The US client is a Joint Commission accredited behavioral health care organization. This 400-bed hospital is certified to provide treatment by the US Centers for Medicare and Medicaid Services. Psychiatric and medical care is provided to adult, geriatric, forensic, adolescent and child patient populations. Social work, psychology, therapies, pharmacy, lab, radiology, dental, vision, nutrition and other services are provided. This teaching hospital has psychiatry resident training for two universities. It provides training rotations for medical students, nurses, social workers, psychologists, physical therapists, occupational therapists, recreational therapists and chaplains.
The hospital had no funding available for a proprietary electronic health record. But in 2013 the client successfully implemented open source VistA in-house without assistance from an integration vendor. As a result, they retained total control of enhancements, maintenance, and operational support enabling fast in-house response. The hospital maintains 100% clinician adoption and exceptionally high levels of end user satisfaction throughout all disciplines. Their continuous in-house end-user training, help desk and informatics support has helped achieve this. Based on VistA and other components of their electronic health record framework the client achieved and maintains HIMSS Stage 6 certification.
The hospital had made a pioneering and courageous decision to implement VistA, against the popular clamor to go for expensive proprietary solutions. This success has avoided the enormous cost of vendor lock-in and dependence; truly in the best interest of a State hospital, run on taxpayer money.
VistA addresses most requirements in a large hospital. However, this Behavioral Health client had one mission critical need that it did not cater to effectively. The client had spent several years of reviewing Vendor provided solutions for a suitable Master Treatment Planning technology. The treatment planning model needed to be integrated with VistA based on the following six (6) guiding principles:
A team of psychiatrists, social workers, psychologists, nurses, and pharmacists work together with the patient and family/guardian to develop a comprehensive Master Treatment Plan.
This Master Treatment Plan requires frequent scheduled plan review, renewals, and updates during the patient’s hospital stay. VistA allows this to be done using its templates feature, but does not provide features that allow for a user-friendly collaborative documentation and update processes.
At the time that Edgeware Technologies met the client, the hospital was documenting the Master Treatment Plans and updates generally on paper. Some of the psychiatrists were preparing the document using Microsoft WORD. All Master Treatment plans and updates were signed on paper. There was no method to electronically relate intervention and progress notes in VistA to the problems, goals, and interventions specified in the current paper Master Treatment plan. All 400 patients required multi-page documents with continuous and frequent multi-disciplinary collaborative updates. The client had determined that scanning and attaching the document to a note in VistA was not feasible or desirable. The result was that the Master Treatment Plan was the only critical document stored in the paper chart and not available in VistA.
Edgeware Technologies offered to adapt their existing VistA based Multi-Disciplinary Treatment Plan to the needs of the client. The adaptation required changing from the MySQL database to the MS SQL database used by the hospital. Also needed was the capturing of patient registration through an HL7 interface from Quadramed through a MIRTH engine for patient admission, discharge and transfers. The hospital required the use of an Enterprise ID and password for each user to login to their VistA system in place of the standard access and verify codes used in VistA. This uses the Microsoft Active Directory to connect to VistA. Integration with VistA is accomplished primarily using the standard VistA RPC calls.
The new highly efficient work-flow made possible with this solution is as follows: