The Albany Campus of the State University of New York (SUNY) has launched a new VistA EHR Studies program—the most comprehensive one of its kind in the United States. The program, which began on March 24, provides students the basis to learn and manage VistA’s fast-growing open source electronic health record (EHR) system. The decision to launch the full program follows a successful pilot course taught at the university this past fall.
SUNY is responding to the opportunity created for its students by the New York State's Office of Mental Health's (OMH) full scale deployment of VistA statewide. With hundreds of facilities across the state, OMH is one of the largest healthcare delivery organizations in the United States. OMH is in the first phase of its VistA implementation and expects to have VistA up and running in 23 hospitals and more than 300 clinics over the next three years. This is the largest implementation of VistA outside of the U.S. Department of Veterans Affairs (VA) and one of the largest EHR implementations in the world.
As a consequence of this deployment, there is a growing need for health IT technologists with experience in VistA and its associated topics, such as the programming languages MUMPS and Delphi, and the actual configuration and management options of VistA itself.
During the first phase of the VistA EHR implementation in the State of New York, OMH will work closely with its contractors, CGI, and their team of VistA experts led by DSS Inc., and healthcare IT leader NTT Data to install VistA, with different configurations and different modifications, in a number of OMH hospital facilities. This initial phase will allow OMH to test the options and decide how to modify VistA to produce its own version of VistA. The New York version of VistA is to be called “Empire State VistA.” This version of VistA will then be implemented at all remaining OMH hospitals and outpatient clinic facilities.
This deployment is discussed in an article that appeared in Open Health News last year titled VistA rivals Epic and Cerner in major deployments of EHR systems. The article's authors, Roger A. Maduro and Peter Groen, refute the assertion of commercial EHR consultants that Epic and Cerner are the only options for large-scale EHR deployments. In fact, as Maduro and Groen document, proprietary EHR deployments for healthcare systems that are substantially smaller than OMH are coming in at over $1 billion each. In contrast, the contract for the VistA deployment in New York is more cost-effective, with the deployment contract valued at just $48.7 million for a superior EHR.
In parallel to the contracted implementation effort, OMH is working to develop the local expertise to manage and enhance VistA independently. OMH is committed to owning and managing Empire State VistA. This creates the perfect conditions for bringing together state government, industry, and academia in an open and agile collaborative environment, for the success of its own program, and contributing to the larger VistA open source community.
The New VistA Curriculum
In response to this increasing demand, and the high likelihood that there will be many more VistA deployments around the United States as well as internationally, the College of Computing and Information (CCI) at the State University of New York at Albany is introducing in the curriculum of the Informatics Department, new classes that cover specific VistA-related topics. The initiative has been possible thanks to the support and leadership of Dr. Jennifer Goodall, assistant dean at SUNY Albany CCI. The classes are being planned in collaboration with other institutions, in particular with Dr. Alberto Odor at the University of California Davis Medical School in Sacramento, CA, who has been teaching a series of VistA courses at the medical and nursing school.
There have been several meetings to fine tune the syllabus for the upcoming VistA classes.
In these meetings, the curriculum team was fortunate and grateful to have the participation of Sam Habiel (WorldVistA / VistA Expertise Network), Don Hewitt (OSEHRA), Luis Ibanez (OSEHRA / Kitware / SUNY), Jason Li (OSEHRA / Kitware), Marci Keiser (Central Regional Hospital, NC), Erynn Petersen (Outercurve Foundation), David Whitten (WorldVista / Central Regional Hospital, NC) Jerry Sicard (VA), Joe Snyder (OSEHRA / Kitware), Wes Turner (OSEHRA / Kitware), Brad King (OSEHRA / Kitware) and Bill Hoffman (OSEHRA / Kitware).
These experts represent the leading edge of information on VistA and how it works. North Carolina's Central Regional Hospital, for example, just completed its VistA self-implementation last fall as detailed in this article. The hospital staff team, led by Dr. Stephen Oxley as Clinical Champion, and assisted by David Whitten and Dr. Matt King, with the help of the general VistA community, was able to implement VistA in the 398-bed hospital for less than $1 million. The hospital, represented by Keiser and Whitten at the SUNY syllabus development meetings, serves the acute and long-term inpatient mental health and medical needs of North Carolina citizens from 26 counties and employs more than 1,900 staff, including 50 doctors, 300 professional nurses, 700 nursing assistants, 40 psychologists, and 70 social workers. It is a major teaching site for 23 psychiatric residents per year from Duke University and the University of North Carolina medical schools. It also provides training for medical students from both schools as well as psychiatry subspecialty fellowship training.
One of the main syllabus discussion meetings was hosted at Kitware’s offices in Clifton Park NY, with several participants joining remotely via teleconference. Kitware, as part of the OSEHRA team, has been able to get more directly involved in supporting this academic initiative thanks to its location in Albany and the proximity to the offices of the VA Albany Medical Center, the NYS OMH and the SUNY campus. In an animated and enthusiastic discussion the group converged toward the consensus of making a first class on “Introduction to VistA”, to be followed by specific classes that focus on (a) MUMPS programming, (b) VistA programming and (c) end User applications (such as the Computerized Patient Record System [CPRS]). The introductory class itself is planned for the second half of the spring semester, and will last for eight weeks.
As a follow up, classes for the fall 2014 at SUNY Albany are already planned for a second run of the “VistA Introduction” class, and a new “VistA Intermediate” class. The syllabus is being prepared in an open, agile and collaborative manner. The current version is available here. The class will meets twice a week, in 80 minutes sessions. The planning committee welcomes input from the open source community.
The distribution of topics includes:
In the class, students will engage in hands-on activities working with VistA instances installed in a Linux server in the Amazon AWS cloud. The use of this equipment is thanks to an academic grant that Amazon AWS graciously provided to SUNY Albany CCI. Linux and GT.M have been selected as the platform for the classes, to provide students with a fully open source stack that they can replicate in their own computers. By sharing a Linux server in the AWS cloud, all students in the class can collaborate in a single VistA instance and get exposed to the multi-user aspects of a VistA implementation.
The class is open to graduate and undergraduate students and has minimal prerequisite requirements. Manuals and course material are in the process of development, building upon pre-existing materials such as that developed by HHS (VistA for Education), the Veterans eHealth University (VeHU), and the webinars available at the vxVistA Hub, and at OSEHRA.
Creating a New Generation of Experts
The goal of the classes is to create a new generation of technologists who understand the underlying design principles of VistA, have learned how it integrates with the medical workflows, and are familiar with its programming paradigms. The classes will provide students with enough detail to further pursue training on how to deploy, maintain and improve the system at clinical facilities. The University, in collaboration with OSEHRA, plans to connect students with internship and employment opportunities.