FAQs about Medsphere/OpenVista

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Medsphere is the leading provider of affordable and interoperable healthcare IT platform solutions.

Medsphere bolsters the patient care process for hospitals via rapid deployment and support of OpenVista®, the first commercially implemented open-source software application for management of the clinical care cycle. With development roots in the U.S. Department of Veterans Affairs' (VA) VistA solution, OpenVista is a responsible re-application to commercial healthcare of the federal government's $8.5 billion investment in the creation of an efficient and paperless clinical environment.

By commercializing OpenVista and offering it broadly via a unique subscription model, Medsphere has given the healthcare industry an economically sustainable EHR alternative that frees healthcare organizations from vendor lock, lack of interoperability, high cost and other pain points that have paralyzed the industry and precluded widespread EHR adoption.

By its very nature, the provision of healthcare is a collaborative process. Consequently, Medsphere is cultivating a collaborative healthcare community oriented around OpenVista as a comprehensive health IT platform. As an innovative healthcare industry leader, we are also amassing a significant data store of relevant clinical content. This valuable asset will be used to serve clinicians in their daily workflows by benchmarking best practices data at the point of care to improve quality and decrease costs. For a more detailed explanation of the benefits of open source, please refer to the Medsphere white paper "Transforming Healthcare Through Open Source."

Two fundamental realities drive Medsphere's use of open source technology. First, software is a commodity, which elevates the importance of services and creates a mutually beneficial relationship between vendor and customer that is lacking in the proprietary model. Medsphere uses commercially enhanced open source software as a platform for professional services that produce operational, financial, and clinical transformation. Second, like the provision of medical care, open source is an inherently collaborative process that is improved by the coordinated sharing of information as part of a community of practice. As a custodian of the source code, Medsphere provides safe, reliable, and timely enhancements to the OpenVista enterprise solution, making it possible to build customized healthcare improvement technology that enables better patient care. For a more detailed explanation of the benefits of open source, please refer to the Medsphere white paper "Transforming Healthcare Through Open Source."

Yes. Medsphere has an expert development team that will continue to improve OpenVista according to changes required by best practices and feedback from our clients. Medsphere evaluates requests for inherent value to all OpenVista end users. Those requests that are broadly appealing are incorporated into the product roadmap and receive attention based on priority and market demand. Medsphere's original white paper, "From VistA to OpenVista," describes in detail the enhancements Medsphere has made to the original VA solution.

Midland Memorial Hospital, one of Medsphere's first customers, achieved Stage 6 in the HIMSS Analytics EMR Adoption Model (EMRAM) in much less time and at only a fraction of the cost of other proprietary EHR systems. Midland was one of only eleven initial Stage 6 hospitals among 5,000+ monitored by HIMSS Analytics, demonstrating how successfully and affordably OpenVista can be deployed in a non-VA healthcare setting. All of our other customers are on the same road to success.

At last count, Medsphere had more than 200 provider sites using our EHR technology to improve healthcare efficiency and quality. Our diverse customer-partner mix includes healthcare agencies, acute and long term-care hospitals, critical-access hospitals (CAHs), and behavioral health and psychiatric facilities. The mix also includes numerous Indian Health Service facilities. These customer-partners serve highly diverse communities spread throughout the U.S., including Alaska and Hawaii. Many of our customers are safety-net hospitals.

Click on Medsphere customer-partners to learn more.

OpenVista incorporates a single, integrated database for core and ancillary applications, including lab, radiology, nutrition and food service, pharmacy, bar code medication administration (BCMA), electronic medication administration (EMAR), physician and nursing documentation, computerized provider order entry (CPOE), clinical flowsheets, and other advanced clinical functions. Working in tandem with additional system functions, such as decision-support tools, these highly flexible modules enable care providers in virtually any care setting access to real-time information via a longitudinal electronic chart. Physician and patient portals are also available to enable Web-based, secure access to patient data and compliance with national interoperability standards driving meaningful use. Medsphere's original white paper, "From VistA to OpenVista," describes in detail the enhancements Medsphere has made to the original VA solution.

Yes, it can. Medsphere's EHR solutions are currently in use by over 200 sites of care, including many ambulatory sites at the Indian Health Service and in clinics affiliated with our larger hospital clients. OpenVista is flexible and configurable to meet the local needs of facilities across the continuum of care. The graphical interface is easy to use and highly customizable to meet both the informational and workflow needs of various users.

