Saving Healthcare Billions: Let’s fork the VA’s Electronic Health Records System

Alternative title for this post: How our Government’s fear of Open Source Software is costing us Billions.

So, I’ve been meaning to blog this for several months now.

Back in November I remember coming across this great, but very short, interview in the Globe and Mail with Ken Kizer. Who, you might ask, is Ken Kizer? He’s a former Naval officer and emergency medicine physician who became the US Veteran’s Affair’s undersecretary for health in 1994.

While the list of changes he made is startling and impressive, what particularly caught my attention is that he accomplished what the Government of Ontario failed to do with $1Billion in spending: implementing an electronic medical record system that works. And, let’s be clear, it not only works, it is saving lives and controlling costs.

And while the VA has spent millions in time and energy developing that code, what is amazing is that it’s all been open sourced, so the cost of leveraging it is relatively low. Indeed, today, Ken Kizer heads up a company that implements the VA’s now open source solution – called VistA – in hospitals in the US. Consdier this extract from his interview:

You have headed a company that promoted “open-source” software for EHR, instead of a pricier proprietary system. Why do you think open source is better?

I believe the solution to health-care information technology lies in the open-source world that basically gives away the code. That is then adapted to local circumstances. With the proprietary model, you are always going back to the vendor for changes, and they decide whether to do them and how much they will cost. In Europe, open source EHR software is zooming. It’s the most widely deployed EHR system in the world, but not here.

Sometimes I wonder, do any Canadian government’s ever look at simply forking VistA and creating a Canadian version?

I wonder all the more after reading a Fortune Magazine article on the changes achieved in the VA during this period. The story is impressive, and VistA played a key role. Indeed, during Kizer’s tenure:

The VA saw the number of patents it treat almost doubke from 2.9 million 1996 to 5.4 million patients in 2006.
Customer satisfaction ratings within the VA system exceeded those of private health care providers during many of those years.
All this has been achieved as the cost per patient has held steady at roughly $5,000. In contrast the rest of the US medical system saw costs rise 60 percent to $6,300.
And perhaps most importantly, in a time of crises the new system proved critical: while Hurricane Katrina destroyed untold numbers of cilivians (paper) healthcare records, VistA’s ensured that health records of veterans in the impacted areas could be called upon in a heartbeat.

This is a story that any Canadian province would be proud to tell its citizens. It would be fascinating to see some of the smaller provinces begin to jointly fund some e-health open source software initiatives, particularly one to create an electronic healthcare record system. Rather than relying on a single vendor with its coterie of expensive consultants, a variety of vendors, all serving the same platform could emerge, helping keep costs down.

It’s the kind of solution that seems custom built for Canada’s healthcare system. Funny how it took a US government agency to show us how to make it a reality.

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