US Hospital moving to open source medical apps

Laboratory, pharmacy and patient management systems at a three-campus facility are going open source. China Martens reports

Midland Memorial Hospital in Texas hopes to have the bulk of its electronic health record (EHR) system up and running on open-source software by late spring or early summer, says David Whiles, the hospital's IS director.

Operating across three campuses 8km from each other and linked by high-speed networks, Midland Memorial is a 371-bed hospital run as a single organisation. It is also on track to fully implement Medsphere Systems' OpenVista software and services.

The Medsphere software is based on the open source VistA electronic health record system developed by the US Department of Veterans Affairs (VA) and in use at VA hospitals. VistA stands for Veteran Health Information Systems and Technology Architecture. The system was developed to unify all the different departments within a hospital. Medsphere ported VistA to Linux and removed some of the system's specifications that related solely to veterans' healthcare.

Migrating to open-source software has been a long process for Midland Memorial. In 2003 the hospital began evaluating a move to update, better integrate and improve the efficiency of its systems. It also began working with Medsphere that year.

From the start, Whiles says, the hospital put together an executive team from different hospital departments to "self-educate ourselves on the new system". The software evaluation continued into 2004 and involved a couple of site visits to VA hospitals and a major test of the system at Midland Memorial, he says.

The cost of fully implementing OpenVista will be US$7.1 million (NZ$10.1 million), half of what it would have been if the hospital had gone with commercial software, he says.

Implementing OpenVista required six months of initial development work starting in March 2005 before the first hospital application, a pharmacy application, went live in October. The laboratory application went live in early December.

Over the past two weeks, the hospital has taken other applications live, including its first clinical unit EHR software as well as EHR capabilities for a nursing unit and its same-day surgery unit. Midland Memorial also has a small computerised physician order entry application running.

On March 20 the hospital plans to bring onstream the general order entry services division and continue to roll out EHR across the entire facility over the next few months.

With the EHR applications that went live last year, Midland Memorial is already realising some benefits — for example, there is far more integration and exchange of information between the lab and pharmacy systems, Whiles says. Having the lab monitor medication or blood levels in patients and report those results immediately back to the pharmacy is functionality that wasn't possible previously, he says. "We have also seen some improvements in access times to lab results".

Midland Memorial is running OpenVista as part of an open-source software stack on Red Hat's Linux Enterprise AS (advanced server) operating system, Whiles says. The Linux software runs on two Hewlett-Packard ProLiant DL850 servers working in an active/passive cluster.

Both the hospital and Medsphere have worked with HP Professional Services on the OpenVista implementation.

With a lot of risk factors already involved in the project, Midland Memorial decided against adopting open-source database management software, Whiles says. "We felt it was a level of risk that we didn't want to take on." Instead, the hospital chose to go with InterSystems' Caché proprietary database.

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