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

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In this slideshow, Geraint Lewis, Senior Fellow at the Nuffield Trust, outlines why VistA, an open source electronic medical record system, would be a viable option for the NHS.

Geraint Lewis presented at the Nuffield Trust seminar: Sharing international experience: Is implementing the VA's electronic health record system an option for the NHS? in July 2012.

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

  1. 1. The VA’s Open-Source Electronic Medical Record System: An opportunity for the NHS? Dr. Geraint Lewis Senior Director, Walgreen Co.
  2. 2. Veterans’ Health Administration  Established in 1778  Only part of the Federal Government that delivers health care*  Responsible for 23 million “…to care for him veterans (8.1 million actively who shall have enrolled) borne the battle, and for his widow, and his orphan” Abraham Lincoln*along with the Indian Health Service and the TriCare military health system
  3. 3. 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 Transformation involved  shift from secondary to primary care  performance measurement  electronic medical records (VistA)
  4. 4. 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
  5. 5. VistA Patient Portals
  6. 6. Hospital Doctor’s Perspective NHS VANo background information on new Full access to complete medical recordpatientsNo automated prompts or warnings Multiple safety systems including alerts for drug interactions and allergies and prompts for overdueNo inbox equivalent Inbox for important overdue tests, screening, and admissions and proceduresMultiple idiosyncratic IT systems Single unified IT systemNo avenue for dealing with frustrations Ability to write new programmes in open- source software
  7. 7. Hospital Doctor’s Perspective NHS VANo background information on new Full access to complete medical recordpatientsNo automated prompts or warnings Multiple safety systems including alerts for drug interactions and allergies and prompts for overdue testsNo inbox equivalent Inbox for important overdue tests, screening, and admissions and proceduresMultiple idiosyncratic IT systems Single unified IT systemNo avenue for dealing with frustrations Ability to write new programmes in open- source software
  8. 8. Airbus or Boeing?
  9. 9. 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
  10. 10. 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)
  11. 11. What happens if an NHS hospital wants to change IT supplier? Now If NHS used VistAKeep hospital running 24 hours a day Select new supplier on basis of cost and qualityTrain staff on new system Nothing else changesInstall new system in parallelIn the existing supplier’s best interest tomake transition as awkward as possible Stagnation and uncompetitive Competitive health IT market that healthcare IT market protects patient safety
  12. 12. What happens if an NHS hospital wants to change IT supplier? Now If NHS used VistAKeep hospital running 24 hours a day Select new supplier on basis of cost and qualityTrain staff on new system Nothing else changesInstall new system in parallelIn the existing supplier’s best interest tomake transition as awkward as possible Stagnation and an uncompetitive Competitive health IT market that healthcare IT market protects patient safety
  13. 13. 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
  14. 14. 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)
  15. 15. www.nhsvista.net
  16. 16. 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

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