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W. VA. Rolls Out Enhancements To VistA

Officials with the West Virginia bureau of behavior health and health facilities are putting some finishing touches on VistA installations cutting across the state, adding computerized laboratory information to a six-year-old implementation.

West Virginia officials have implemented Vista in seven communities, Modern Healthcare reports. Facilities include an acute-care hospital, two psychiatric hospitals, four long-term care hospitals, a nursing home and two ambulatory care clinics. The facilities are all connected to a central database in Charleston via T1 lines.

The state has been working on contract with Medsphere Systems Corp. to install a VistA version known as FOIA VistA, a version in the public domain that can be obtained freely from the VA under the Freedom of Information Act, Modern Healthcare notes.

Though VistA itself is free, the state has spent heavily on installing it across the seven sites. Since FY 2005, West Virginia has paid Medsphere $8.4 million for system implementation, development and support, and is contracted to pay the vendor $939,800 this year for support.

In addition to paying Medsphere a monthly fee for systems support, the state pays licensing fees to InterSystems, developer of Cache, a version of the MUMPS database and programming language. It also licenses Keane’s financial system, which interfaces with VistA.

West Virginia began looking at a common infrastructure for all of its facilities when HIPAA passed back in 1996, noting that the idea behind it was portability and accountability. Now state officials are glad they moved ahead. “It’s expensive,” but “in terms of satisfaction, I think we’d all agree it was well worth it,” deputy commissioner for administration Craig Richards told the magazine.

Healthcare Big Data vs Skinny Data

I have heard a number of people talk about healthcare big data was all the buzz in the healthcare IT world. There’s little doubt that there’s a lot of conversation happening around big data and analytics in healthcare. While I think there’s tremendous value to be found in healthcare big data, I’ve been more intrigued by what Encore Health Resources calls skinny data.

You can read more about the Encore Health Resources CoreANALYTICS announcement, but the approach is what I find really interesting. Instead of trying to create a huge enterprise data warehouse that can be all healthcare data for everything, they instead decided to focus on created a smaller solution that just focused on one major problem: meaningful use.

Encore Health Resources was open about the reason why they chose to go with a skinny data model as opposed to a full enterprise data warehouse model, time and budget constraints. They basically were asked to produce a result with a limited budget and so there wasn’t time or money to do anything but achieve the desired results. One of the architects of the system said, “If you can give me the extra data for free, then give it to me. If it costs [time or money] more to get that data, then don’t do it. Although, if you don’t give me these other data elements, then I’m going to have issues.”

It seems like a pretty simple concept to me that makes me wonder why I haven’t seen more of it in healthcare. Encore has taken these concepts and started to expand beyond meaningful use and into other areas like at-risk populations, clinical analytics for care coordination, and financial analytics.

I asked them if CoreANALYTICS would eventually grow into what essentially becomes an enterprise data warehouse. They suggested that it wouldn’t likely ever get that large, but I can see a path to that type of result.

What I do love about skinny data is that it’s user the information a hospital has available and creating actual results. It’s one thing to have the data, but it’s what you do with that data that really matters.

EMR Vendors Need To Get Their Act Together

For quite some time now, EMR vendors have gotten away with selling products that aren’t very usable and may even pose safety risks. But that’s the price enterprise EMR buyers have been willing to pay to jump in and automate. Very soon, though, vendors may be held to a higher standard, a new report from KLAS.

KLAS recently held a bake-off comparing Allscripts, Cerner, Epic, McKesson’s Paragon, Meditech 6 and Siemens’ Soarian EMRs head to head where it comes to usability and efficiency, SearchHealthIT reports. The study looked at how the products worked for individual users, and then looked at how they meet organizational quality of care demands.

Some of the EMRs – and I wish SearchHealthIT had told us which ones — took a full month for physicians to learn. In some cases, physicians who were willing to take that month ended up with a richer experience than those which were easy and quick to learn, while in other cases, the darned thing still wasn’t usable. Of course, those with long learning curves and unimpressive features suffered from low physician adoption, the publication notes.

