Part one of a two-part series (Access part two here):
The recently announced decision by the Middle East nation of Jordan to install the Veterans Affairs Department’s VistA electronic health record in its government-run healthcare system probably won’t be a dam-breaker for VistA in the private sector in the U.S., but it could have a huge impact on information technology globally, people close to the project said.
Under terms of the contract for the pilot project, Perot Systems Corp., Plano, Texas, is to install WorldVistA EHR, an open-source version of the VA’s system, at 488-bed Prince Hamza Hospital, a teaching hospital opened in 2006 in Amman, the capital of Jordan.
Perot also is to install the software at the hospital’s affiliated outpatient Amman Comprehensive Medical Clinic and at the King Hussein Cancer Center, which was founded in 1997 and is undergoing a renovation due to be completed this year, increasing its capacity to 200 beds.
Physician Rami Farraj is chairman of the board of directors of E-Health Solutions, a not-for-profit Jordanian company created to oversee the government’s IT development program. Farraj said the Jordanian government chose the WorldVistA version that runs on GT.M, an open-source iteration of the Massachusetts General Hospital Utility Multi-Programming System, or MUMPS, database and programming language. GT.M is developed by Fidelity National Information Services, Jacksonville, Fla. The VA runs VistA on Cache, a proprietary version of MUMPS from InterSystems Corp., Cambridge, Mass.
“We have always aimed to take the open source, most cost-effective options,” Farraj said. “With regards to the MUMPS platform, we will go with GT.M from Fidelity. The difference in cost is huge; despite Cache’s experience, the cost is too big.”
Price also was a significant driver for Jordan to select VistA itself, but its relatively lower cost—only a few of the VistA modules are proprietary and come with licensing fees—was far from the only criteria. Most of VistA is in the public domain and can be copied free of charge under the Freedom of Information Act. The costs of a VistA installation still include significant hardware, implementation and training costs.
“We have looked at all the possible systems that would fit for a whole country and the VistA system seemed the most appropriate for a national health information management system,” Farraj said. “Many of the commercial systems don’t have the features that Vista does,” including those focused on preventive care, he said. “Don’t get me wrong. Some of them are great programs; but for Jordan, we wanted a program that is cost-effective. The ones we can afford are not of the quality that we want.”
Farraj said that Jordan long has been a center for health tourism, drawing patients from throughout the Middle East, “mainly because lots of effort has been put in very early on to improve the medical system in Jordan, and lots of effort has been put into the education of doctors and nurses. They are highly qualified and keep up with the latest in medicine. But we need a system that doesn’t let people fall through the cracks. Having a national (IT) system will help fill those cracks," according to Farraj.
Even the newest hospitals in Jordan still keep records on paper, which he says, ironically, is “a significant advantage over the U.S.” as Jordan develops its national IT infrastructure. With no costs sunk into legacy software systems: “We don’t have to integrate. We can install one system for the entire country.”
Big plans
While the initial contract with Perot is only for two hospitals and a clinic, Farraj foresees a potential for a three-phased expansion after the pilot. The first would be to roll out the system at the remaining 42 government hospitals and 500 clinics, all of which will be connected, Farraj said.
“We are already in the process of setting up a fiber-optic network that goes to every governmental office in Jordan, including clinics and hospitals and schools,” Farraj said. “This, hopefully, will be done in the coming two or three years. We should be able to connect to this network all of the 500 clinics.”
The next step will be to offer the system to the 20 or so private-sector hospitals in the country.
“The private-sector hospitals have shown an interest in having VistA,” Farraj said. “We will only charge for implementation. By that time, we should have Jordanians trained in implementation. Many of them have tried to put in the systems that are available, but the cost is too high. Once you develop the local expertise over the next few years, Jordan will be able to decrease the cost of implementation significantly. The private hospitals will be able to implement a first-rate software at low cost.”
The third step will be to take the Jordanian IT show on the road, bringing the system to other countries in the Middle East, which will have economic development implications for Jordan and the region. One of the goals of Jordan’s King Abdullah II bin Al-Hussein, the royal sponsor of the VistA project, is to take lessons learned from the installation in Jordan and export that IT knowledge and experience to neighboring countries.
According to its formal request for quotations on the project, Jordan said the importance of training and effective technology transfer to Jordan “cannot be overemphasized.”
“This is a primary objective of Jordan's initiative and a critical success factor in establishing long-term local sustainability and successful evolution of the national healthcare" IT infrastructure, the request for quotations said.
“Jordan has been famous throughout the area for its education and its healthcare, and IT is a close third over the last couple of years,” Farraj said. “Doing health IT just comes naturally to the Jordanian population. Although we are doing a pilot for Jordan at this time, if it does work out and we get a national system going, Jordan will be a pilot for other countries, which will hopefully be what we all hope for in healthcare, a global healthcare network.”
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