While you may have heard of the Veterans Health Information Systems and Technology Architecture (VistA), what you may not know is that enterprising companies are taking the highly successful clinical information technology system and adapting it for use by their healthcare clients. Offering cost-savings and efficiencies, use of the VistA model outside government in both hospitals and physician practices might even be a significant step toward uniform electronic health records, experts say. Once an inefficient behemoth, the Veterans Affairs healthcare-delivery system underwent a transformation in the 1990s with Dr. Kenneth W. Kizer, a Clinton administration appointee, at the helm. As the VA's undersecretary of health, Kizer oversaw patient-centered changes that automated and synchronized the delivery of healthcare services while also improving patient satisfaction. One of the most significant changes was VistA, an integrated outpatient and inpatient information system. In July, VistA won a Harvard University's Innovations in American Government Award. "Outside of VA, because patient records are not readily available, one out of seven Americans ends up hospitalized when outpatient care is all that's needed. For the same reason, one out of five lab tests is needlessly repeated outside the VA system. And while the costs of healthcare continue to soar for most Americans, the VA is reducing costs, reducing errors, and becoming the model for what modern healthcare management and delivery should look like," said a joint statement from Harvard and the VA. There's another good thing about VistA — it was funded by taxpayer dollars and therefore available via the Freedom of Information Act. Thus, there are no license fees, and entrepreneurs are launching their own platforms based on VistA while benefiting from their own enhancements to the software as well as continual updates by the VA. "Billions of dollars have gone into this product, and millions of dollars continue to go into it every year. In the end, we can have that value, and what we invest just puts more icing and whipped cream and cherries on top," said Frank Pecaitis, vice president of sales and marketing for California-based Medsphere Systems Corp. Medsphere is one of many companies that has taken advantage of the availability of VistA, and Medsphere's CEO and chairman is Kizer, the former VA undersecretary. While many companies have based their software platforms on the VistA model, Pecaitis said Medsphere is the first to offer an open-source model, which provides users the source code so they may make changes to its operation. "The basic idea behind open source is very simple: When programmers can read, redistribute and modify the source code for a piece of software, the software evolves. People improve it, people adapt it, people fix bugs. And this can happen at a speed that, if one is used to the slow pace of conventional software development, seems astonishing," according to the Open Source Initiative, a nonprofit organization. There's also an organization specifically dedicated to promoting the widespread adoption of VistA to improve healthcare. It's called the VistA Software Alliance, promoting the use of the software as a launching pad for efficient and integrated medical-records technology. According to the alliance, VistA is "easily customizable and can be configured to fit any type of healthcare organization, from clinics and medical practices to nursing homes and large hospitals." Pecaitis said that Medsphere targets medium to large-sized physician practices and hospitals of all sizes. The company also is recruiting state-owned delivery systems to its subscription-based service. The latest is West Virginia, which will use the company's OpenVista® platform in seven state-operated acute care hospitals, psychiatric hospitals and long-term care facilities. Medsphere has installed its platform more than 60 times across the country and has "a growing list of potential hospitals and clinics in our sales pipeline right now," he said. A cost-saving improvement at a cost-effective price is the beauty of VistA-based software, Pecaitis said. "When it was built, it was ahead of its time because fundamentally it doesn't discriminate whether you're an inpatient or an outpatient, a doctor or a hospital. It can be deployed in various healthcare settings. It can be scaled down to a small healthcare provider practice or up to a 2,000-bed, multi-hospital system," he said. Then there's the added bonus that it can link with other systems. "Imagine this: An entire state system and all the patients they treat in that system will have an electronic medical record once we're completed," he said. Then states using the same system will connect. "There are a lot of upstanding features that go beyond just automating an electronic record for a single hospital or a single physician. They (the VA) really have architected this product to provide regional health information sharing," Pecaitis said. The VA had a once-in-a-lifetime opportunity and didn't squander it. Today, its more than 1,400 hospitals, clinics and nursing homes use VistA — because it works. "VistA was built and designed by the largest health system in the country, primarily with their development team working closely with their clinical staff," Pecaitis said. "It wasn't a vendor specification idea that was in an ivory tower that was then introduced to hospitals. They built it unencumbered for their internal use and used a tremendous amount of internal brain trust in terms of their clinicians influencing the features and the applications and telling them what they needed to run both hospitals and clinics." The result? A clinical system, although Pecaitis explained that OpenVista does "capture the data that drives charging and reimbursement" for operations that want to mesh VistA-driven systems with billing and accounting ones. Medsphere offers clients the platform, plus support, implementation, training, documentation, updates and enhancements. November 2006