Though West Virginia may not be in the top national rankings when it comes to overall health, wealth and education, it is leading the way in electronic health record (EHR) open source adoption. 

Recently the state chose to adopt EHRs the old fashioned way...by stealing from the federal government...sort of. By tapping into the Veteran's Affairs (VA) EHR system that is available to health providers at no cost, West Virginia became the first state to adopt the EHR system state-wide, implementing the software across its state-run hospitals and nursing homes. 

The VA medical record system, otherwise known as VistA, was developed in the seventies by MIT researchers in conjunction with VA physicians and is touted as a leader in EHR software in the market-and best of all, its free. Well, close to free. VistA is supported by our tax dollars and the users must pay for installation, training, and support, but it is a formidable basement bargain relative to its competitors.  

Referred to by health care quality guru Philip Longman as an "unrecognized national resource," VistA's open source code is constantly being improved and updated by its users.  However, John Halamka MD, Chief Information Officer at the Beth Israel Deaconess Medical Center in Boston, is quick to note that VistA is not designed for complex billing scenarios that challenge large hospital systems because the VA is a single payer system unlike the health system for the general public. That being said, the software does give smaller and lower revenue generating facilities an opportunity to modify the open source code to work for their healthcare environment.

Senator John D. Rockefeller (D-WV) wasted no time in showing his support for the open source movement by proposing new legislation that would further support open source adoption.

The Health Information Technology Public Utility Act of 2009 (now in Committee) would expand support for the open source model by facilitating communication between users, ensuring interoperability, creating a child-specific EHR component that supports Medicaid (currently not a part of VistA), and integrating quality standards into software modules.  Private vendors such as Medsphere that commercially support the use of open source code would benefit from the bill while strictly commercial vendors grumble about it.

Alas, a few caveats; just as EHRs are not the end-all to healthcare efficiency woes, open source code may not be the panacea to overcoming EHR cost barriers to market entry. Sometimes trying to force existing software to fit specific needs is more costly than custom tailoring a product commercially. Finally, bloggers are quick to site the mishaps that the VA experienced last year regarding patient privacy and security when over 20,000 medical records were breached.  And the conversation continues as security, cost and interoperability challenge our transition to the digital age of health information.

Dig Deeper:

[+] Doctors aided by emerging offshoot of EHR software

[+] DOD and the VA stumble toward shared EHR system 

[+] New study cites poor uptake of electronic health records