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CA Hospital Adds CPOE To VistA Implementation

Posted on July 1, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s still rare these days to see a private hospital roll out open source EMR VistA, despite VistA’s excellent reputation. But one such hospital has not only implemented VistA, it’s added CPOE to its VistA rollout.

The facility in question is Oroville (CA) Hospital, which spent three years self-implementing the VA platform. Oroville has spent seven years developing a paper-based order set system, and has now converted its order sets from paper to electronic.

For a year the medical staff at Oroville had been using paper order sets and the VistA EMR, but that arrangement was getting old, so the transition was a happy one, according to Dr. Matthew Fine, the hospital’s chief medical officer, who’s quoted in a press statement.

“After a whole year of using paper and electronic charts the staff was chomping at the bit to go live and the anticipation outweighed the fear… so turning on CPOE was almost a welcomed event. The inadvertent strategy of having hybrid charts seems to have been a good way to make full conversion to EHR/CPOE more palatable,” Dr. Fine said.

To make the CPOE transition, the Oroville staff created a mechanism for systematically converting order sets to an electronic format, the press release notes. Each order set, once transformed, was reviewed by a relevant group of physicians along with 20-odd additional staff including department/section heads, nurses, pharmacists, nutritionists, lab staff and anyone else who might be carrying out the orders in the order sets.

Since go-live in October of last year, electronic order volume has mounted, and now 80 percent of orders are electronic. The hospital’s goal is for 100 percent of orders to be electronic, but it has hit a stumbling block in that it has been unable to adapt VistA’s original CP Flowsheet module.

For that reason, Oroville will have to create its own CPOE solution for several areas of the hospital, including outpatient surgery and the PACU.

A Hospital Chooses VistA EMR Over The Giants

Posted on January 15, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s a story out of the pages of Forbes which should make open source advocates happy. In it, we hear the tale of a northern California hospital which decided to buck corporate trends and go with VistA rather than pay for a big-ticket EMR from a vendor giant.

Three years ago, at the outset of its EMR search, Oroville Hospital was going down the same path as most of peers. But the CEO wasn’t terribly happy with that path. While the 153-bed hospital had shortlisted giants like Cerner, McKesson and Meditech as possible candidates, chief executive Robert Wentz was worried about the sky-high cost, disruption and — as a smaller facility — lack of clout with vendors, Forbes reports.

Shunning conventional choices, Wentz decided to take a risk on VistA. Not only did he go with the less-conservative choice, he decided not to partner with companies like Medsphere that help hospitals integrate and develop VistA to meet their needs. Instead, he chose to work with independent VistA experts (a rogue crew with day jobs of their own) rather than be tied to a particular vendor.

To coordinate the project, Wentz worked with the non-profit WorldVistA and Vista Expertise Network, both of which embrace hundreds of programmers with VistA smarts. Wentz worked with programmers from the two groups, not only to build  out the hospital’s EMR but also to develop additional add-ons such as an e-prescribing package. WorldVistA CIO helped Oroville get its package certified for Meaningful Use, which brought in $5 million.

Now, three years into the project, Oroville has spent about $10 million on its EMR, about one-half of what it expected to spend on the giant EMR-makers’ software.

Now, it’s worth bearing in mind that Wentz and his IT team had to be more flexible than they would have if an army of consultants from Cerner or Epic had run the show. (I love the part in the Forbes story where a programmer told Wentz he had to end the call so he could make a trip to Costco. Classic.)  But Oroville seems to have reaped the benefits.  I wonder if this story will lead to more VistA adoption…

VA Plans Baseline Repository for VistA

Posted on December 28, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Right now, there are 133 instances of the VA’s popular VistA software operating across the U.S. In an effort to create some harmony, the VA has set plans to create a special separate repository for its Gold Disk version of VistA which developers can use as a baseline.

According to Healthcare IT News, the VA is also planning a software testing platform, open source dev standards and documentation of open source community outreach planning.

The idea behind the VA’s move is to attract more developers and code contributions to VistA, which despite its popularity is getting a bit long in the tooth at more than 30 years old, HIN reports.

VistA is already being renovated by the community managed by the Open Source Electronic Health Record Agent (OSEHRA), a not-for profit created by a previously standing contract between the agency and The Applications Informatics Group.

The group is working to create a minimum baseline standard for VistA code behind 20 key modules. To do that, OSEHRA’s working with VA’s internal development team to clean up the code and leverage what works.

Meanwhile, OSEHRA is working as a custodial agent is to certify open source code for integration into the VistA code base and to make sure complimentary software contributions will work with VistA.

According to estimates cited by HIN, OSEHRA should cost less than $10 million per year, while replacing VistA with an existing commercial EMR could cost about $16 billion. (Yeah, there’s a no-brainer for you.)

In any event, the big idea behind all of the VA’s VistA efforts is to get things moving quickly and bring on the innovation.  It’s hard to argue that this is a good idea. Whether OSEHRA itself is the right vehicle to guide and channel this innovation is anybody’s guess, but if it can harness the explosive creative force that is the open source community, watch out!

What Won’t Happen In #HIT By September 2013

Posted on September 7, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As part of the upcoming National Health IT Week (#NHITWeek), which takes place September 10 through 14th) my august colleague John has written up a list of ways in #HIT is likely to make a difference over the next 12 months.  (He makes some great guesses; definitely give the post a look.)

