Oroville VistA Implementation Raises the Bar

One of most exciting presentations at the VistaEXPO 2011 conference was given by Robert Wentz, Hospital Administrator and CEO of Oroville Hospital, a regional hospital in the beautiful mountains of Northern California. Oroville Hospital has achieved a whole series of milestones in close partnership with the VistA community. These range from a full implementation of VistA in the hospital and most of its 20 clinics, to the achievement of full meaningful use certification.

Oroville Hospital follows in the steps of Midland Memorial Hospital in Texas whose visionary CIO, David Whiles hired Medsphere to implement VistA in the hospital. Yet, Oroville has taken this effort one step further. Oroville successfully implemented VistA on their own in collaboration with the VistA community. In addition it funded the development of a whole series of enhancements to VistA to extend the capabilities of the open source EHR and to achieve Meaningful Use.

Wentz gave a detailed report yesterday on the financial factors that led to his decision to go with their own implementation of VistA, factors that he says should lead every regional hospital in the United States to do the same thing. He said that before "drinking the Kool Aid" the Oroville staff met with virtually every single commercial EHR vendor in the country. The decision to go with VistA was taken only after reviewing all other options.

In order to start the project Wentz needed what he called a "wartime CIO." The CIO at the time was opposed to implementing anything other than a well-marketed commercial product. Thus Wentz promoted Oroville's hard-charging director of IT, Denise LeFevre, to the position of CIO. It was LeFevre, who turned down the job offer twice, that led the implementation effort.

The evidence shows that Oroville Hospital made the right decision. VistA has been implemented in the 154-bed hospital, as well as 17 out of the 20 clinics that the hospital owns. It is being used by almost 1,200 general users, more than 400 physicians, as well as more than 60 nurse practitioners and physician assistants.

One of the extraordinary things about the deployment is that VistA is serving not only as a full-blown EHR, but also as a Health Information Exchange (HIE). Any of the patient data gathered in the hospital, or any of the clinics or physicians' offices, is immediately available everywhere else in the health system. Having this data readily available has already saved the lives of many patients who have ended up in the emergency room of the hospital. 

The clinics that have implemented VistA include both general and internal medicine, cardiology, obstetrics and gynecology, pediatrics, pulmonary, surgical, orthopedics, oncology/cancer care, geriatrics, and urgent care walk in clinics.

In a private conversation, Wentz pointed out that one of the most exciting aspects of the VistA rollout in the clinics over the past couple of years was the discovery that their quality measures put Oroville Hospital in the top 5% of the hospitals in the United States. Wentz told OHNews that they have been practicing quality medicine all along, but until the figures started coming out of the EHR, they did not know how high their quality measures were compared to those of other hospitals. Oroville Hospital's quality measures match or exceed those of hospitals considered "top tier" and regularly cited by U.S. News & World Report as the best hospitals in the U.S.

The sudden availability of this data turns out to have been a major factor in the enthusiastic adoption of VistA by physicians and nurses. Even initially recalcitrant physicians have been able to see how well they are doing and figure out ways to improve the quality of care they are providing their patients.

A key to the success of Oroville Hospital has been the close collaboration with the open-source VistA community. Lacking the necessary knowledge and skills to implement VistA by themselves, Oroville Hospital partnered with WorldVistA and the VISTA Expertise Network. 

The VISTA Expertise Network has served as a sort of broker, facilitating the hiring of individual consultants who have come in to work on specific projects. In addition the VISTA Expertise Network has been training Oroville Hospital's own staff to become VistA experts. Oroville Hospital now has four database administrators, one full-time developer, and a dozen Clinical Access Coordinators (CACs), half of whom develop templates while the other half are dedicated to supporting and educating the users. In addition there are a large number of ADPACs within the hospital staff.

The partnership with WorldVistA brought many mutual benefits. This collaboration led to the achievement of meaningful-use certification. According to Matthew King MD, the Chief Clinical Content Developer for WorldVistA’s certification project, “All in all, we were able to achieve both Hospital and Ambulatory Certification through the efforts of dedicated volunteers in the open-source community with major parts of the project funded by both WorldVistA and Oroville Hospital. Without this ‘Village Effort’ it would not have been possible,” he emphasized.

In addition to the joint MU certification effort, a large number of WorldVistA members contributed their time to help Oroville Hospital develop all the add-ons and enhancements that they needed. I asked both LeFevre and Rick Marshall from the VISTA Expertise Network for the names of some of the consultants and volunteers that most helped Oroville Hospital with their implementation. They both said it would take the rest of the day to outline, so I will mention just a few below.

In addition to certification and meaningful use, Oroville Hospital collaborated with the community in the development or enhancement of ePrescribing, pediatric growth charts,  and an entirely new scheduling package. Interestingly enough, the later two were built from scratch using the new Enterprise Web Developer (EWD) software in just a few weeks. EWD has been developed by Rob Tweed who gave several presentations at the VISTA Expo conference on the tool.

