Question: When will VistA Office EHR (VOE) be available?
Answer: The initial release was scheduled for August 1, 2005. In conversations with contractors for CMS, it is uncertain when VOE will be available for download.
Question: What is VistA Office EHR? (VOE)
Answer: VistA stands for the Veterans Health Information Systems and Technology Architecture. It is an enterprise-wide electronic medical record that has been developed and used by the Veteran’s Affairs Hospital system for approximately 20 years.
VistA Office EHR is a version of the larger system that has been developed by Daou Systems, Inc., under contract from CMS for use in small- and medium-sized medical practices. It is intended to be a low-cost EHR alternative to commercially available systems. We believe that it will be distributed by the Iowa Foundation for Medical Care (http://www.ifmc.org/).
Question: How does VOE compare with EHRs that are commercially available and currently in use by family physicians?
Answer: It is purported to have much of the same functionality as the version used in VA hospitals with several enhancements, but also with several components missing that are often included in EHRs on the market now.
Our current understanding is that pharmacy, radiology, and laboratory results reporting applications will not be included in the VOE version scheduled for release August 1, 2005. We also understand that it will not include scheduling or billing (practice management) modules that are commonly found in EHRs used by family physicians today. (Although there is still some doubt about what will, and what will not be, included in the first release of VOE, promised by August 1, 2005, but now delayed.)
Question: What will it cost a small practice to purchase and install VOE?
Answer: This is not yet clear, although we know there will be no licensing fee charged by CMS to physicians and others who download the software. Not all components of the VOE system are going to be free, however. For example:
- The CACHE database software at the heart of the VOE must be licensed, we understand, from InterSystems. This cost is several hundred dollars per user per year.
- VOE does not include the cost of the CPT codes necessary for generating a claim from the encounter information. This must be purchased from the American Medical Association for $89.95 per year.
- Other software and operating system requirements (e.g. Windows 2000 and Windows 2003 Server) could cost several hundreds or several thousands of dollars, depending on the number of users.
- Perhaps the largest expense associated with VOE in a small practice, however, will be the cost of technical support for installation, customization, and ongoing problem resolution. CMS has indicated it may offer some limited technical support, but it is unclear how this will be delivered.
The likelihood is that VOE’s cost to small practices will vary greatly, but will be in the range of $5,000 to $10,000 per doctor in the first year, and perhaps 20 percent of this amount each year thereafter. This does not include the cost of base hardware such as the computers and network upon which the VOE will run. Roll-out and training are not included, nor is the cost of an associated billing or practice management software program and the interfaces that must connect it to VOE. These could easily add another $5,000 to $10,000 per doctor in the first year of purchase and implementation.
The AAFP’s Center for Health Information Technology will be monitoring closely any of our members’ practices who install VOE, and we expect to publish actual expenses from the field for cost comparison with commercial systems at the earliest possible date. The Center will also post reviews of VOE on our Web site, along with the numerous reviews of EHRs already available there.
Question: Who will issue the software and be responsible for maintaining, updating, and versioning VOE?
Answer: This is not clear at this juncture. The VistA Office EHR initiative is unique in that the VOE software is in the public domain, and there is no software “vendor” in the traditional sense. There is a non-profit organization called WorldVistA (http://worldvista.org/) that plans to “guide VistA adopters and programmers towards developing a collaborative, consensus-based, and open-source community,” and which may help potential users of VOE to contact consultants and technology firms that will be offering to continue the development of VOE.