Vista is a complete system of medical data and applications, originally developed by the Department of Veterans Affairs (VA) and Indian Health Services (IHS). It is robust, integrated, open-source software, and has been certified as an EHR (Electronic Health Record) that meets federal requirements for Meaningful Use.

Of all the enterprise-level EHRs available, Vista is the least expensive. It is robust, having been in continuous use since the 1970s. Support is available from a broad coalition of government, commercial, and nonprofit organizations. Vista has already been certified for Meaningful Use, and has a proven track record of improving patient care.

Vista has been in use since the 1970s, and looks it. User interfaces work very well, but appear old-fashioned to modern users. Some progress has been made in this area—in particular, the main interface used by doctors and nurses has a windows-like look and feel—but there is a lot more yet to be done.

Vista was originally designed for use in the VA, for veterans, so certain areas of Vista aren’t as well-developed as others. For example, Vista originally didn’t have much in the way of support for Pediatrics, although great strides have been made by IHS in recent years. Billing is another area where Vista is not as developed as it could be; the VA, of course, didn’t bill for services. Work is moving forward on improving Vista’s native billing capabilities, but for the time being, most adopters prefer to interface Vista with third-party software. Because so many adopters have chosen this option, the process for interfacing Vista with billing software is fairly standard and well-established.

No. Vista is a large-scale system, originally designed to be run at multiple, full-service hospitals. It has been re-worked to a certain extent, and is now appropriate for any size hospital.

However, it probably isn’t the best option for small clinics, unless those clinics are affiliated with a hospital using Vista. Larger clinics, or clinics that operate together as a group, would benefit from installing Vista, but it hasn’t yet been scaled down to be useful to a small clinic. Most Vista professionals would like to see this happen, and there are several projects now ongoing to facilitate it, but it’s a slow process. For now, Vista is not a good option for a small clinic.

Vista is free.

Before you get too excited about that, we should probably explain. It’s as if somebody offered you a free car, which consisted of a whole bunch of car parts dropped off on your lawn, free of charge. Yes, there are enough parts to make a car—actually, a really good car—but unless you know how to put the car together, it isn’t going to do you much good.

Similarly, Vista software is free, but it must be installed, set up, and configured by experts who know what they’re doing. That’s where we can help.

How much this costs depends on a number of factors, including the type of facility, the expected timeline, and the availability of key clinical personnel. As a very rough estimate, plan on about $1 million per year until installation is complete.

That depends on the definition of “up and running.”

What most US facilities mean is “up and ready to apply for Meaningful Use incentive payments.” This can usually be accomplished in 9 months to 2 years, depending on the current state of the facility’s health IT. We need to make clear, however, that being able to apply for Meaningful Use doesn’t mean that the system is fully mature, or ready to move into maintenance mode. It is likely that staff training, hardware support, backup/failsafe measures, complete customization, and final testing will not be complete at this time. Of course, once the Meaningful Use payments start coming in, it will be easier to pay for the rest of the process.

Some facilities interpret “up and running” to mean “all set up so we never have to worry about it again.” In that case, the answer is “never.” Even a fully mature system needs to be backed up and patched on a regular schedule. Changes in medicine need to be reflected by changes in the software. No EHR is ever going to be so “finished” that nobody ever has to worry about it again. Medical software is not—cannot be—an “install and forget” proposition.

The Vista Expertise Network is a nonprofit 501(c)3 organization. Our mission is to improve people’s health by changing the way medical software is developed, distributed, and supported. We do this by helping facilities adopt Vista for the lowest possible cost. We also develop and improve Vista software for large institutional users of Vista, such as VA and IHS. Most of the software we develop is made available to the wider open-source Vista community.

Our staff are experts in their respective fields, and we believe in paying them what they’re worth. We also have to keep the lights on and the phones working. The fees we charge reflect the money we need in order to do those things—and no more. We do not add a percentage as a profit margin.

Information Technology is expensive, and the fact that we are a nonprofit does not change that. It does, however, guarantee that you are paying only for programming, documentation, and support; you are not padding our bottom line or paying for somebody’s beach house.

This is a common misconception. Over the years, we’ve all been conditioned to believe that large companies, developing proprietary software, create the most reliable products. However, this is not true.

A thriving, engaged open-source community has two main advantages over a single-source software vendor. First, any bugs or errors that do make it into the code are quickly found and eliminated. This is because there are more “eyes” on the problem, and more “hands” that know how to fix it. The second advantage is that no adopter has to be tied to a single vendor. If you have a disagreement with your Vista vendor and don’t want to work with them anymore, or if they go out of business, you can simply find another vendor to work with. If you install proprietary software, you are entirely dependent on that company for service and support.