Standardized EHR moving forward

At press time, VistA-Office EHR (VOE), a joint project between the Centers for Medicare & Medicaid Services (CMS) and the Veterans Health Administration (VHA), was about to begin beta testing at a handful of private physicians' offices, J. Ben Davoren, M.D., says. He is director of clinical informatics at the San Francisco Veterans Administration Medical Center.

Many observers expected the project to reach this phase around mid-2005, he says. "But it's only now that the beta testers are going to deploy the system in smaller-group or individual physician offices," he tells Dermatology Times.

The system has already been used in hospitals and in other countries, Dr. Davoren adds, but it hadn't yet been ported down to the small-group or individual practice environment.

"It's not something that people can buy today, install on a PC in their back room and suddenly have their office equipped with an EHR. That's certainly the goal, but many pieces have to come together for this all to work out," he explains.

Presently, he says, the issue is whether users can take a product that's proven its mettle within the Veterans Administration, where it was developed, and build "hooks" to existing systems they use for functions such as managing appointments and entering laboratory records.

Evolution of EHR

VOE got its start more than 10 years ago, when the VA began working on the VistA computerized EHR that has become the system's building block. Dr. Davoren says that during the past eight years, the software has gone through at least 26 versions. About two and a half years ago, he adds, the government decided to "put its money where its mouth is" in terms of providing standardized electronic medical record tools for the nation.

Once the Department of Health and Human Services got involved, Dr. Davoren says, "it became a natural extension to take something the government had built and make it available to practices in the United States as a way of promoting electronic record use, and providing something that hopefully would be relatively simple to maintain, has a long track record and is not going to be bought out or discontinued" by a vendor.

The system is unlikely to meet dermatologists' unique photographic needs until at least fall 2006, Dr. Davoren says.

Addressing the issues

"There are more issues with the Food and Drug Administration (FDA) and imaging applications than with EHRs," he notes, "so there are some additional hurdles." For example, he says that with radiology workstations, the FDA seeks to ensure that the resolution at which one sees an image is high enough that one can make a diagnosis from that image.

Though the VistA imaging component won't be ready for the beta test, he says one day it will provide the ability to index scanned documents and images (including digital ones) in a way that links them to a particular patient or electronic progress note.

"If one wanted to see a picture from Nov. 1," Dr. Davoren explains, "one could relatively quickly pull it up next to a picture from April 1 and see what they look like seven months apart."

Internally, the VA combines these capabilities with applications such as a teledermatology service it currently runs in Hawaii, he adds. This system allows VA practitioners based there to consult with VA dermatologists in San Francisco to help diagnose problems such as suspected melanomas, usually by sending store-and-forward images and text, but sometimes through real-time videoconferences that include patients.