George Lilly developed several packages including ePrescribing, VistACom, and CCR/CCD package to assist with certification and meaningful use. He was helped by several people, in particular David Wicksell. Marty Mendelson did most of the VistA patching. Dan Gray developed the lab interface to Mysis/Sunquest. Lloyd Milligan's ADT Interface let Oroville connect VistA to Oroville's McKesson Series registration and patient-movement system.

Larry Carlson improved the interface to the Pixys pharmacy systen and developed the billing interfaces. Mark Amundson worked on multiple parts of the project, including the pharmacy interface. Other Amundson partners, including Maggie Anderson, Char Feldman, and Harlan Scheibe also helped with the system.

System configuration and management was done by Fourth Watch Software and Oroville employee Zach Gonzales. Joe Tastrom just started working on-site to help will all kinds of tasks. Stuart Frank is working on configuring and further developing his imaging and radiology software. Rick Marshall and Zach Gonzales have done a huge amount of coding that will be released to the community. Joan Carlisle helped bring up the Dietetics module. JoAnne Brougham has been helping them configure and manage the patient and patient movement files.

Oroville Hospital chose to implement VistA using the GT.M database. Thus K.S. Bhaskar helped with the implementation and configuration of GT.M. Interestingly enough, GT.M has allowed Oroville Hospital to not only manage their hospital and clinics, it can potentially allow them to also host other regional hospital and clinic VistA deployments in their facilities.

LeFevre told OHNews that Oroville Hospital has spent about half a million dollars developing and enhancing the packages and interfaces mentioned above. According to LeFevre this money was "well spent." On the one hand, this amount is far smaller than what Oroville Hospital would have had to spend for similar applications, according to LeFevre, and on the other, these enhancements provide Oroville Hospital with what it needs. In addition the Oroville Hospital staff has gained a great depth of knowlege and capabilities.

Oroville Hospital is contributing all of this software back to the community as open-source software. Wentz firmly believes that hospitals should collaborate with each other. He emphasized during his presentation that this is all about making their patients healthy. Oroville Hospital's software enhancements are being released only after the community has vetted them to make sure that they work properly with other versions of VistA. 

In total, Oroville Hospital's VistA implemenation has cost approximately $10 million. That figure, however, includes all costs, according to Wentz. That includes all the new computer and networking hardware that had to be purchased, as well as a large amount of new medical and lab equipment with interfaces that could work with VistA. This equipment includes a large number of iPads. VistA is going to run on the iPads using a virtual desktop infrastructure.

Oroville Hospital has just received the first payment for meeting the meaningful use criteria for inpatient care. The first check is for $3 million and several more are expected as the hospital has met many other criteria.

Comments

You Tube Video

Tom M. also provided a link to an interesting You Tube video on the EHR system implemented at the Oroville Hospital. See http://www.youtube.com/watch?v=yWyyBSiF-gY

Thank you for your coverage

Roger,

Thank you for your great article and kind words related to our project at Oroville Hospital. Your article is the most comprehensive and coherent description of the project, the talent and the context in which this open source product is deploying that I have seen. Many of our regional journalists have tried to capture the depth and potential importance of this project only to fail due to there limited knowledge of the technology and the healthcare environment. It is clear that you have a firm grasp on both issues. I plan to forward your piece to members of the California Hospital Association and the local (Sacramento) press so that they may gain a better understanding of what is available in the open source world and what can be done to achieve our goals in Healthcare.

You are a gifted writer and journalist. It was a pleasure meeting you and hope to see you in the future.

Bob Wentz CEO Oroville Hospital

Robert, thanks for your

Robert, thanks for your compliments but I think I was just at the right place at the right time. VISTAExpo was the right venue for what you guys had to present. Other hospitals need to see what you have accomplished at Oroville Hospital. It shows that a hospital can implement a world-class EHR, on their own and at significant cost savings compared to proprietary EHRs. And, as you pointed out in your presentation. you are in control of your long-term support and maintenance costs while hundreds of hospitals are going to go out of business when the vendors start sending the invoices for upgrades. Hope they pay attention in Sacramento. Please do keep us posted on the continuing progress of your implementation.

Great coverage, Roger

This is indeed a great story...

and here is a picture of you as you were covering this: http://www.flickr.com/photos/munnecket/6377354413/in/set-72157628082755557

and chatting with Phil Longman, author of Best Care Anywhere: http://www.flickr.com/photos/munnecket/6377343671/in/set-72157628082755557

Tom, thanks for the pictures.

Tom, thanks for the pictures. Very exciting presentations at VISTAExpo. Looking forward to further discussions on your "pattern-language approach" for the next generations of EHRs.