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Midland Memorial Case Study

How Midland Became One of America's Best Hospitals

Midland Memorial Hospital is a three-facility, 35-department, 320-bed healthcare system in West Texas offering comprehensive, community-based acute healthcare services to Permian Basin communities. Owned and operated by the Midland County Hospital District, MMH provides a full range of acute-care services while serving as a regional referral center for other communities throughout west Texas and southeast New Mexico.

MMH went live with Medsphere's OpenVista electronic health record system in February 2006. It has since achieved "paper-light" status, with no paper charts in use on the units.

The Midland Memorial story

In November 2002, MMH had a new CEO, massive capital needs, financial losses in the millions, and pharmacy, lab and health information systems facing obsolescence. While it was clear an electronic health record was critical for future success, the hospital’s financial condition limited its options. In addition, the organization faced multiple acquisition and deployment challenges. These included:

• justifying a new system
• creating organizational buy-in
• enabling physician adoption
• training personnel, and
• supporting the "go-live" process

Other challenges included dealing with duplicate paper and electronic records, and implementation personalities. In addition, multiple system interfaces threatened to make integration a complex, timely and resource-intensive process.

Solution

To head off what it saw as an oncoming crisis, MMH explored a variety of EHR solutions. To start, the hospital commissioned an assessment project from a legacy vendor. This assessment found that comprehensive system replacement would cost a minimum of $20 million for hardware and software alone; ongoing service, licenses, consulting, updates, etc., would cost millions more.

Midland Memorial had to find an effective but less expensive alternative.

The hospital then found VistA, a comprehensive EHR first developed in the mid-1970s for use in US Department of Veterans Affairs hospitals and clinics throughout the U.S.

VistA is credited with helping turn the VA into a national leader in quality patient care. The technology is based on open-source code available to the public through the Freedom of Information Act (FOIA). For Midland, VistA represented a leap forward at low cost.

After on-site VA visits with key staff and clinicians and a comprehensive enterprise assessment, MMH felt VistA was the right solution but also had to ensure ongoing commercial support. This brought the hospital to Medsphere and the company’s OpenVista EHR. Building on the widespread success of VistA, Medsphere enhanced the original solution to meet the needs of non-VA healthcare providers and added professional services, ongoing product development, and 24x7 technical support, providing a professional open-source delivery model without expensive up-front proprietary license fees.

The result is a comprehensive EHR solution that can be deployed more rapidly and inexpensively than other approaches, and offers clinicians a feature-rich, user-friendly, secure environment for real-time access to patient information.

OpenVista is also supported by a large and growing Healthcare Open Source Ecosystem. This collaborative community includes academicians, clinicians, hospital administrators, software developers, value-added resellers  and other interested parties dedicated to improving patient care through open-source tools.

The Ecosystem enables participants to:

• develop OpenVista according to particular needs and desires;
• use, modify and enhance it in support of internal processes and workflows; and
• communicate feedback, share enhancements and benefit from one another's work.

Central to OpenVista's success, and cost efficiency, is its ability to seamlessly integrate existing third-party applications—from administrative and financial applications to clinical data repositories and picture-archiving-and-communication systems (PACS). This high level of interoperability is made possible because OpenVista incorporates Mirth and interfacing standards such as Health Level 7 (HL7) for the exchange and retrieval of electronic health information. The result is preserved legacy IT investments, applications that “talk” seamlessly with each other, and superior time-to-value and time-to-benefit.

Midland’s EHR project was approved in November 2004. Infrastructure and organizational development, as well as software modifications and training, took place throughout the first half of 2005. Integration of the pharmacy, laboratory, order entry, full CPRS and bar code medication administration (BCMA) systems took place through late 2006. By February 2007, MMH was operating with a fully electronic medical record.

Results

In the months since deploying OpenVista, MMH has seen a number of improvements in operational efficiencies:

• Improved medication reconciliation and subsequent reduction in medication errors of 59 percent
• More than 50 percent overall compliance with computerized physician order entry (CPOE) and 100 percent physician utilization of CPOE
• Improved overall efficiency, productivity and communication across departments: eliminated lost charts and reduced time spent clarifying orders and documentation
• Reduction in time spent reviewing records—faster resolution of patient inquiries
• Improved documentation compliance
• Reduction in time spent retrieving patient records (from one week to instant)
• More rapid financial audits
• More than 433 users remotely accessing information
• Faster chart coding thanks to improved access and availability—with OpenVista, MMH caught up on a backlog of $16.7 million in coding/billing records (about 4,500 records) in four weeks.

