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The VA’s Open-Source Electronic Medical Record System: An opportunity for the NHS? . Dr. Geraint Lewis Senior Director, Walgreen Co. “…to care for him who shall have borne the battle, and for his widow, and his orphan” Abraham Lincoln. Veterans’ Health Administration.

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The VA’s Open-Source Electronic Medical Record System: An opportunity for the NHS?

Dr. Geraint Lewis

Senior Director, Walgreen Co.

veterans health administration
“…to care for him who shall have borne the battle, and for his widow, and his orphan”

Abraham Lincoln

Veterans’ Health Administration
  • Established in 1778
  • Only part of the Federal Government that delivers health care*
  • Responsible for 23 million veterans (8.1 million actively enrolled)

*along with the Indian Health Service and the TriCare military health system

transformation of the va
Transformation of the VA
  • Major transformation mid-1990s
  • Peer-review study found that the VHA outperforms all other sectors of American health care in 294 measures of quality
  • Transformationinvolved
    • shift from secondary to primary care
    • performance measurement
    • electronic medical records (VistA)
the vista ehr
The VistA EHR
  • ≠ Microsoft Vista™
  • VistA = Veterans’ health information systems & technology Architecture
  • Comprehensive electronic health record system, spanning primary, secondary, and social care
  • Open Source
open source software
Open Source Software
  • VistA was written by Federal employees so it is subject to Freedom of Information requests
  • Open source
    • Software that can be used, redistributed or rewritten free of charge
  • General Public Licence
    • ‘Keep-it-free’ licence
  • World VistA ecosystem
darwinian improvement
Darwinian Improvement
  • Bright ideas spread organically across the VA
  • Bad ideas wither on the vine
  • Example: cascading abnormal results (K+=5.9 mmol.l-1)
byrne et al 2010
Byrne et al., 2010
  • VA spends proportionately more on IT than the private health care sector
  • Higher IT adoption
  • Better quality of care
  • Net return on investment was $3.09 billion
key benefits of vista
Key Benefits of VistA
  • Safety (Boeing versus Airbus)
  • Cost (no licence fees, free training, and economies of scale)
  • Evidence-based
  • Darwinian improvements
  • Stimulates competition in IT support
  • Popular with staff (written by doctors)
further reading
Further Reading
  • Asch SM, McGlynn EA, Hogan MM, Hayward RA, Shekelle P, Rubenstein L, Keesey J, Adams J, Kerr EA. Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample. Annals of Internal Medicine 2004;141(12):938-945
  • Byrne CM, Mercincavage LM, Pan EC, Vincent AG, Johnston DS, Middleton B. The Value From Investments In Health Information Technology At The U.S. Department Of Veterans Affairs. Health Affairs 2010; 29(4):629-638
  • Demonstration of VistA available at http://www.ehealth.va.gov/EHEALTH/CPRS_demo.asp
  • Litvin C, Cavanaugh J, Callanan MG, Tenner CT. To err is human continued: A failure of follow-up. Journal of Clinical Outcomes Management. 2008;15:21
  • Longman P. Best care anywhere: why VA care is better than yours. Sausalito, California: Polipoint Press, 2007