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User-Driven Innovation of VistA: Central Regional Hospital

User-Driven Innovation of VistA: Central Regional Hospital. Stephen Oxley, M.D, CMO Central Regional Hospital Butner, NC. Open Innovation in Electronic Health Records HIMSS14 Orlando, FL February 23, 2014.

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User-Driven Innovation of VistA: Central Regional Hospital

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  1. User-Driven Innovation of VistA:Central Regional Hospital Stephen Oxley, M.D, CMO Central Regional Hospital Butner, NC Open Innovation in Electronic Health Records HIMSS14 Orlando, FL February 23, 2014

  2. Central Regional Hospital is one of three psychiatric hospitals operated by the North Carolina Department of Health and Human Services (NCDHHS)

  3. Central Regional Hospital • 398-beds • Located 10 miles northeast of Durham, North Carolina in the Research Triangle region of the state. • Was completed and occupied in July 2008.

  4. EMR Implementation Central Regional Hospital chose to implement an open-source EMR Chose the Veterans Healthcare Information Systems and Technology Architecture (VistA)

  5. EMR Implementation VistA is available for download from several sources in several flavors CRH chose a version available from an open-source VistA community non-profit organization

  6. EMR Implementation • This version was selected because: • It was true enough to the VA version to be able to accept all updates from the VA patch stream • Its main modification had been to allow VistA to work with a totally open-source stack: • Linux • GT.M • VistA

  7. VistA Innovations Self-implementation

  8. Self-Implementation • Hired as full-time employees: • A technical expert with 18 years experience with VistA in the VA • A physician with extensive experience configuring VistA for end-users • Leveraged this expertise by knowledge transfer to 15 other existing employees

  9. Self-Implementation It took 30 months from project initiation to last go-live Trained 1526 end users System used for care on all 398 beds

  10. VistA Innovations Self-implementation Patient pictures

  11. Added Patient Pictures

  12. Added Patient Pictures

  13. VistA Innovations Self-implementation Patient pictures Primary contact

  14. Added Primary Contact

  15. Added Primary Contact

  16. VistA Innovations Self-implementation Patient pictures Primary contact MOCHA replacement

  17. MOCHA Replacement Medication order checking is one of the most valuable patient safety features of an EMR The VA has compiled, maintained and done open-source distribution of a drug database they call the National Drug File (NDF)

  18. MOCHA Replacement Until recently VistA has used the National Drug File (NDF) for medication order checking However, the NDF only supports a limited set of order checks Commercially available drug databases new offer a wider range of order check information

  19. MOCHA Replacement The VA has modified VistA to take advantage of the commercially available drug information and do expanded order checks To accomplish this upgrade, the VA created the Medication Order Check Healthcare Application (MOCHA)

  20. MOCHA Replacement • While MOCHA dynamically accesses the most recent commercially available drug data: • it uses expensive proprietary technology • it requires a very expensive subscription to the proprietary drug database • it resides on VA servers and is not accessible to VistA users outside the VA

  21. MOCHA Replacement

  22. MOCHA Replacement

  23. VistA Innovations Self-implementation Patient pictures Primary contact MOCHA replacement Interface to ADC management system Automatic Replenish/Ward Stock (AR/WS)

  24. Interface to the ADC System CRH uses Automated Dispensing Cabinets for medication storage and distribution at the hospital ward level

  25. Interface to the ADC System The ADC Server holds each patient’s medication profile and also tracks what medications are stocked in which cabinet and which drawer within the cabinet

  26. Interface to the ADC System The Pharmacist processing med orders in VistA Pharmacy needed to know if a medication was stocked in the ADC on the patient’s ward. The ADC Server needed to update a patient’s medication profile when an order was entered or discontinued.

  27. Interface to the ADC System We leveraged the ARWS module in VistA to map the cabinets information for VistA Pharmacy. We employed the open-source HL-7 interface engine, MIRTH, to facilitate the communication between VistA Pharmacy and the ADC Server

  28. VistA Innovations Self-implementation Patient pictures Primary contact MOCHA replacement Interface to ADC management system Automatic Replenish/Ward Stock (AR/WS)

  29. Open-Source Innovation The State of North Carolina could not afford to implement a proprietary EMR Open-source software allowed us to implement a very powerful system for about $2700 per bed An open-source system made customization to meet our unique needs readily available and affordable

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