Yes, OpenVista incorporates a Web-based Centralized Clinical Data Repository (CCDR) that consolidates patient data from multiple data sources, including OpenVista and physician office EHRs, through an Enterprise Master Patient Index (EMPI). This solution also includes a Clinician Portal for secure remote access to patient data. For more information on Medsphere enhancements to the VA's VistA system, read "From VistA to OpenVista," our original white paper.

In addition to the Medsphere components, the cost of the database management solution (Fidelity GT.M), pharmacy formulary/decision support database (First DataBank), server operating system maintenance (RedHat Linux), and interfaces between OpenVista and the Mirth and Data Innovations interface engines are included in our subscription costs. Additional costs associated with Data Innovations (medical device interface solution) and server hardware are not included in overall pricing. Customers have the option of running OpenVista in a Windows environment with InterSystems Caché.

Yes, it does. The OpenVista Insight Revenue Cycle Management software system is a true end-to-end, fully integrated revenue cycle information management software solution that offers an ideal all-inclusive replacement option for existing health information systems and their costly, disparate bolt-on applications.  With OpenVista Insight, hospitals, healthcare networks, and behavioral health providers across the country are controlling costs, accelerating revenue collection, and providing better patient services...all while reducing or even eliminating dependencies on multiple applications.

OpenVista Insight provides users get an all-inclusive suite of Patient Access (Enterprise Scheduling, Patient Registration, Eligibility Checking), Patient Accounting (Universal Billing, Collections & Payments, Contract Management), Claims Management, and Informatics solutions.

OpenVista Insight enables healthcare providers to:

  • Streamline the entire patient access process from Scheduling to Registration to Discharge to Billing
  • Accelerate accounts receivable payment collections
  • Perform real-time payer eligibility checks during Scheduling and/or Registration
  • Integrate payer rules and enforce financial accountability
  • Achieve a true Digital Financial Record (DFR)
  • Reduce billing delays and denials
  • Significantly improve clean claims rates
  • Eliminate dependencies on and the associated costs of third party “bolt-ons”
  • Get real-time information when and where it is needed
  • Accurately measure organizational productivity and performance via Business Intelligence


Medsphere utilizes the Mirth Open Source HL7 engine for all system-to-system interfacing. The cost of the solution is embedded in our subscription pricing and all interfaces are built and maintained by Medsphere. For lab device interfacing, we standardize on the Data Innovations (DI) Instrument Manager. Medsphere's OpenVista Interface Suite is included in the solution and incorporates ADT, orders, billing, and transcription interfaces, among others. If a specific interface is not in the standard library, Medsphere will create it as part of our subscription cost.

Medsphere provides a ready-to-go implementation model that enables all new customers to take advantage of the successful customer deployments that have preceded them. In this way, Medsphere is able to reduce the project implementation timeline and increase the time-to-value, focusing significantly more attention on the change management, process redesign, and clinical transformation possible using OpenVista. Our typical implementation is anywhere from 6-9 months depending on the size of the customer. We put a great deal of attention on transferring knowledge directly to the customer, ensuring that they are empowered to make their own necessary changes to the solution, thus facilitating contributions to the broader customer ecosystem. Medsphere's "Five Ways to Go Live" white paper provides more comprehensive information on the implementation process.

Medsphere's subscription fees are based on the provision of services related to the deployment and support of a single EHR solution across the enterprise, requiring no significant capital outlay. Our flat subscription fee based on a five-year agreement, paid quarterly in advance, includes all implementation, project management, interfaces, training, updates/upgrades, product enhancements, and ongoing 24/7 customer care. Every hospital can afford OpenVista. For a written proposal, contact Medsphere sales at 1-877-MEDSPHERE or sales@medsphere.com.

Medsphere provides 24/7 x 365 support for all clients that have a service agreement with the company. Clients can report a problem by calling 1-877-MEDSPHERE or by e-mail. The www.medsphere.org web site also serves OpenVista end users as a clearinghouse for VistA and OpenVista related questions. Ecosystem participants can review previous discussions for relevant information and post questions that Medsphere personnel and other Ecosystem members respond to.

With the announcement of the final meaningful use certification requirements, the health IT industry now knows exactly what the systems we create and develop must do to meet federal standards. The government's decision to move from an “all or nothing” approach adds flexibility and choice to the meaningful use requirements, enabling more hospitals to meet the requirements and qualify for ARRA stimulus funds.

Even before July 13, 2010, Medsphere's research and informed projection enabled us to both effectively prepare for certification and guarantee customers that we could ensure meaningful use. In short, it is now absolutely clear that OpenVista will meet all federal certification standards, ensuring that our customers achieve meaningful use, qualify for ARRA stimulus funds and realize improved outcomes and efficiencies in the long term. As we expected, the final certification requirements focus on ensuring that hospital health IT systems will enhance clinical workflow while adapting to existant hospital culture and processes.

