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CMS Releases Test Version of Electronic Health Record for Doctors' Offices

SEPTEMBER 20, 2005 -- The Centers for Medicare and Medicaid Services (CMS) announced Monday the availability of a test version of an electronic health record system for use in doctors' offices.

The release of the test system is part of a Bush administration goal of fostering widespread adoption of such systems within 10 years.

"EHRs" are designed to provide a comprehensive list of all aspects of treatment a patient has received, as well as to issue reminders for preventive care and provide for electronic entry of drug prescriptions.

The test system was developed by the Department of Veterans Affairs, recognized as a pacesetter nationally in the adoption of electronic health records. Its name is "VistA-Office;" "VistA" stands for "Veterans Health Information Systems and Technology Architecture."

Rep. Pete Stark, D-Calif., said in a hearing in July that VistA is "basically the system that we could start with tomorrow" and added it would be available for free.

But Rep. Jim McCrery, R-La., also at the hearing, expressed concern about government intrusion on the private marketplace. He questioned if the release of the VistA system would in effect be a declaration that "that's going to be the platform forevermore."

The CMS press release Monday was written in language that seems unlikely to play up expectations for the software. The version being released will allow "an assessment of its effectiveness in private physician's offices," the agency said. The system is not "free" software, it added.

CMS said it also wants a chance to assess the system's potential for "interoperability"—that is, to work with other computer systems. Agency administrator Mark B. McClellan added that the test will help a public–private advisory committee created by HHS Secretary Michael O. Leavitt create a process for certifying electronic health records software.

Is VistA some sort of Trojan horse through which the Bush administration seeks to dramatically speed IT in spite of its philosophy against government involvement in the marketplace?

If so, National Health Information Technology Coordinator David Brailer certainly isn't letting on. Brailer emphatically denied at the July hearing by the House Ways and Means Health Subcommittee that VistA would become the de facto platform for electronic health records. He called it a "good solution" for "particular practice settings" but "not transformative" for health information technology adoption.

Michael Zamore, a policy adviser on health care information technology to one of the most liberal members of the House, Rep. Patrick J. Kennedy, D-R.I., agrees. "I think as a general rule the more physicians we can get using electronic medical records, the better off we're going to be."

But "this is a small step in that direction," he added. Only one-third of total adoption costs relate to software, he said; one-third is for hardware and the other third goes to training costs. VistA "doesn't obviate the need for a major move by the federal government to catalyze the movement of the health system into the information age."

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