To explain the historical significance for the healthcare industry of what is happening in Texas requires a few modifiers.
What is likely to be the first installation in a U.S. acute-care hospital outside the Veterans Health Administration by a private-sector company of a clinical information system based on the Veterans Affairs Department's Veterans Health Information Systems and Technology Architecture, or Vista system, is under way at Midland (Texas) Memorial Hospital.
The financial impact is more straightforward. Midland's IT project is budgeted for $7.1 million, well below half the $18 million price tag comparable commercial systems would cost, according to David Whiles, Midland's director of information systems.
In February, the hospital contracted with Medsphere Systems of Aliso Viejo, Calif., to install its Medsphere OpenVista software system throughout Midland's main hospital, its west-side campus and its inpatient rehabilitation hospital, with 230 total beds.
The "open" comes from the historical fact that Medsphere was involved in the 2003 adaptation of the VA's Vista program to run on the open-source Linux operating system. A trademark dispute between Medsphere and the not-for-profit WorldVista organization, which aims to promote the use of the Vista system outside the VA, is working its way through the U.S. Patent and Trademark Office. Medsphere won the most recent round in that battle as the patent office on June 18 denied WorldVista's request for an extension of time to file a protest against granting Medsphere the trademark.
Medsphere is targeting sales in small to midsized hospitals, says Scott Shreeve, M.D., a co-founder of the company and its chief medical officer. Its software is based on the VA's Vista system, often called FOIA Vista, because copies of the software running at 157 VA hospitals and 850 clinics are available free under the Freedom of Information Act.
Medsphere recently completed installing FOIA Vista in seven nursing homes operated by the Oklahoma Veterans Affairs Department, Shreeve says, but this will be the company's first sale of its own Vista version to an acute-care hospital. The Midland installation will run on Red Hat Linux, but, at Medsphere's recommendation, the hospital will use a proprietary version of the MUMPS database and programming language, Cache, which also is used by the VA, and not use the open-source alternative, GT.M, an option suggested by WorldVista.
Medsphere also will create interfaces between its system and a half dozen or so legacy systems Midland will keep, including its year-old picture archiving and communications-radiology information systems, or PACS-RIS; its surgery department management system; and its perinatal monitoring system.
Whiles says that about two years ago, the hospital got word that several of its key software systems would no longer be supported by their vendors.
Chief among them is Midland's 17-year-old Precision 2000 system from McKesson Corp. that handles its payroll, admission, discharge and transfer, patient coding, billing and collections functions.
Instead of looking simply to replace only these aging legacy systems, the hospital embarked on a strategic analysis of its future IT needs, Whiles says.
From that came a plan also to update Midland's aging laboratory and pharmacy systems, and add a PACS-RIS and an electronic medical-records system. Then Whiles went shopping for the package and got a jolt.
"We were looking at north of $18 million based on best estimates of pricing in the market at that time," Whiles says, noting it would have been the largest IT investment in the history of the hospital. "The sticker shock of the initial capital investment was significant for a facility of our size."
Lawrence Sanz, chief financial officer at Midland, says the cost for a comprehensive system was a deal-breaker.
"There was no way we could spend the $18 million in one year," Sanz says. "We'd have to have done it in little pieces. That's what we've done in the past."
Whiles says he began exploring open-source alternatives and then began lengthy conversations with Medsphere.
The hospital signed a contract with Medsphere in February. Whiles says configuration and interface development are well under way and they plan to fire up the computerized lab and pharmacy modules this month or in September, with patient documentation beginning to come online in December.
Whiles says there is still "a lot of nervousness" about going forward as the first installation of its kind for Vista and contracting with Medsphere, a 3-year-old company.
"I'm cautiously optimistic we can have success here that other people can follow," Whiles says. "It's the best solution I've seen in the industry, not just the price. It's a very strong system."