It is clear that the government's goal is to certify systems that demonstrably improve care, not just incorporate specific functions—a correct approach by any measure. For example, Leapfrog studies have shown that genuine meaningful use of health IT is based on the actual implementation, training and institutional acceptance of a solution. Medsphere's goal is to help our customers achieve broad adoption of an EHR solution, with the focus on optimizing patient care and improving operational, financial and clinical results at the institutional level. The release of final certification criteria has enabled us to focus our efforts more fully on pursuit of that goal.

Click on Certification quick facts for links to the latest federal certification information.

Through the use of a single clustered server configuration with storage, backups, failover, and redundancy are provided for in case of disaster or other significant issue. Customers have the option to purchase their own hardware solution and can run the solution in a virtualized environment using existing blade servers, if available.

Not in the traditional sense. Medsphere will soon offer a platform-as-a-service (PaaS, if you will) model because it provides customers, particularly small physician practices, with the most value in terms of reducing both start-up costs and the costs of ongoing deployment and development. In this scenario, Medsphere innovates around the platform and provides a portfolio of value-added services that create a template for meaningful use and improved patient care. Medsphere is, for example, developing personal health record (PHR), continuity of care record (CCR), and continuity of care document (CCD) solutions through a PaaS model.

Medsphere is supported by multi-year contractual agreements with our customers. Our investors include Azure Capital Partners and Epic Ventures, two of the most successful, selective and sophisticated venture capital firms in the country.

Our unique business model is disruptive, proven and secure. Our opportunity to redefine healthcare and facilitate improved outcomes is readily apparent. Our experienced team is focused on delivering value and success to all customers and investors. And Medsphere's subscription model defers a certain level of profitability for system affordability and the long-term sustainability of the overall strategy.

The open source business model demands that Medsphere face as much risk as our partners. Because the OpenVista solution is free, our bread and butter is the services we provide and our ability to provide partners with comprehensive knowledge, unfailing support, and the freedom to innovate and collaborate. These aren't just words and ideas. Medsphere also builds an at-risk value proposition into contractual agreements: We wager a significant percentage of potential revenue on our ability to bring a partner live in time to realize meaningful use and maximize federal stimulus funds. The point of both the open-source approach and putting revenue at risk is that we are absolutely committed to improving healthcare through cooperation and shared mutual sacrifice. Even in the short run, to say nothing of the long, we cannot succeed if our partners cannot also realize their financial and clinical objectives.

The question of VistA maintenance is a good one. Indeed VistA has historically been costly to maintain for several reasons.

For one, it uses MUMPS, a robust, mission-critical programming language that has been around since the late 1960s. MUMPS has been used by Wall Street for decades. And while they don't advertise it, many of the leading proprietary health IT vendors depend on MUMPS for its excellent performance, flexibility and scalability. Those who know it love it because it is virtually bulletproof. And as far as supportability goes, the MUMPS-based VistA system has much better up-time than most of its competitors.

That said, MUMPS developers are hard to find and younger developers don't want to program in their father's language.

Medsphere gives customers the best of both worlds. We continually work to update, maintain and enhance OpenVista—our VistA derivative—but we've got some young hotshots back here in R&D who are committed to keeping Medsphere cutting edge. For instance, our new OpenVista Interface Domain (OVID) elegantly layers a Java-based platform right on top of the original VistA-based modules. A set of software development tools, OVID was designed to give developers easier access to OpenVista data. Our collaborative development model is one of several reasons OpenVista hospitals can achieve meaningful use in nine (9) to twelve (12) months and for less than a third the cost of proprietary systems.

One other aspect of OpenVista to keep in mind is that Medsphere customers do not buy software, they subscribe to a support and implementation services plan. In other words, if there is any heavy lifting to maintain OpenVista, it's all on our end!

Another distinction to consider when evaluating EHR systems is that OpenVista is truly integrated; our modules were designed from the get-go to work together not bundled together from a marketing point of view, often through mergers and acquisitions, with complex interfaces added later at great expense and aggravation. And guess what? Every time our competitors' systems need an update, all those expensive interfaces need updating, too!

For Medspherian Ben Mehling's response to comments on VistA maintenance issues raised by IAC VistA Policy Group Chair Ed Meagher, click here.

According to the VA: "While the costs of healthcare in the United States continue to soar, VistA is reducing costs and errors and increasing safety and efficiency. The price of maintaining the system is $87 per patient per year, less than the cost of one unnecessarily repeated lab test."