Re: [Hardhats] Clinica Adelante post mortem
Sam Habiel
it doesn't say.
Why is VISTA treated like a black-box proprietary product? It says 'we
had problems in such and such an area', but there is no effort to fix
it.
Oh never mind...
Sam
On Sat, Sep 11, 2010 at 2:08 AM, kdt...@gmail.com <kdt...@gmail.com> wrote:
> The recent DRAFT Final Version of the Report on Congress on the
> Availability of Open Source HIT has some interesting commentary on the
> implementation at Adelante Healthcare, which was ultimately pulled.
>
> On a previous post (which I can't find now), I wondered about an
> objective exposition of why it was pulled. Below are excerpts that
> gives more information.
>
> Kevin
>
>
>
> Adelante Healthcare, a Federally Qualified Community Health Center
> (FQHC) headquartered in Surprise, Arizona with sites dispersed amongst
> 14 locations within Maricopa County estimated that the organization
> spent up to $300,000 per year beginning in 2007 for ongoing
> development, maintenance, and support of its WorldVistA implementation.
> (interview with Manny Ferreiro, 2010).
>
> ...
>
> Adelante Healthcare initially chose WorldVista as their EHR system
> because of the knowledge and expertise of their Chief Medical Officer
> as well as the belief that the comprehensive functionality that VistA
> offered was sufficient for their needs and for the communities they
> served. At the time the decision was made, Adelante was using GE
> Centricity as their practice management system and wanted an EHR that
> could interface directly with that system. They acquired VistA in
> 2008 and began working on customization and implementation through the
> Chief Medical Officer and a consulting firm known as Edgeware, based
> in New Dehli, India.
> Adelante Healthcare also extended the installation of WorldVista to
> two other community health centers in Phoenix, Arizona: Mountain Vew
> Healthcare, one of the largest community health centers in Arizon, and
> the newly FQHC-designated Wesley Community Health Center located in
> downtown Phoenix. As such, the three organizations formed the largest
> safety-net networks using the Vista EHR system within the United
> States.
> Ultimately, the implementation of VistA was viewed as failure by
> Adelante because of a number of reasons: lack of a bi-directional
> interface between VistA and the Centricity practice management system;
> the lack of a comprehensive obstetrics/gynecology module that was
> needed within Adelante’s Women’s Health Center; lack of a usable
> module for pediatric care within the Adelante community; faults within
> the medication management module in which erroneous medications were
> prescribed or duplicate medications were ordered; and the overall cost
> to Adelante to continually update and modify the VistA application.
> All of the maintenance updates and software fixes were done through
> the Chief Medical Officer or Edgeware. There was no dedicated IT
> staff to support the VistA application for Adelante after it went
> live; and there was no training on the MUMPS language or the VistA
> components to enable staff to provide assistance when needed.
> In early 2010, both Mountain View and Adelante opted to withdraw from
> the WorldVista network and ultimately sunset the application at the
> end of this year to be replaced with another system, potentially from
> a commercial vendor. Adelante expects to implement their new EHR
> system sometime in the late Spring or Summer of 2011.
>
>
> ...
>
>
> Reducing costs by utilizing internal staff can be a risky
> proposition. While a number of community health centers sought to
> reduce costs by using internal staff to implement, maintain and
> support the EHR system, there were some potential risks associated
> with this approach. Safety net settings with the adequate technical
> expertise to maintain a system or network using programming languages
> of open source systems, such as RPMS, were difficult to find. Most of
> the time, the expertise was concentrated in one individual. This sole
> person was then responsible for the implementation and maintenance of
> the open source EHR system for their entire organization. This
> created a “single point of failure”; if this individual left the
> organization for any reason, then the expertise and institutional
> knowledge of that system also would follow them. Unless they
> appropriately trained a successor, the safety net provider would find
> themselves in a precarious position of trying to maintain and support
> a system with limited knowledge or expertise. The health centers
> would then find themselves in the position of hiring consultants or an
> outside organization to assist with the process, which could prove to
> be financially burdensome for those settings with limited resources.