For my part, being the naughty contrarian that I am, I thought It’d turn John’s blog post on its head and answer the question “What Won’t Come Together In Health IT Over the Next 12 Months?”  Here’s some of my predictions:

* EMR-to-EMR interoperability:  Folks, from what I see we’re definitely more than a year from having a workable form of interoperability between systems or even routine high-volume data sharing. Really, do I even have to debate this one?

High penetration by HIEs:  With funding mechanisms and goals ranging all over the map — and players including health plans, broadband network providers like Verizon, hospital coalitions and more — I just can’t see the HIE picking up a lot more market share over the next 12 months. Too many organizations involved, and too much to figure out.

Major uptick in open-source HIT  use:  Time and again, I’m reminded that far too many hospital leaders, government CIOs and medical practice leaders aren’t ready to take open-source tools seriously despite the myriad of good reasons to do so. I don’t think this is poised to change in the near term, sadly.

Epic controls the hospital EMR world for good:  Yes, hospitals are still switching over to Epic. And yes, hospital cutovers to Epic probably haven’t even hit their all-time peak.  But the smaller to medium-sized hospitals that just can’t afford Epic are still in play, and there’s a lot of them. Let’s see who comes riding in to put the lock on this niche before we crown Epic world heavyweight champ.

* Major growth in remote monitoring:  Mobile technologies are becoming more critical daily to the practice of medicine. But somehow, that doesn’t translate to a hunger for home-monitoring patients using, say, wireless glucose monitors. I’ve been watching this sector for years and it still seems like it could explode, but I’m not seeing critical mass this year.

Having been Scrooge for a bit, I certainly have to join John in saying that yes, this is likely to be a pivotal year for the EMR industry, and for #HIT entrepreneurs.  I just think we’re going to remain stuck with some of these legacy issues for some time to come.

Sometimes Epic Doesn’t Win: Public Hospital Goes Open Source

Posted on June 18, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most of the hospitals I write about go with big, expensive commercial EMR packages and suffer through upgrades and code fix schedules imposed by the vendor.  The process seems pretty miserable, and rather inefficient, but IT departments are stuck with it.

That being said, at least some hospitals take advantage of the open source paradigm, including the following midwestern facility.

Oklahoma-based Stilwell Memorial Hospital, a 50-bed public facility, has decided to install Medsphere Systems Corp.’s OpenVista EHR.  The Medsphere product is an open source derivative of the Department of Defense’s widely praised VistA system.  Rather than millions of upfront bucks, Medsphere charges a subscription fee for OpenVista use.

As part of choosing OpenVista, Stilwell Memorial becomes part of Medsphere’s “Healthcare Open Source Ecosystem,” in which various users share code, system upgrades and tips for managing the system.

The question that pops into my head, as I read the background on this install, is why we’re hearing about a 50-bed hospital making this selection, but few if any medium-sized or large community hospitals.

After all, given its history as a massive DoD implementation, I don’t think there’s any question that VistA scales up well. And we are all over the taint open source once had as too casual a community for hard-core enterprise use, right?  By at least a decade?

The truth, however, is that we probably all know the answer. The reason open source EMR installations are still in the minority is that CEOs and board members like the sound of having a giant, sprawling corporate partner better than working with a community.   Meditech, Epic, Cerner and Siemens are more or less automatically shortlisted.

Sigh. Wouldn’t it be nice if hospital C-suite folks and boards were more flexible?  Great things could happen.

Why “Top 10″ Hospital EMR Lists Are Bad News

Posted on October 5, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Everyone likes the comfort of choosing a product from a pre-approved list of some kind, especially a “top 10″ list ranked by a credible source.  And if you’re a hospital IT leader, it’s certainly reassuring if your vendor has the KLAS or HIMSS seal of approval stamped on it.

But do those lists really help you select the right system for your hospital? Or are they high school popularity contests?

I’d argue that while some lists are better than others — particularly if someone has actually tested the systems themselves! — most stifle innovation and push hospitals into deals they regret later.

Sure, I understand why hospital leaders want the reassurance of choosing from a “best of” or “most installed” list when they’re buying an EMR. Not only are they making a huge investment of time and capital, they’re also making some critical bets on where the industry is headed. And the stakes are remarkably high. Of course, CIOs in any industry take big risks and spend big bucks when buying mission-critical software, but few face an industry as volatile as healthcare when they spend their money.

That being said, these lists aren’t great for the hospital industry, for a number of reasons:

* What, me innovate?  Top 10 lists tend to end up selecting for big, established vendors — either because they pay for the privilege or because they’re well-known — and those players usually aren’t cutting-edge types. Then, once you buy from them, they have even less reason to make risky, potentially valuable changes.

* Setting standards artificially:  Another effect of Top 10s is that they tend to reward certain types of products, say, those who fit some set of HIMSS criteria, while ignoring other models.  (After all, they’ve got to select their winners somehow.) It’s easy to get caught up in the hype and forget that their selection criteria may not be the best ones.

*Discouraging new vendors: Because the Top 10 lists select for giant vendors meeting certain criteria, they discourage vendors from spending much on alternative models that might have great promise. For example, why aren’t commercial open source EMRs or cloud-based EMRs getting more attention?

Take it from me, boys and girls, as an editor who’s created more than one of these lists in her day. Yes, they’re worth reading to gather a bit of industry intelligence, and certainly to understand the trends.  And it doesn’t hurt to know what your peers are buying.  But don’t make them a key part of your buying cycle; they’re best used, ultimately, for their entertainment value.