This is all interesting enough, but what grabbed me about the story was a provider quote from an end user, supplied by KLAS:

“As suggested by the new 2014 certification standards, vendors should take more responsibility for both the usability and safety of their products. These responsibilities shouldn’t be the sole purview of healthcare organizations and providers like they have been until now.”

Could it be that providers have finally gotten to the point where they’re no longer going to put up with unusable products and bring the hammer down even on giants like the big-shouldered group listed above? After all, so far providers have swallowed hard and accepted a lot of ugly technology.

Maybe Meaningful Use demands are finally giving health organizations the backbone they need to stand up to Jabba the Hutt vendors?

What Would It Take To Get More Hospitals On VistA?

Recently, we shared the story of of a California community hospital that decided to bypass big vendors like Cerner and Epic and go for a VistA installation instead. While Oroville Hospital ended up spending $10 million on its VistA implementation, that turned out to be about half of what it would have spent on Cerner and its big-vendor cousins. Then, to boot, Oroville got a $5 million Meaningful Use payout.

Yes, without a doubt, Oroville had a different experience when it went with VistA than it would have if it hired on Epic and had armies of be-suited consultants descend onto its campus. Any open source project faces the risk that the fervor and volunteer labor that makes up the backbone of its ongoing development efforts.

But given how much flexibility hospitals get out of the deal, and how much they save, it seems to me that you’d still expect to see more VistA projects being mounted. What would it take? Here’s a few ideas:

* Get a CCHIT-certified VistA product out there: Right now, hospitals don’t have such a choice. The only reason Oroville got its instance certified was thanks to special help from World VistA.

* Have more happy talk stories on how VistA can really work appear in serious business publications like Forbes: Arguably, peer pressure is a major reason hospitals stick to a short list of popular solutions. More coverage of VistA successes in major pubs creates its own buzz which may encourage IT leaders to reconsider their existing plans.

* VistA consulting firms need to become more common: Right new there are a few firms, like Medsphere, that will walk hospitals through the VistA installation process. But what if, say, Accenture had a division devoted to VistA support?

There’s not a lot you can do if a hospital CEO is determined to buy Epic or Meditech or Cerner. But if they want to consider VistA, there’s a lot the industry could do to help.

Planning for EHR Consultants in an EHR Go Live

At CHIME 2012 I asked David Tucker, MBA, MHA, FCHIME, VP of National Sales at ESD and Kelly Mulligan, RN, BA, Chief Operating Officer at ESD about how a hospital CIO should plan for an EHR consultant. While we’d love to think that a hospital could just ask for an EHR consultant and have one there the next day, the reality is much different. Sure, you could have an EHR consultant there the next day, but if you want the best EHR consultants it takes some forethought and planning to make sure you get on their schedule. David Tucker, former hospital CIO, talks more about planning for EHR consultants in the video below.

What differentiates EHR Consulting Companies?

While at CHIME 2012, I had the chance to sit down with David Tucker, MBA, MHA, FCHIME, VP of National Sales at ESD and Kelly Mulligan, RN, BA, Chief Operating Officer at ESD. I learned a lot from them about what’s happening with hospital CIOs. Plus, it was great to get some first hand perspective on the EHR industry from a former hospital CIO (David Tucker) and an RN (Kelly Mulligan).

I pulled out a video camera to capture some of the things we talked about. I’ll be posting a number of videos with them over the next few weeks, but I’ll start with their answer to the question: What differentiates EHR consulting companies? They mention the KLAS EHR consulting form ratings and even talk about hospital CIO’s being burned by EHR consulting companies in the past.

What Differentiates EHR Consulting Companies Video

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W. VA. Rolls Out Enhancements To VistA

Healthcare Big Data vs Skinny Data

EMR Vendors Need To Get Their Act Together

What Would It Take To Get More Hospitals On VistA?

Planning for EHR Consultants in an EHR Go Live

What differentiates EHR Consulting Companies?

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