VistA's open-source extension into W.Va. nears completion

David Elyard, a health IT coordinator in West Virginia's bureau of behavior health and health facilities, drove the winding roads of his mountainous state last week to trouble-shoot the launch of the computerized laboratory information module being added onto the predominately open-source VistA electronic health-record system developed by the Veterans Administration.

The seven communities, home to an acute-care hospital, two psychiatric hospitals, four long-term care hospitals, one nursing home and two ambulatory-care clinics, represent, arguably, the largest state government installation of VistA in the U.S. outside the VA. For the past six years, all of the bureau's hospitals, clinics and nursing homes have used VistA as their main EHR system, connected to a central database in Charleston via T1 lines.

Shuttling in a triangle between his office in the capital Charleston, and state-owned hospitals in Welch in far southern West Virginia coal country, and in Weston, 160 miles farther north, Elyard, 63, said they needed to finish installations at both the 49-bed acute-care Welch Community Hospital, with its outpatient clinic and 60-bed nursing home, and the 150-bed psychiatric-care William J. Sharpe Jr. Hospital in Weston on the same day.

“We're still doing some debugging,” Elyard said. “It's only a week and a half since we went live at Bateman.” That would be the Mildred Mitchell Bateman Hospital, the other state-run inpatient psychiatric facility, located in Huntington on the Ohio River.

Elyard is clearly excited about the job, digitizing the receipt of lab results, which would finally add one of the few missing elements to an otherwise complete, 6-year-old VistA installation. The lab module had been tied up until recently in the procurement process.

“We've been scanning in our lab test results for six years,” Elyard said. But when the lab module installation is done, lab results will be received and stored as discrete data elements. “You can run reports on it and analyze it.”

While the VistA software was free, operating it across all seven sites has been far from it, according to Craig Richards, the bureau's deputy commissioner for administration. Working under a state contract, Medsphere Systems Corp. helped West Virginia install what's commonly called FOIA VistA, a version of the EHR that's in the public domain. It can be obtained from the VA without charge under the Freedom of Information Act.

West Virginia pays Medsphere for ongoing system support. It also pays licensing fees to InterSystems, the Cambridge, Mass.-based developer of Cache, a version of the MUMPS database and programming language also used by VistA at the VA, and to Keane, a unit of NTT DATA, whose financial system interfaces with West Virginia's VistA system.

Richards said the state has paid Medsphere $8.4 million since FY 2005 for introduction of the system, development and support. The base contract amount this year for support is $939,800, he said.

“It’s expensive,” Richards said, but, “in terms of satisfaction, I think we’d all agree it was well worth it.”

Richards said the state began thinking about a common EHR for its network of facilities when the Health Insurance Portability and Accountability Act passed in 1996.

“We looked at HIPAA and it was all about portability and accountability,” Richards said. “We talked about how the data transfer could happen moving medical records from one facility to another. As we were thinking about that, we were saying, 'How can we do this?' and well, here's a free system. We said, let's do it.”

The state soon learned that even with free VistA software, it wasn't home free. “Just because you have the key ingredient for having a successful system doesn't mean you have a successful system,” he said. The state needed to add a billing and financial software system because VistA's limited system didn't suffice.

The state views VistA as a foundation on which the bureau has built, and will continue to build, a VistA “variation” tailored to its needs. “It's uniquely ours at this point,” he said. “We are definitely one of the states that have reaped the benefits. We're starting to lap other people now and thinking, how far can we take this? We're getting real-time feedback from people saying, 'What if we could do this?'”

Although West Virginia is one of the leaders in the use of open source healthcare systems, it is not unique among states, according to Peter Groen, a retired VA technologist from Charles Town, W.Va.

“There's a couple that's similar,” Groen said. “Oklahoma, they've got seven up and running, in their state veterans homes.”

Groen has been something of an open source health IT Johnny Appleseed, both in his adopted home state and globally, promoting the use of both VistA and an Indian Health Service version of VistA called the Resource and Patient Management System. RPMS is still in use in several rural West Virginia health clinics, although its use is being phased out. VistA also is run at several federally qualified health centers in West Virginia under contract with the VA's community-based outpatient clinics program, he said.

In Hawaii and the Pacific Rim, more than a dozen private- and public-sector care sites are running VistA or RPMS, many assisted by a support program run out of the University of Hawaii, said Groen, who operates Open Health News, a website devoted to open source software in healthcare.

Groen's current pet project is an eye-popping map of all VistA and RPMS sites around the world.

Follow Joseph Conn on Twitter: @MHJConn

This item has been updated to correct the amount of the contract with Medsphere.