Changing from paper charts to electronic medical records sounds like a relatively easy sales pitch. It improves patient care, decreases the risk of error and adds enormous efficiency into the system.
But bringing state-of-the-art technology to health care is expensive, often running well into eight figures. Still, there are ways to keep the cost down and also provide excellent care. Forbes caught up with David Whiles, CIO of Midland Memorial Hospital in Midland, Texas, to look at ways to save huge amounts of money without sacrificing quality.
Forbes: What are you trying to accomplish with your electronic medical records?
David Whiles: First and foremost is patient safety. After that it's efficiency. We started this project five or six years ago after receiving sunset notices on our major systems. That started us looking at replacing those systems and trying to figure out what the future would bring. We saw what was coming down the line. That was when Bush was putting his health IT plans into place and forming the Office of the National Coordinator for Health Information Technology. There were a number of reasons to move to electronic health records. We did not have any sort of electronic health records in place at the time.
What did you have before that?
We had a hospital information system, which is for the financial side of the business--patient accounting, general accounting, registration and basic order entry. It did not include physician order entry. We had automated our pharmacy department, too, but all of these were all separate systems with only a limited interface to the financial system. We had no clinical alert or bedside medication administration that notified the staff as to the appropriateness of the medication.
Did everything go smoothly from the start?
Well, we were somewhat shell-shocked from the sticker price. We were not in a financial situation to take advantage of the commercial systems that were being offered.
So what did you do?
We came across the VistA (Veterans Health Information Systems and Technology Architecture) system, which was developed by the Veterans Administration. That's used by all the 160-plus VA hospitals in the United States, plus all of their outpatient ambulatory clinics. It's been in use by the Veterans Administration for more than 20 years. It's a very mature system. It's won a number of accolades from the Institute of Medicine.
Is that available to non-VA hospitals?
Yes. It was released to the public through the Freedom of Information Act by the Veterans Administration. Today it's publicly available. For a nominal fee, they'll send you CDs of the software.
How much does it cost if you go to the commercial market.
Four or five years ago, the price was $18 million to $20 million for a hospital our size.
What does it cost to implement the VistA system?
The software is basically free, but it's not free to install it. You need expertise to do that. It's not a plug-and-play application. It's a custom clinical system.
When you tallied all the costs, what was the final bill?
Our budget was $6.3 million, which was approved by our board of directors. That's exactly what we spent. It included hardware--we have a full wireless system on both of our campuses--about 600 workstations, including 80 mobile workstations, and the bar code scanners and printers. The bulk of that money was for professional systems by Medsphere Systems Corp. They're still our support vendor today. We rely on them for the technical expertise. They also have a lot of ex-VA employees who have experience with the Vista system.
Is it more upkeep on an open software system or less?
It's probably about the same.
Is it fully implemented?
Yes. It was finished on Feb. 5, 2007. That's the day we removed all legacy paper charts from our organization. At 5 a.m. that morning they pulled every paper chart. We're not completely paperless, but we have no paper patient charts anymore.
Is it the same kind of complexity as an ERP system?
It's probably far more complex. There are a lot of components to electronic health records, and the VistA system has the majority of those components. We use it for our lab system, pharmacy department, respiratory therapy and a number of departments around the hospital. That includes any nursing care, physician care and electronic documentation. When a patient is admitted, they get a wristband with a bar code. The nurses can scan that bar code to make sure it's the right patient. The system matches the medication to the patient, makes sure it's the right time for the medication, the right dosage and the right route of administration. When it matches up correctly, it gives them a green light.
Does it allow add-ins like portable devices?
Right now we're evaluating portable devices. We have workstations on a stand right now for documentation or medication or administration. We don't have any handheld portable devices yet.
What are your criteria for those?
It has to be light so people can carry it around but it also has to display the full application, so it won't be cellphone size. We're looking at tablet PCs. They also have to be waterproof. In the medical arena, you get stuff on devices. You have to be able to clean them and sanitize them. They also have to withstand shock if they're dropped. And they need wireless connectivity for the barcode scanners.
But will those devices work with the overall VistA system?
Yes. That's just a hardware issue. And there are plenty of good devices on the market these days.
How about security?
They will communicate through the wireless network. We've spent a lot of time on that network. They won't be able to be tapped into.
Can they still access the Internet for information?
Yes. We have that already in our system.
What does the VA system run on?
The VA typically runs on Windows. We run on Linux. We're using Hewlett-Packard servers, Red Hat Linux, the InterSystems Cache database management system, which is the only proprietary component in the stack. On top of that runs OpenVista.
Will there be changes to what you've installed over time?
Yes, it is a continuously evolving system. We are looking at adding in RFID technology for patient tracking and various other purposes.
Have you gotten a handle on what this has done for your legal liability?
It certainly improves patient safety in a number of areas. Medication is a big one. It's certainly more foolproof than paper. Anything you do is kept permanently, and it has a lot of built-in protection from changing records. It's a complete record of the patient care.
Is there a study that shows how much you've saved from an efficiency standpoint?