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What Would It Take To Get More Hospitals On VistA?

Posted on January 22, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

Recently, we shared the story of of a California community hospital that decided to bypass big vendors like Cerner and Epic and go for a VistA installation instead. While Oroville Hospital ended up spending $10 million on its VistA implementation, that turned out to be about half of what it would have spent on Cerner and its big-vendor cousins. Then, to boot, Oroville got a $5 million Meaningful Use payout.

Yes, without a doubt, Oroville had a different experience when it went with VistA than it would have if it hired on Epic and had armies of be-suited consultants descend onto its campus. Any open source project faces the risk that the fervor and volunteer labor that makes up the backbone of its ongoing development efforts.

But given how much flexibility hospitals get out of the deal, and how much they save, it seems to me that you’d still expect to see more VistA projects being mounted.  What would it take? Here’s a few ideas:

*  Get a CCHIT-certified VistA product out there:  Right now, hospitals don’t have such a choice. The only reason Oroville got its instance certified was thanks to special help from World VistA.

* Have more happy talk stories on how VistA can really work appear in serious business publications like Forbes:   Arguably, peer pressure is a major reason hospitals stick to a short list of popular solutions.  More coverage of VistA successes in major pubs creates its own buzz which may encourage IT leaders to reconsider their existing plans.

* VistA consulting firms need to become more common:  Right new there are a few firms, like Medsphere, that will walk hospitals through the VistA installation process. But what if, say, Accenture had a division devoted to VistA support?

There’s not a lot you can do if a hospital CEO is determined to buy Epic or Meditech or Cerner. But if they want to consider VistA, there’s a lot the industry could do to help.

Why Aren’t You Using the VistA EMR?

Posted on September 26, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

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.