Dr. David H Chan wrote:
John, can you recommend me to community practices you know who haveI think it's important to think about the relative context of how these systems are installed, supported and used.
successfully deployed VistA as an EMR? I would very much love to learn from
them and see if VistA has a role to play in Canada.
While some family practice or GP are operationally connected with large health care organizations and thus can use the systems deployed by those organizations (which includes the services of a multi-person professional IT staff), many, if not the majority, are not so connected.
This is indeed the challenge for VISTA, which has a heritage in the large entity world. Can it make or even should it make the transition? That is to say, maybe VISTA fulfills a different niche. Seen in this light, John is right, there is nothing close to it available in the open source world, and maybe there will never be anything close to it. It's a relatively small market with high costs.
Small practice's on the other hand, assuming they stay small and independent would be another niche, and that niche seems to be where a lot of the action is in open source medical systems. (A much larger market)
Another very viable niche is in public health (analysis, warning, reporting, registries, etc.). (A small market again, so maybe only one OSS option?)
All of these niche's need to interchange information with each other, albeit with different aims in mind and different privacy and security issues to be resolved. However, this interchange could and probably should be de-coupled from the actual systems.
The other valuable observation that has been made in these discussions, one that can be capitalized on, is the opportunity to provide a more relevant training experience. Someone associated with the AAMC commons activity mentioned to me at the OSHCA conference that most family practice (and GP's I would assume) get trained in a hospital organization but eventually practice in a much smaller organization. The kinds of systems they train on are rarely available for use once they move on to their career. That creates a huge opportunity (and challenge) for academic medical centers to take on the task of training folks on the kinds of systems they are likely to be using.
