The VA’s Open-Source Electronic Medical Record System: An opportunity for the NHS?
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Transcript of The VA’s Open-Source Electronic Medical Record System: An opportunity for the NHS?
The VA’s Open-Source Electronic Medical Record System:
An opportunity for the NHS?
Dr. Geraint Lewis Senior Director, Walgreen Co.
Veterans’ Health Administration
“…to care for him who shall have
borne the battle, and for his widow,
and his orphan”Abraham Lincoln
Established in 1778 Only part of the Federal
Government that delivers health care*
Responsible for 23 million veterans (8.1 million actively enrolled)
*along with the Indian Health Service and the TriCare military health system
Transformation of the VA Major transformation mid-1990s
Peer-review study found that the VHA outperforms all other sectors of American health care in 294 measures of quality
Transformation involved shift from secondary to primary careperformance measurement electronic medical records (VistA)
The VistA EHR ≠ Microsoft Vista™
VistA = Veterans’ health information systems & technology Architecture
Comprehensive electronic health record system, spanning primary, secondary, and social care
Open Source
VistA Patient Portals
Hospital Doctor’s Perspective
NHS VANo background information on new patients
Full access to complete medical record
No automated prompts or warnings Multiple safety systems including alerts for drug interactions and allergies and prompts for overdue
No inbox equivalent Inbox for important overdue tests, screening, and admissions and procedures
Multiple idiosyncratic IT systems Single unified IT system
No avenue for dealing with frustrations Ability to write new programmes in open-source software
Hospital Doctor’s Perspective
NHS VANo background information on new patients
Full access to complete medical record
No automated prompts or warnings Multiple safety systems including alerts for drug interactions and allergies and prompts for overdue tests
No inbox equivalent Inbox for important overdue tests, screening, and admissions and procedures
Multiple idiosyncratic IT systems Single unified IT system
No avenue for dealing with frustrations Ability to write new programmes in open-source software
Airbus or Boeing?
Open Source Software VistA was written by Federal employees so it is
subject to Freedom of Information requests
Open sourceSoftware that can be used, redistributed or rewritten
free of charge
General Public Licence‘Keep-it-free’ licence
World VistA ecosystem
Darwinian Improvement Bright ideas spread
organically across the VA
Bad ideas wither on the vine
Example: cascading abnormal results (K+=5.9 mmol.l-1)
What happens if an NHS hospital wants to change IT supplier?
Now If NHS used VistAKeep hospital running 24 hours a day Select new supplier on basis of cost and
quality
Train staff on new system Nothing else changes
Install new system in parallel
In the existing supplier’s best interest to make transition as awkward as possible
Stagnation and uncompetitive healthcare IT market
Competitive health IT market that protects patient safety
What happens if an NHS hospital wants to change IT supplier?
Now If NHS used VistAKeep hospital running 24 hours a day Select new supplier on basis of cost and
quality
Train staff on new system Nothing else changes
Install new system in parallel
In the existing supplier’s best interest to make transition as awkward as possible
Stagnation and an uncompetitive healthcare IT market
Competitive health IT market that protects patient safety
Byrne et al., 2010 VA spends proportionately
more on IT than the private health care sector
Higher IT adoption Better quality of care
Net return on investment was $3.09 billion
Key Benefits of VistA Safety (Boeing versus Airbus) Cost (no licence fees, free training, and
economies of scale) Evidence-based Darwinian improvements Stimulates competition in IT support Popular with staff (written by doctors)
www.nhsvista.net
Further Reading Asch SM, McGlynn EA, Hogan MM, Hayward RA, Shekelle P, Rubenstein L,
Keesey J, Adams J, Kerr EA. Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample. Annals of Internal Medicine 2004;141(12):938-945
Byrne CM, Mercincavage LM, Pan EC, Vincent AG, Johnston DS, Middleton B. The Value From Investments In Health Information Technology At The U.S. Department Of Veterans Affairs. Health Affairs 2010; 29(4):629-638
Demonstration of VistA available at http://www.ehealth.va.gov/EHEALTH/CPRS_demo.asp
Litvin C, Cavanaugh J, Callanan MG, Tenner CT. To err is human continued: A failure of follow-up. Journal of Clinical Outcomes Management. 2008;15:21
Longman P. Best care anywhere: why VA care is better than yours. Sausalito, California: Polipoint Press, 2007