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User-Driven Innovation
of VistA:
Central Regional Hospital
Stephen Oxley, M.D, CMO
Central Regional Hospital
Butner, NC
Open Innovation in
Electronic Health Records
HIMSS14
Orlando, FL
February 23, 2014
Central Regional Hospital is one of
three psychiatric hospitals operated by
the North Carolina Department of
Health and Human Services
(NCDHHS)
Central Regional Hospital
398-beds
 Located 10 miles northeast of Durham,
North Carolina in the Research Triangle
region of the state.
 Was completed and occupied in July
2008.

EMR Implementation

Central Regional Hospital chose to
implement an open-source EMR

Chose the Veterans Healthcare
Information Systems and Technology
Architecture (VistA)
EMR Implementation

VistA is available for download from
several sources in several flavors

CRH chose a version available from an
open-source VistA community non-profit
organization
EMR Implementation

This version was selected because:

It was true enough to the VA version to be
able to accept all updates from the VA patch
stream
 Its main modification had been to allow VistA
to work with a totally open-source stack:
Linux
 GT.M
 VistA

VistA Innovations

Self-implementation
Self-Implementation

Hired as full-time employees:

A technical expert with 18 years experience
with VistA in the VA
 A physician with extensive experience
configuring VistA for end-users

Leveraged this expertise by knowledge
transfer to 15 other existing employees
Self-Implementation

It took 30 months from project initiation to
last go-live

Trained 1526 end users

System used for care on all 398 beds
VistA Innovations
Self-implementation
 Patient pictures

Added Patient Pictures
Added Patient Pictures
VistA Innovations
Self-implementation
 Patient pictures
 Primary contact

Added Primary Contact
Added Primary Contact
VistA Innovations
Self-implementation
 Patient pictures
 Primary contact
 MOCHA replacement

MOCHA Replacement
Medication order checking is one of the
most valuable patient safety features of an
EMR
 The VA has compiled, maintained and
done open-source distribution of a drug
database they call the National Drug File
(NDF)

MOCHA Replacement
Until recently VistA has used the National
Drug File (NDF) for medication order
checking
 However, the NDF only supports a limited
set of order checks
 Commercially available drug databases
new offer a wider range of order check
information

MOCHA Replacement
The VA has modified VistA to take
advantage of the commercially available
drug information and do expanded order
checks
 To accomplish this upgrade, the VA
created the Medication Order Check
Healthcare Application (MOCHA)

MOCHA Replacement

While MOCHA dynamically accesses the
most recent commercially available drug
data:

it uses expensive proprietary technology
 it requires a very expensive subscription to
the proprietary drug database
 it resides on VA servers and is not accessible
to VistA users outside the VA
MOCHA Replacement
MOCHA Replacement
VistA Innovations
Self-implementation
 Patient pictures
 Primary contact
 MOCHA replacement
 Interface to ADC management system
Automatic Replenish/Ward Stock (AR/WS)

Interface to the ADC System
CRH uses Automated
Dispensing Cabinets
for medication storage
and distribution at the
hospital ward level
Interface to the ADC System
The ADC Server holds each patient’s medication
profile and also tracks what medications are stocked
in which cabinet and which drawer within the
cabinet
Interface to the ADC System
The Pharmacist processing
med orders in VistA Pharmacy
needed to know if a medication
was stocked in the ADC on the
patient’s ward.
The ADC Server needed to
update a patient’s medication
profile when an order was
entered or discontinued.
Interface to the ADC System
We leveraged the ARWS
module in VistA to map
the cabinets information
for VistA Pharmacy.
We employed the opensource HL-7 interface
engine, MIRTH, to
facilitate the
communication between
VistA Pharmacy and the
ADC Server
VistA Innovations
Self-implementation
 Patient pictures
 Primary contact
 MOCHA replacement
 Interface to ADC management system
Automatic Replenish/Ward Stock (AR/WS)

Open-Source Innovation
The State of North Carolina could not
afford to implement a proprietary EMR
 Open-source software allowed us to
implement a very powerful system for
about $2700 per bed
 An open-source system made
customization to meet our unique needs
readily available and affordable
