Psychiatric Hospital Finds VA System is Cost-Efficient EHR Option

A freestanding psychiatric facility in Connecticut is adopting an open-source version of the U.S. Department of Veterans Affairs' (VA) VistA electronic health record (EHR) system.

Silver Hill Hospital, of New Canaan, Conn., has signed a five-year contract with Medsphere Systems Corporation to implement OpenVista as its comprehensive electronic health record.

The development is noteworthy because the VistA system has been touted as an EHR that could be adopted nationally by hospitals and other health care facilities at low cost compared with other commercial systems. VistA has been developed over 20 years with billions of taxpayer dollars and so is in the public domain as an open source, meaning that the code for the software is available to any individual or company to use or customize essentially for free.

“What makes this interesting is that after several years of hearing about the potential of the government-developed VistA system to bring a high-quality, low-cost EHR to the private sector, this is the first I've heard of its being implemented in a private psychiatric setting,” said Robert Plovnick, M.D., director of APA's Department of Quality Improvement and Psychiatric Services.

A study in the April 16 New England Journal of Medicine found that just 1.5 percent of U.S. hospitals had any kind of EHR that was present in all clinical units.

Rick Jung, chief operating officer at Medsphere, which is contracted to implement the VistA system at Silver Hill, reports that an open-source EHR has also been adopted by the West Virginia Department of Health and Human Services and by the Indian Health Service. Both of those systems include psychiatric facilities.

But Silver Hill, a 129-bed inpatient and long-term residential facility, appears to be among the first freestanding psychiatric facilities to opt for the VistA system.

Sigurd Ackerman, M.D., president and medical director at Silver Hill, would not disclose the cost of implementing the system but said that it was“ less than half” the cost of buying and implementing a commercially available system.

“Three years ago we brought in an electronic medical record,” Ackerman told Psychiatric News. “It has been up and running and everyone likes it, but for technical reasons we have hit a wall. We are about 75 percent paperless right now, but we can't go beyond that without spending a fortune.

“So we have been re-looking at a number of complete systems around the country,” he said. “We have gotten prices from some excellent systems, but because we are relatively small, it's been much more than we can afford.”

So the hospital contracted with Medsphere, one of several companies that offer VistA customization, to implement the OpenVista system and tailor it to the hospital's specific needs. Ackerman said the system will offer two significant improvements over the hospital's current system—a computerized system for physician order entry and complete electronic integration of the order entry, medical record, laboratory, pharmacy, and business systems.

“Right now there is a paper order that goes to the pharmacy,” he said. “The pharmacy inputs it, then it goes to an outsource program for review, then it gets faxed back. There are lots of chances for errors. All that will be eliminated now. There will be a huge time savings and a reduction in medical errors.”

Ackerman is counting on the possibility that other hospitals and health systems will follow suit.

“We have an opportunity to bring in at a reasonable price a system that is very likely to be stable and robust over time,” he said.“ We are also very interested not just in having our own system but in being able to communicate with others outside. We are hopeful that some large practices and hospitals might have a variant of this system and that we will be part of a larger communication system.”

“Use of Electronic Health Records in U.S. Hospitals” is posted at<http://content.nejm.org/cgi/content/full/NEJMsa0900592>.▪