The move by the federal agency is meant to make it much more affordable for small doctor offices and clinics to adopt health IT, such as clinical software, which often costs several thousand dollars to deploy and support.
The new VistA-Office EHR software is "dirt cheap by computer standards," a CMS spokesman says. Doctors and clinics ordering the software will likely pay less than $50 to purchase the software from CMS, including a $39 mailing fee. Downloading the software via the Web will avoid the mailing fee.
However, software-licensing costs, including the third-party operating system and Cache database from InterSystems Corp., which is part of the electronic health-record system, brings the estimated deployment costs of VistA-Office EHR to about $2,700 for a five-doctor practice in the first year. After that, CMS estimates it will cost about $1,000 per year for that size practice to run and support the software.
Getting doctors--especially those in small practices--to use electronic health-record systems in their offices is a very important aspect of the federal government's overarching goal of broader adoption of clinical IT systems and the creation of an interoperable, national health data exchange. President Bush last year set a national goal for most Americans to have digital health records by 2014.
The Veterans Health Administration, part of the Department of Veterans Affairs, developed VistA and has been using the software in its facilities for about 20 years. The Veterans Health Administration has long made it available for free to doctors and clinics. However, the older version of the software is said to be difficult to install and use, so relatively few doctors or clinics reportedly have adopted it.
CMS's new expanded version, renamed VistA-Office EHR, is easier for small practices to install and use than the older version, the CMS spokesman says.
The relatively small fee to purchase the software is aimed at "helping the little guys who can't afford" more-expensive commercial packages, he says.
Even with the inexpensive price tag and improved user-friendliness, it's still uncertain whether small clinics and doctors in small practices will swarm to VistA. Like all IT adoptions, the software will require tech support, not to mention having clinicians revamp their business processes and workflows and adapt their culture--all big challenges that have put off many doctors from adopting information technology.
A number of private, third-party services companies are expected to offer installation and support services for VistA-Office EHR. CMS has established a nonprofit vendor-support organization for VistA-Office EHR called WorldVistA to help train third-party companies.
Medsphere Systems Corp., an IT services company specializing in open-source systems, plans to sell an enhanced version of VistA-Office EHR called Open Vista that has been modified using open-source development methodologies and will run on open-source systems, says Dr. Scott Shreeve, Medsphere's chief medical officer and co-founder.
While the federal government is making a good effort to promote adoption of digital health record technology and standards, CMS doesn't offer training or support for VistA-Office EHR, "which we'll do as a [technical services] provider," Shreeve says.
Health plan WellPoint Health Networks Inc. learned nearly two years ago that giving away free IT products to doctors wasn't a sure bet for tech adoption. One in four of WellPoint's 25,000 contracted doctors passed on WellPoint's offer for free PDAs or PCs to use in their practices.
The biggest hurdle for doctors participating in WellPoint's $42 million giveaway of IT products wasn't the installation of the gear and software, but keeping it running. WellPoint chairman Leonard Schaefer has said publicly that "free isn't cheap enough" when it comes to trying to get many physicians to adopt IT.