Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.
CMS is releasing a test version of the softwarecalled VistA-Officein an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.
"The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process," CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.
The goal is to refine the software based on the results of the test period and to develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process that is recognized by the Department of Health and Human Services.
The VistA-Office EHR was adapted from the hospital information system of the Department of Veterans Affairs (VA). The VA system is used in 1,300 sites and has been in use for more than 20 years.
The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.
The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of 17 users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.
Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.
"It's good for physicians to have more choices," said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.
But Dr. Leavitt warned that participating in a beta test isn't for everyone. "A beta test definitely stresses the office," he said. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said. The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.
Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.
As with any other EHR, it's important for physicians to survey their own office and work flow, he said.
Family physicians are looking forward to evaluating and providing feedback on the ease of use and associated costs of the product, said David C. Kibbe, M.D., director of the Center for Health Information Technology at the American Academy of Family Physicians.
While the costs cited by CMS were below market costs for most EHR systems, Dr. Kibbe cautioned that charging at all for a beta test could diminish physicians' participation. "Uncertainty is a cost as well," he said.
The test software provides a reasonable cost option for physicians, said Arthur McDowell III, M.D., a cardiologist in Middletown, Conn., who has already implemented an EHR in his practice.
But what will really spur adoption of EHRs will be government-sponsored pay-for-performance programs, Dr. McDowell said.
The fear among physicians on pay for performance is that the government will choose to pay physicians less. Instead, the government needs to take the step of providing reasonably priced software and then offering payments for making the change, Dr. McDowell said.
The current discussion about incentives from the federal government is very promising, said Dr. Leavitt. Physicians want to see incentives that offer extra payment or lower the cost or administrative hassle, he said. While there are some pilot projects that offer incentives, the challenge is to make them available to the mainstream, he said.
The Certification Commission can help spur incentives, he said, because then government payers and health plans will know that they are paying for something robust.