West Texas Hospital Is the Nation's First Private Sector, Acute Care Facility to Successfully Adopt Veterans Administration's Electronic Medical Record

Hospital Project, funded in part by the VHA Health Foundation, Offers a Model for Other Small- and Medium-size Hospitals that are Computerizing Health Records to Improve Patient Care

[EDITOR'S NOTE: This news release was issued by the VHA Health Foundation (VHA Inc.) and posted on the Midland Memorial Web site. VHA is not affiliated with the Veterans Health Administration, which is frequently abbreviated as the VA or the VHA.]

DALLAS—A West Texas hospital has become the first private-sector hospital in the nation to entirely adopt the Veterans Health Administration’s VistA Electronic Medical Record, a milestone in national efforts to computerize health records to avoid medical errors, reduce costs and improve patient care.

The fully-integrated, affordable system at Midland Memorial Hospital (MMH) in Midland, Texas, is based on an open-source system developed and currently used in more than 170 Veteran’s Administration hospitals nationwide.

The Electronic Medical Record system, also known as EDITH (Electronic Data Information for Team Healthcare), became fully operational in January. It has immediately become a model for America’s other acute care hospitals seeking ways to reduce errors and improve patient care.

“With the financial challenges we face as the safety-net provider for our community, we were unable to afford a commercial IT solution. The OpenVista product offered us a proven, comprehensive system that we could afford,” said Russell Meyers, President and Chief Executive Officer of MMH.

The innovative project that serves nearly every hospital function, from pharmacy to physician orders, was supported in part through a grant from the VHA Health Foundation.

“Our ultimate hope is that EDITH will improve patient safety, but I’ve become aware of the national implications of what we are doing here, of showing that this is a real, viable solution for other hospitals of similar size and with similar financial constraints” said David Whiles, Director/Information Systems, who conceived of and oversaw the project and now counsels other hospitals from throughout the nation and around the world.

“Midland Memorial has broken the cost barrier with an information technology system that is economical and relatively quick to deploy,” said Linda DeWolf, President of the VHA Health Foundation. “This is a good alternative for other small and mid-sized hospitals and Midland-Memorial already is sharing what they’ve learned with other hospitals around the country and the world. We’re proud to support Midland Memorial’s efforts in spreading the word on what has been done here to make electronic records a reality.”

MMH is a 320-bed, acute care hospital spread across two campuses that include a licensed bed facility, two emergency departments in separate locations, an inpatient pharmacy, an outpatient pharmacy for indigent care and employees, an outpatient imaging center, mammography services and a magnetic resonance imaging center. MMH patients and its 200 affiliated physicians live in a sparsely populated county that covers 900 square miles. To install, configure, support and train staff, most large corporate vendors of EMR systems wanted $16-20 million for a 2-5 year project.

But Whiles had heard about the Veteran Administration’s open source VistA system and found a start-up company willing to assist. Medsphere Systems Corporation was engaged in a professional consulting agreement to implement their OpenVista adaptation of the VistA system. Two years later, and at half the cost quoted by large corporate vendors, EDITH took over and eliminated most paper documents from the hospital. And much of the work that MMH did to customize VistA can be shared by other hospitals thanks to the Open Source software used. Whiles says the non-proprietary technology means the hospital “is not held hostage to a proprietary system that someone else owns. We can show independence from vendors,” Whiles said.

EDITH is used as the primary source for patient care information by all caregivers throughout MMH including physicians, nursing staff and all other patient care workers. Physicians have access to the complete patient record and use the system to enter patient orders, review results, write daily progress notes and much more. They can access EDITH and any patient’s up-to-the-minute chart either at the hospital, from their offices or even from home. Nursing staff use EDITH to document all aspects of patient care including vital signs, assessments and medication administration. With the implementation of Bar Code Medication Administration (BCMA), the administration of medications is checked by EDITH to provide an additional, higher level of assurance that the right medication is given to the right patient at the right time.

Despite the convenience offered to the physicians, nurses and other healthcare workers, the technology challenges were matched by the “cultural” challenges in introducing such new technology into a traditional hospital setting.

MMH took a number of steps along the way to assure adoption and use. Steps were taken in the beginning to gain the complete support of the hospital’s Board of Directors and top management. Whiles recruited eight registered nurses onto the technology team from the earliest days because “it was extremely important to have people with a high level of clinical expertise involved” and also provided modest financial incentives to encourage physicians to use the system.

“We’ve always seen this as a significant cultural shift, not just one more IT project, so we brought them in, gave them a little bit of technology training and then they did a huge amount of work like creating order sets and documentation templates. They’ve been on the front lines of creating and implementing this system,” he said.

“There’s a lot of interest in what we did here,” he said. “And as we measure impact, return on investment and tweak the technology in the coming year, we will find new uses and extend how we utilize EDITH. The long-term benefits could be enormous.”

The VHA Health Foundation, located in Irving, Texas, is a public foundation created by VHA Inc. to encourage leadership and innovation in addressing health and health care issues. Efforts benefit VHA member health care organizations as well as non-members. The VHA Health Foundation supports programs that focus on new approaches to health and health care that makes a difference, generate synergies that bring resources to add value and enhance outcomes, and diffuse knowledge and best practices.

[EDITOR'S NOTE: Click here to access a third-party case study that details how Midland used its EDITH/OpenVista EHR system to achieve HIMSS Analytics Stage 6 status and significant clinical improvements.]