Looking at VistA

Stephen Bowerman knows a bargain. He's chief financial officer at 320-bed Midland (Texas) Memorial Hospital, among the first users of OpenVista, one of several versions of the "free" VistA electronic health record software available from the Department of Veterans' Affairs. (OpenVista is developed and supported by Medsphere, Carlsbad, Calif.)

The system had been in place for two years when he arrived at the county-owned hospital in 2009, and Midland had just been validated as Stage 6 in the HIMSS Analytics EMR adoption model. The presence of advanced information technology helped induce Bowerman to take the job despite Midland's $14 million loss in 2008. Switching to a new accounting information system and tightening procedures such as co-pay collection and insurance verification helped Midland move to a $1.5 million surplus in 2009.

Bowerman describes himself as a "dangerous" CFO for the I.T. department, because he started his health care career on the I.T. side, implementing a cost accounting system for a government hospital. "At least I can ask intelligent questions," he says.

On costs

"OpenVista is not free. The code is free, but how you implement it is not.

"If you had the resources and the right team you could implement it yourself, but we didn't feel like we had the resources.

"Medsphere helped tailor some of that free source code to our needs. We paid them to come out and help us implement the system and it wasn't cheap, but it was probably 30 percent to 40 percent of the cost of going with Epic or McKesson. It was early on and I'm sure Medsphere today could offer even more than they offered us. We were a beta site for some of their development and they've learned from us and can do it better.

"Our maintenance ticket is cheaper than it would be with one of the other guys."

On meaningful use

"I appreciate having quality data at my fingertips, because I like to data mine on my own.

"The biggest key for me is that we will have additional reimbursement under the HITECH Act. I think we're in good shape to access the incentive payments and avoid the penalties [of not having an EHR]. We have the tools in place to get there, and now it's just a matter of making sure we have the processes in place."

On Stage 7

"We're just not ready to pour additional resources [into attaining HIMSS Analytics Stage 7 recognition]. We may do it when our finances are stabilized.

"We're in the black right now, but with health care reform there's a lot of uncertainty, and we haven't recovered all of our losses. We have further to go before I'd call us stable."

NOTE: Prior to joining MMH in Feb. 2009, Bowerman was chief financial officer at Odessa Regional Medical Center, a for-profit institution.

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