User-Driven Innovation of VistA: Central Regional Hospital
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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
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Central Regional Hospital is one of three psychiatric hospitals operated by the North Carolina Department of Health and Human Services (NCDHHS)
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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.
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EMR Implementation
Central Regional Hospital chose to implement an open-source EMR
Chose the Veterans Healthcare Information Systems and Technology Architecture (VistA)
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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
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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
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VistA Innovations
Self-implementation
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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
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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
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VistA Innovations
Self-implementation Patient pictures
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Added Patient Pictures
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Added Patient Pictures
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VistA Innovations
Self-implementation Patient pictures Primary contact
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Added Primary Contact
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Added Primary Contact
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VistA Innovations
Self-implementation Patient pictures Primary contact MOCHA replacement
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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)
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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
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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)
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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
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MOCHA Replacement
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MOCHA Replacement
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VistA Innovations
Self-implementation Patient pictures Primary contact MOCHA replacement Interface to ADC management system
Automatic Replenish/Ward Stock (AR/WS)
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Interface to the ADC System
CRH uses Automated Dispensing Cabinets for medication storage and distribution at the hospital ward level
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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
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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.
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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
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VistA Innovations
Self-implementation Patient pictures Primary contact MOCHA replacement Interface to ADC management system
Automatic Replenish/Ward Stock (AR/WS)
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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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