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Sunday, August 2, 2009

Memo to Thune: Stop Health IT Bailout, Protect Better Open Source Software

Senator Thune, I have a bailout for you to stop.

This year's stimulus package includes $20 billion to encourage hospitals to make "meaningful use" of health information technology. According to Phillip Longman, vendors of proprietary health information technology are lobbying to define "meaningful use" to favor their products over open-source software like VistA (the software that has helped make the VA the best care in America). Longman says the vendors are also marketing like crazy to cash in on the stimulus money and lock hospitals into their software.

In effect, the health IT stimulus may be acting as "a giant taxpayer bailout of health IT companies whose business model has never really worked" [Longman, 2009].

Senator Thune should push Congress to do what Longman recommends:

Rather than shoveling $20 billion into software that doesn’t deliver on the promise of digital medicine, the government should put a hold on that money pending the results of a federal interagency study that will be looking into the potential of open-source health IT and will deliver its findings by October 2010.

Senator Thune has said he is committed to lowering health care costs for all Americans. Blocking expenditures on inferior proprietary health IT and opening the door for more implementation of open-source medical software will save hospitals, patients, and taxpayers billions of dollars. The VA's open-source software has demonstrated its ability to improve health outcomes, win acceptance from practitioners, cut implementation costs by 90%, and hold down the cost of delivering care (adjusting for inflation, VistA cut costs per patient 32% over a decade when those costs rose nationwide by 50%). VistA is also freely available to every hospital in the world that wants to use it.

Senator Thune, don't let profit-motivated lobbyists manipulate the law and federal dollars to crowd out the most effective health IT solution on the table. Put that stimulus money on hold. Let the open-source study do its work and guide us to the health IT solution that will save lives and save money.

Read more!
  • Senator Thune (and the rest of us!) can learn more about why proprietary health IT has failed from Fred Trotter's April 28, 2009, testimony to the National Committee on Vital Health and Statistics.
  • Senator Thune may also want to give the VA a shout and tell them not to risk ruining VistA by squashing local innovation and centralizing development.
  • Update! Doug Wiken reminds me that he wrote about VistA and wondered last April why Avera and Sanford here in South Dakota would spend so much money trying to develop their own system when they could adopt VistA for a fraction of the cost.


  1. I have posted several times at Dakota Today on the Veterans Admin. software since I first read about it in a linux magazine probably two years ago. It mentioned the medical records system that was available for download and that it would run on Linux systems.

    At that time I could not understand why hundreds of thousands of dollars was being dumped into developing another "wheel" by hospitals. Contacting hospital administrators was like walking into a brick wall.

    The VA uses a programing language with MUMPS acronym. It appears Republicans are so intent on demeaning government that they are unwilling to look at a free system when they can apparently waste millions.

    My wife's sister was a nurse in the VA and said the electronic medical records system worked very well...and has for several years.

    I may be missing some very fundamental fact in all this, but it seems to be just one more example of how medical costs can be ever more expensive for no rational reason.

    I hope there are more comments on this issue who know more about this than I do.

  2. Some Anon who apparently can't read the comment policy or linked articles asks for a customer satisfaction survey. Why do I have to do all the work?

    But o.k.: The VA actually outperforms the private sector on customer satisfaction while cutting costs:

    "Veterans are increasingly satisfied by changes in the VA health system. On the American Customer Satisfaction Index,20 the VA bested the private sector's mean healthcare score of 68 on a 100-point scale, with scores of 80 for ambulatory care, 81 for inpatient care, and 83 for pharmacy services for the past 3 years. Similar improvements have been achieved in each value domain.

    "It also is worth emphasizing that since 1996, improved outcomes have been achieved in each of the value domains, while simultaneously reducing the cost per patient by more than 25%. Returning to the value equation, it would seem evident that the numerator (outputs) rose while the denominator (resource inputs) dropped, signifying enhanced value" [Jonathan B. Perlin, MD, PhD, MSHA; Robert M. Kolodner, MD; and Robert H. Roswell, MD, "The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care," American Journal of Managed Care, 2004.10.31].

    Any questions, Anon?

  3. Thankfully, I'm not an app developer, just the guy who has to maintain the systems they run on and keep them secure. So my perspective is a step removed. However, I can tell you a few reasons why open-source apps like VistA are slow to catch on in hospitals:

    1) VistA and many other open-source apps don't run on Windows. Like it or not, this is a Windows shop. The majority of the apps that tie into the patient care process have been coded for Windows. I know there are ways of making these platforms work together, but these people can barely make their apps play nicely on the same platform. I pushed for Linux-based dumb terminals years ago; instead, full Windows workstations are still deployed in every exam room, but locked down to the level of a dumb terminal. Many patient-related apps used on those workstations are Citrix-based, which confounds me further why we have them (the workstations).

    2) There is a perception within healthcare that open source = less secure. It's easy enough for an in-house developer to tweak an open-source app to conform to HIPPA and the company's security requirements, but remember that most enterprise-wide IT decisions are being made by doctors, not IT people. And doctors play golf with people from, say, IBM. We pretty much get told, "You WILL use this", and that only changes if the app goes down in flames in a high-profile fashion.

    3) (And this is really where most of the reason lies.) Hospitals have spent too much purchasing off-the-shelf software and mucking with it to not use it. I don't know how many in-house-customized apps I have to use that are just terrible, that everyone agrees are just terrible, but which we've spent too much on to spent further buckets of money to undo.

  4. I forgot. I'm Olivander everywhere else on the blogs.


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