User-Driven Innovation of VistA: Central Regional Hospital Stephen Oxley, M.D, CMO Central Regional Hospital Butner, NC Open Innovation in Electronic Health.

User-Driven Innovation of VistA:

Central Regional Hospital Stephen Oxley, M.D, CMOCentral Regional Hospital

Butner, NC Open Innovation in Electronic Health Records

HIMSS14Orlando, FL

February 23, 2014

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

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.

EMR Implementation

Central Regional Hospital chose to implement an open-source EMR

Chose the Veterans Healthcare Information Systems and Technology Architecture (VistA)

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

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

VistA Innovations

Self-implementation

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

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

VistA Innovations

Self-implementation Patient pictures

Added Patient Pictures

Added Patient Pictures

VistA Innovations

Self-implementation Patient pictures Primary contact

Added Primary Contact

Added Primary Contact

VistA Innovations

Self-implementation Patient pictures Primary contact MOCHA replacement

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)

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

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)

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

MOCHA Replacement

MOCHA Replacement

VistA Innovations

Self-implementation Patient pictures Primary contact MOCHA replacement Interface to ADC management system

Automatic Replenish/Ward Stock (AR/WS)

Interface to the ADC System

CRH uses Automated Dispensing Cabinets for medication storage and distribution at the hospital ward level

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

Interface to the ADC SystemThe 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.

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

VistA Innovations

Self-implementation Patient pictures Primary contact MOCHA replacement Interface to ADC management system

Automatic Replenish/Ward Stock (AR/WS)

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