Why Aren’t You Using the VistA EMR?

For years, health IT pundits have marveled at the VA’s open source EMR, VistA, which has long had the reputation of being one of the best platforms available anywhere. Not only has it been in existence since the late 70s, making it arguably the most mature EMR anywhere, it’s, well, free.

You’d think that being able to download it gratis might make VistA a bit popular among agonized hospital CIOs, who otherwise face spending several million on systems that might not work.

Not only has VistA run with enormous success within the sprawling VA system, which includes 152 hospitals and 804 outpatient clinics, it’s also been nurtured for commercial use since 2002 by the WorldVistA project.

But no. Despite all of this effort, hospitals have been slow to adopt the VA’s wonder child. Why? Well, consider some of the commentary on the subject and see what you think.

Former Beth Israel Deaconess Medical Center CIO John Halamka, an industry tastemaker if there ever was one, was quoted once as saying that while he’s a fan of open source, VistA wouldn’t work for many settings, as it was designed for big institutions with a single payer. As much as I respect Dr. Halamkha, I’m not sure I follow why a billing issue would prevent hospitals from leveraging VistA’s excellent clinical functionality.

Other talking heads have noted that while VistA — and other open source EMR/EHR projects — are free, it can cost millions to customize and integrate such systems. (And their point is what, that it’s really cheap to implement, say, a proprietary monster like Epic?)

OK, I get it. Open source EMRs are still freaky, weird and insufficiently controlled by big, centralized vendors. They’re, well, too unpredictable for hospital organizations with rigid rules. They’re managed by hippie programmers with long beards. They don’t come in pretty packages and their developers don’t wear Dockers.

Seriously, guys, you disappoint me. I realize that even massively successful tools like Linux were strange and mysterious in 1996, but it’s been 15 years since then. I’d bet that virtually any developer on your facility’s team could jump into open source dev projects in a heartbeat.

Wait — you know that already. So it must be the doddering 75 year old traditionalists who still run some hospitals that are keeping the brakes on, long after hyperconservative industries like pharma and financial services have taken open source to their breast.

It’s sad to think that after this long, the fact that LAMP developers hate wearing ties is more important than whether WorldVista, OpenEMR or its peers can actually save money and/or do a better job. But sadly, I think that’s where we’re at. Bummer.