In addition, the nearly paperless and highly secure system, now in use by all MMH healthcare personnel to access patient information, has helped facilitate better decision-making and patient-care processes that have, in turn, enhanced clinical outcomes and patient care.

Specific benefits include the following:

• Fewer patient deaths
• An 88 percent reduction in infection rates
• A reduction in hospital acquired pressure ulcers (bed sores)
• A 77 percent increase in compliance with ventilator care support, which can lead to reduced hospital-acquired pneumonia
• Reduction in sepsis related to central venous access that can lead to reduced length of stay and death

HIMSS Analytics Stage 6 Recognition

In March, 2008, MMH was recognized by the Health Information Management and Systems Society (HIMSS) as one of only 13 Stage 6 healthcare facilities in the United States. The designation recognizes facilities that have implemented healthcare IT solutions and achieved established levels of automated patient care and clinical process improvement. Stage 6 is the highest level of automation recognized by HIMSS to date. According to HIMSS Analytics, the hospitals on this list saw significant improvements in a number of clinical metrics through the implementation of an EHR coordinated with internal process, workflow and cultural changes.

With Medsphere’s OpenVista, MMH was able to achieve Stage 6 for about one third of the implementation cost ($7 million vs. an average of $22 million) and in roughly half the implementation time (3 years vs. 7 years) required by other Stage 6 organizations.

The validity and importance of Stage 6 recognition is borne out by the results achieved at the facilities on the list. According to HIMSS Analytics, the hospitals saw significant improvements in a number of clinical metrics through the implementation of an EHR coordinated with internal process, workflow, and cultural changes.

“This really does validate what we’ve done. I’m really proud of what our people have accomplished,” said Midland Memorial CEO Russell Meyers. “Our ability to share information has made a tremendous difference to our doctors.

“We were a struggling community hospital,” Meyers added, illustrating how far the organization has come in choosing the OpenVista EHR and subsequently garnering Stage 6 status. "This was a no-brainer for us. OpenVista is a more economical solution, it’s proven and reliable, and I don’t see any major advantages offered by more expensive solutions over what we’ve done."

Data provided by HIMSS Analytics indicates that the selected Stage 6 facilities make up only 0.3 percent of the more than 4,000 acute care facilities in the organization’s database. The specific definition of Stage 6 includes full physician documentation with structured templates for at least one patient care service area, and the availability to physicians of all digital and film images through a secure network. In the case of MMH, as with many community hospitals, the significant cost and time savings provided by Open Source and OpenVista is crucial.

“Entry-level cost is a huge factor” for small to medium-sized hospitals and health systems, said David Whiles, Director of Information Systems at MMH. “From a clinical standpoint, [OpenVista] is a very functionally rich system, and having a truly integrated system is a huge plus.”

If the Stage 6 recognition for Midland is an endorsement of Medsphere’s EHR system, it is equally an acknowledgment that EHRs are quite simply a component in overall changes to process and workflow that must be made by healthcare facilities focused on improving patient outcomes.

“Implementing an EHR is definitely an organizational project, not an IT project,” Whiles said, adding that the most basic benefits of an integrated system—universal access to patient data and legibility of information—resulted in tremendous changes at MMH.

Fig. 1: Facility Costs

Fig. 2: Timeframes for Stage 6 Facilities

The Ecosystem Advantage

Medsphere believes, quite simply, the more sources of development are better than fewer, particularly with an EHR like OpenVista that is derived from a system (VistA) with an existing, engaged and enthusiastic community. The Medsphere Healthcare Open Source Ecosystem, organized around the Medsphere.org site, provides OpenVista users with the freedom and support necessary to eliminate vendor lock and collaborate with a broader creative community. An open-source approach provides clients with resources beyond what Medsphere alone can bring.

As Medsphere facilitates an organic ecosystem that revolves around VistA-based IT solutions, the benefits flow back to the customer in the form of OpenVista enhancements and upgrades. Medsphere evaluates enhancements through a review process, puts those selected as valuable to all OpenVista users through a Q&A and testing process, and incorporates them into later releases. Open source enables community members to see what Medsphere is doing, which builds trust and shared commitment, and focuses on the patient as the primary beneficiary of OpenVista development efforts.