HITS@WorldVistA VistA usecontinues to grow in Mexico

There are 56 hospitals in Mexico running on a modified version of the clinical information system developed by the Veterans Health Administration, and maybe in a year or so, there will be nearly as many hospital's in Mexico running on the VA's VistA system as in the VA.

Christian Alexis Diez Ocaña, an engineer with the Instituto Mexicano del Seguro Social in Mexico City, provided an update on the VistA-in-Mexico development during the 14th WorldVistA community meeting at the National Institute of Standards and Technology in Gaithersburg, Md. WorldVistA is a not-for-profit organization whose members promote the use of the VistA computer system outside the VA.

The IMSS operates 270 hospitals and more than 35,000 clinics that provide healthcare services to 40 million people in Mexico. IMSS officials first heard about the VA's VistA system at a Health Level 7 conference, Diez Ocaña said. A team visited VA officials in Washington, D.C., in 2004 and obtained a copy of the VistA software, which is available under the Freedom of Information Act. The program was translated into Spanish and otherwise modified to fit the needs of the IMSS and was installed in the first 12 hospitals in Mexico in May 2005, as part of an ongoing, $100 million information-technology development program within IMSS.

The 56 hospitals in which IMSS-VistA is operating range in size from 50 beds to 800 beds. Unlike IMSS clinics, each hospital operates its own independent IT system, so connectivity remains a work in progress, Diez Ocaña said. The IMSS is testing a communications system to send HL7 messages between the hospitals, he said. The hospital systems already are connected to a central data repository set up as the hub of a previously installed homegrown electronic health record for IMSS' clinics.

About 1,000 of the busiest clinics that handle about 75% of IMSS patients use the application service provider EHR system that was rolled out in 2003, he said. Thus far, the database has acquired about 11 million outpatient records.

"From the outpatient system, we can schedule admissions into VistA and from the hospital, VistA sends information to the outpatient system," he said. In addition, physicians can access and open the outpatient system from IMSS-VistA.

Doctors also use IMSS-VistA to write prescriptions, which are filled by the pharmacy in each hospital, but e-prescriptions cannot be written on the system and sent to outside pharmacies.

"Physicians are happy with the system," Diez Ocaña said. "The physicians now know about all of the possibilities these systems can provide so they are hungry for the advancements."

IMSS-VistA runs on GT.M, an open-source version of the MUMPS database and programming language from Sanchez Computer Associates, Malvern, Pa., a division of Fidelity Information Services, and the open source Linux operating system.

"We expect to complete 120 hospitals," Diez Ocaña said. "That's the goal, but we don't have a schedule" when they will be completed. Though the ambitious program was launched during the presidency of Vicente Fox, whose term ended last month, Diez Ocaña said it appears support for the project will continue under Fox's successor, Felipe Calderon.

Promoting the use of VistA elsewhere in Latin America has been a goal of WorldVistA for years and representatives at the conference talked about interest in the system coming from other countries, but Diez Ocaña said that so far, no other Spanish-speaking nation has asked for a copy of the IMSS-VistA translation.

"Some people have asked us for some information, but that's all," he said. "Nothing official."

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