that VA clinicians have the best tools possible, and that Veterans receive the best health care possible."

VA expects to begin conversion to an Open Source version of VistA by this summer. A key step in this process will be the selection of a custodial agent to perform all aspects of operating the Open Source community. On Feb. 18, 2011, VA released a Request for Information (RFI) asking for information from stakeholders and potential offerors for a custodial agent. Concurrent to this announcement VA issued a draft RFP for custodial services.

The VistA system is widely viewed as the most extensively used electronic health record system in the Nation. It is currently used in 153 major VA hospitals and more than 800 community based outpatient clinics across the U.S. It forms the basis of the Resource and Patient Management System (RPMS), the EHR system used by the Indian Health System, as well as the basis of installations in more than 50 hospitals globally. A vibrant community outside VA already uses VistA.

"Over the past year, we have followed a deliberative process to examine the implications of Open Source for VistA, and we are convinced that this is the best approach for VA, Veterans, and taxpayers," said Roger Baker, VA assistant secretary for information and technology. “Our primary goal is to re-ignite the innovative processes that made VistA such a great EHR system. We also want to ensure that vendors of proprietary products can easily and confidently integrate their products with VistA to make them available for VA to purchase and use in our facilities.“

VA expects that other organizations may commit to VistA Open Source, and welcomes their participation in the development, use and governance of VistA.

VA Chief Technology Officer Peter Levin, who helped lead the Open Source initiative, said, “This is a terrific example of what the Administration means by Open Government: transparent, collaborative and truly participatory. This is a historic moment for health care informatics. By moving towards standards-based systems that incorporate health records and the best that industry and government can offer, VA will remain at the vanguard of electronic health care delivery.”

Hundreds of companies, organizations, government agencies, universities, Congressional stakeholders, and individuals advised VA’s path towards Open Source via published studies, RFI responses, meetings or individual comments. In the best traditions of Open Source, the combined wisdom of this community has ensured establishment of a much better path than any single institutional stakeholder could possibly have achieved on its own.

Contacts

U.S. Department of Veterans Affairs
Office of Public Affairs
Media Relations
202-461-7600