Midland Memorial Hospital in western Texas has become the first private-sector hospital in the nation to fully adopt a commercialized version of the Veterans Health Administration’s VistA electronic medical record system. VistA, or the Veterans Health Information System and Technology Architecture, is a much-touted open source system developed and currently used in more than 170 Veteran’s Administration (VA) hospitals. VistA is credited with helping turn the VA into a national leader in quality patient care.

The EMR system implemented at Midland Memorial, a 320-bed, two-campus facility, is a commericalized version of the VA’s VistA. Medsphere Systems (Aliso Veijo, Calif.) took the VistA source code, which is in public domain, and commercialized the application, adding professional services, ongoing product enhancements, and technical support. The resulting Linux-based EHR platform is called OpenVista.

An aging legacy system led Midland Memorial to consider an open source-based EMR. The hospital was operating under tight financial constraints, and it was clear that traditional proprietary solutions in the market, costing $16-20 million for a two to five year project, were out of the question, says David Whiles, the hospital’s director of information systems. Currently Linux and open source software do not yet play a big role in hospital data centers, not least of all because of concerns over technical support.

Midland worked with Medsphere to develop and deploy OpenVista, based on the VistA architecture. After two years of implementation, the Midland Memorial EMR became fully operational in January.

Upfront savings were significant. For example, “there were no licensing fees,” says Whiles, who stretched a $7 million dollar budget to cover hardware, interfaces, wireless infrastructure, and Medsphere fees. Costs were also in part defrayed by a grant from the VHA Health Foundation -- a 501c foundation that is unrelated to The Veterans Administration, and was formed to promote innovation in healthcare.

Midland reports that clinical efficiencies also improved. It now uses bar code medication administration (BCMA), computerized physician order entry (CPOE), and picture archiving and communication (PACS), all features derived from VistA. Staff have faster access to lab results, physicians have remote access to medical records, and medication turnaround time has decreased.

“Information is flowing so smoothly that we already see enhancements in quality of care,” says Russell Meyers, president and chief executive officer of MMH.

The system is still being tweaked, and the long-term benefits could be enormous says Whiles, whose optimism is best captured in a slide from his recent HIMSS presentation, the “First Successful Commercial Deployment of VistA-based EHR”: “Operating costs: Net additional, first two years, $2,341,00. On-going annual costs: $1,200,00; 5-year return on investment: $6,172,00.”

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