Case Study: Hospital Provides Update on Open-Source Move


Midland Memorial Hospital hopes to have the bulk of its electronic health record (EHR) system up and running on open-source software by late spring or early summer, according to David Whiles, the Midland, Texas, facility's information systems director.

Operating across three campuses five miles from each other and linked by high-speed networks, Midland Memorial is a 371-bed county hospital run as a single organization. Midland Memorial is also the first facility on track to fully implement OpenVista software and services from Medsphere Systems Corp.

The Medsphere software is based on the open-source VistA electronic health record system developed by the U.S. Department of Veterans Affairs and in use at VA hospitals. Funded by U.S. taxpayer money and thus in the public domain, VistA stands for Veteran Health Information Systems and Technology Architecture. The system was developed to unify all the different departments within a hospital. Medsphere ported VistA to Linux and removed some of the system's specifications that related solely to veterans' healthcare.

Migrating to open-source software has been a long process for Midland Memorial, Whiles said in a recent phone interview. The hospital first started evaluating a move back in 2003 to update, better integrate and improve the efficiency of its systems in a cost-effective manner. In the same year, Midland Memorial begun working with Medsphere.

From the start, the hospital put together an executive team from different hospital departments, including laboratory, pharmacy, radiology, and nursing services to "self-educate ourselves on the new system" while working in conjunction with Medsphere, Whiles said. The software evaluation continued into 2004 and involved a couple of site visits to VA hospitals, he added.

Come June 2004, Midland Memorial brought together 150 hospital staff and about 20 physicians for a software demonstration and to let them try out the system.

The cost of fully implementing OpenVista will be $7.1 million as opposed to more than double that figure if the hospital had gone with commercial software, according to Whiles.

Implementing OpenVista required six months of initial development work starting in March 2005 before the first hospital application, a pharmacy application, went live in late October. The laboratory application went live in early December. With those applications up and running, "we were back to where we started with the legacy system," Whiles said, duplicating with open-source software the hospital's previous system based on proprietary applications.

Over the past two weeks, the hospital has taken other applications live, including its first clinical unit EHR software as well as EHR capabilities for a nursing unit and its same-day surgery unit. Midland Memorial also has a small computerized physician order entry application running. "We'll let that percolate for the next 30 days," Whiles said.

On March 20, the hospital plans to bring onstream the general order entry services division and continue to roll out EHR across the entire facility over the next few months, Whiles said. "In late spring or early summer, we'll be live with the entire [OpenVista] system throughout the hospital," he added, with the exception of bar-code medication administration, which

Whiles said will take another three to five months to roll out.

With the EHR applications that went live last year, Midland Memorial is already realizing some benefits. There's much more integration and exchange of information between the lab and pharmacy systems, Whiles said. Having the lab monitor medication or blood levels in patients and report those results immediately back to the pharmacy is functionality that wasn't possible previously, he added. "We have also seen some improvements in access times to lab results," Whiles said.

"We'll start to see the big benefits when the system is fully deployed," Whiles said, particularly in providing more clinical efficiency for patients.

Midland Memorial is running OpenVista as part of an open-source software stack on Red Hat Inc.'s Linux Enterprise AS (advanced server) operating system, Whiles said. The Linux software runs on two Hewlett-Packard ProLiant DL850 servers working in an active/passive cluster.

Both the hospital and Medsphere have worked with HP Professional Services on the OpenVista implementation and Midland Memorial also uses an HP SAN (storage area network) as part of the EHR system. HP provides support for the VA and has plenty of familiarity with the original VistA system.

With a lot of risk factors already involved in the project, Midland Memorial decided against adopting open-source database management software, Whiles said. "We felt it was a level of risk that we didn't want to take on," he added. Instead, the hospital chose to go with InterSystems Corp.'s Caché proprietary database.
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