Blog: A tale of two systems

It takes some pluck to drive in West Virginia, probably to live there, too, amid the many mountains, valleys, hills and “hollers.”

As one plucky experiment in open-source health information technology ends in the Mountain State, another continues to thrive.

I wrote about both recently: the seven-year test by a consortium of community health centers using a remote-hosted version of the Indian Health System's EHR, the Resource and Patient Management System, or RPMS, which is winding down; and the deployment in another network of the VA's VistA EHR across a couple of ambulatory-care clinics and seven state-run hospitals and long-term care facilities, a project that's going strong.

Michael Judy, a native West Virginian and the CEO of the excellent Pendleton Community Care organization in Franklin, said his group, which has been using RPMS since it was launched by the Community Health Network of West Virginia in 2008, plans to swap it out later this year for a combined practice management system and EHR from Athenahealth.

As an EHR for clinicians, RPMS is excellent, Judy said. And the fees they'll be paying Athenahealth will be about twice as high as those charges for RPMS paid to Community Health Network, although Judy says he's confident the total cost of ownership will be mitigated some, but not completely, by staffing adjustments enabled by Athena's more efficient billing system.

While the network at its peak had piped RPMS to seven or eight of the community health clinic organizations across the state, only Judy's organization and one other community clinic remain as customers of the EHR service. Other former RPMS user clinics have switched to commercial products, as will Pendleton Community Care this fall, he says.

“I don't think there was anything that could have served us better in our start up” with an EHR, Judy said, adding, “We would not be moving based on our needs. I just don't want to be the last one standing waving the RPMS flag.”

Meanwhile, the state health department is adding a lab module to its multiple instances of VistA. It will continue to develop the system to match its needs, according to Craig Richards, deputy commissioner for administration of its bureau of behavior health and health facilities. Peter Groen, a former VA health IT official, is an adopted son of West Virginia. He's done extensive historical research about George Washington's family ties to the Eastern Panhandle. He's also the Johnny Appleseed of VistA and all things open source in the state, including championing the use of both RPMS and VistA at the West Virginia clinics and the state hospitals.

Groen is accepting of both the clinics' shift away from RPMS and the state's decision to stay with VistA and make improvements.

“This is a pretty good example of how the market works,” Groen said. “I don't think its experimentation any more. They're learning how to make open source work.”

Follow Joseph Conn on Twitter: @MHJConn