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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.

What Would It Take To Get More Hospitals On VistA?

Posted on January 22, 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.

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.