The biggest stars of the WorldVistA community meeting this year were from Mexico.
The 13th annual conference of advocates of using the Veterans Health Administration's VistA clinical software system to power healthcare facilities outside the VA both in the U.S. and abroad was held June 29 through July 2 this year at Robert Morris University near Pittsburgh.
According to Joseph Dal Molin, vice president of business development for the not-for-profit WorldVistA organization, adopters of various versions of the VA's public-domain software were honored invitees this year.
Among the welcomed users, Dal Molin said, were David Whiles, CIO of Midland (Texas) Memorial Hospital, a 230-bed system that last year began installing a VistA-based system developed by Medsphere Systems Corp. of Aliso Viejo, Calif., and Marcus Werners, who spearheaded the use of a VA-based system at the German Heart Institute in Berlin in 1992.
But the delegation from Mexico -- with their Spanish-translated core elements of the VistA system already deployed in about 24 hospitals within the government-run Instituto Mexicano del Seguro Social, or IMSS -- wowed the 60 or so attendees of the conference, according to Dal Molin, a Toronto-based healthcare IT consultant.
"They are very impressive," said Dal Molin. "I think they've taken some very pragmatic approaches to adapting VistA to their own system without changing the underlying parts of it."
The IMSS obtained a copy of VistA after meeting with VA officials in 2004, and by May 2005 had translated and adapted two key VistA modules, its computerized patient-record system, or CPRS, and its admission, discharge and transfer system and turned them on in 12 hospitals in Mexico City, Monterrey and Guadalajara. Those were the first steps involving VistA in a $100 million, national IT expansion for the agency, which provides healthcare for 40 million workers and their dependents. The goal for IMSS is to install the IT system in roughly half the IMSS' 223 general hospitals.
"The really impressive thing about it is they've done most of this on their own, other than some early contact with the VA and the odd consultant," Dal Molin said.
IMSS officials indicated a willingness to participate in the WorldVistA community, Dal Molin said.
"Looking at this internationally, I think they're going to provide a global benchmark of what's possible," he said. "If you look at their budget, it's a small fraction of what Canada is going to spend on implementing EHRs. Other countries should really be looking at this."
Dal Molin said WorldVistA is working to develop the tools and infrastructure to create something akin to a VistA users group that will help adopters and developers communicate with each other.
"The reason why VistA is so good within the VA is they've had the feedback loop with the people who use it," Dal Molin said. "We're working to put in the mechanisms to make that happen. The groundwork for that we're doing with the VistA Office project, and we'll extend that somewhat" for use by other VistA system adopters.
VistA Office EHR, or VOE, is an effort begun by CMS in 2004 to finance and promote the adaptation of the VA's VistA system for use in small, private physician offices, where EMR penetration rates range between 10% and 20%, according to several surveys.
Daou Systems, Exton, Pa., was paid $2.5 million for development of VOE as a subcontractor of the Iowa Foundation for Medical Care, a Medicare quality-improvement organization and the $4 million primary contractor for VOE.
But development efforts lagged. Originally slated for release in November 2004, the deadline was extended until July 2005, and then pushed back to August 2005. CMS stepped in last September to announce it would only release a beta version of VOE to a handful of selected test sites, while release of VOE to the general public would be pushed back until the end of 2006. Meanwhile, CMS hired WorldVistA to coordinate training of vendors to support VOE when it is eventually released.
Dal Molin, who also serves as WorldVista's project manager for VOE, said one task is to set up a mechanism through which revisions, or patches, to the VistA code coming out of the VA are applied to VOE so the two systems don't fork.
"Our goal is to mimic the methods and tools the VA uses to continually update and make that easier for people to tie into, so they can continuously have a fresh system," a task too complex for many small vendors who are expected to provide front-line support to physician offices using VOE systems, Dal Molin said.
Dal Molin said another goal is to have a VOE version capable of passing the EHR certification process established by HHS under contract with the Certification Commission for Healthcare Information Technology. The software should be ready for CCHIT testing sometime early next year, he said. By distributing a CCHIT-certified version of VOE, support vendors will save money and will be able to offer the software to physicians at a lower cost than if they had to pay for testing individually, Dal Molin said.
John Zimmer, M.D., the soon-to-be medical director of the Council Bluffs (Iowa) Community Health Center, a three-physician public health clinic, attended the WorldVistA meeting to evaluate both the organization and its VistA open-source development program. Zimmer's clinic is a member of the Iowa/Nebraska Primary Care Association, which serves 19 primary and migrant care organizations in two states.
Zimmer said association members use a common, server-based practice-management system, so it would make sense to have a single EHR. Zimmer said he has spoken with members of the association's EMR evaluation committee about open-source applications and was heartened by the amount of time spent at the WorldVistA community meeting on collaborative development.
"I think the idea of building a community of users outside the VA was one of the central themes of the conference," Zimmer said. "The Mexican experience is going to be huge. It's going to be larger than the VA very quickly, and I think WorldVistA is getting stronger about what its role is supposed to be. I think I'm on the right track."
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