>
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Syed
for other modules, Like progress notes,accessing pt chart,data lost,
VOE Scanning, clinical reminders,referral etc. I agree that VistA
application from WV is lacking OB/GYN module as well as pediatric
module. Regarding drug file , providers are adopting online
prescription any way , so drug related issues will not be
there.MDSynergy has integrated sure-script with FOIA VistA.
Development is needed for OB/Gyn and pediatrics. We have recently
started project for OB/GYN and I am sure this will be successful,
actually we will be able to graph Fundal height , Fetal Heart sound
etc.
VistA like any EMR is a difficult application to maintain but is not
as costly as other proprietary EMR. I am also surprised to see the
cost (300,000)per year ( I am sure its major portion includes CMO and
Director salary).
Let me summaries this in one line "CLINICA ADELANTE VISTA
IMPLEMENTATION AFTER THE INITIAL SUCCESS SUFFERED POLITICALLY RATHER
THAN THE APPLICATION ITSELF" .
AT CLINICA VISTA WAS MADE ORPHAN IN 2009 BY STOPPING DEVELOPMENT WORK.
The most develpment work happened in 2007 , but around mid 2008
development work was halted.
Syed Bokhari M.D.
kdt...@gmail.com
document, and not intended for distribution. The involved parties are
given opportunity to voice concerns about statements in the report.
And the final report may well not include the segments posted above.
In short, I didn't realize I was not supposed to post what I did. I
apologize for the screw up.
So please realize that what I posted is NOT THE FINAL WORD on this
issue.
One other point, $300,000 initially seems like a big number. But a
programmer is going to cost at least $100k per year. So paying for
essentially 3 person-years to support a computer system at 14 sites
for multiple years, including ongoing development, seems like a good
deal for Adelante. And I suspect they will pay much more than that
when they go to a commercial system.
So I agree with Syed that this failed for political reasons. But the
purpose of post-mortem analysis is to see what we can learn for the
future. What can we do at other installations so this doesn't happen
again? Why did the decision makers not want to support it?
Kevin
Chris Farley
I started a lengthy soap-box type e-mail, but I'll just say I'm glad this is
only a DRAFT - because it is badly done.
This is one of the shallowest, illogical and lazy reports I've ever seen -
of course the user is going to blame the software when an implementation
fails. I'd be willing to bet good money that a properly done post-mortem
would reveal that 75% or more of the failure points rest on the shoulders of
management - probably on the information source for the report, too. Just
from reading the draft, it is obvious to me that management failed during
the implementation. It is also obvious to me that no one involved in this
"draft" understands what "free" means in relation to FOSS and/or VistA.
The whole thing really is too bad. I'm sure with some proper guidance,
Adelante could salvage the implementation. I hope the VistA software
doesn't take a big reputation hit because of the human failure in the
implementation or because this "draft" gets into the final report.
The only valid points that I read in there were the lack of native OB/GYN
and Pediatric functionality. But, with $300K per year in funding, that
could have been largely or even completely handled through a combination of
coding and configuration.
Christopher B. Farley
HIT Consultant
Kevin
--
Syed
Here is my quote "HEART STOPS BUT TECHNOLOGY NEVER STOPS"
So I am not worried about what is missing in VistA, because surely
with more development this application will finally fulfill every
specialty requirements. It is like building more rooms on a solid
foundation which this VistA application provides.
I am worried more about Political related issues and wrong management,
which can easily lead ANY successful EMR implementation to a failure.
Taking Clinica as an example it is not one, two or three months but
whole one year of successful implementation backed by positive reviews
from providers and eye opening surveys of patient,non provider staff
and providers, SUDDENLY took a WRONG TURN in mid 2008 because of
wrong decisions.In mid 2008 decision making power for EMR development
and implementation slipped from a MEDICAL DOCTOR to a purely
TECHNOLOGY PERSON who does not have any clue what the EMR application
is.
Syed Bokhari M.D.
kdt...@gmail.com
etc.
Kevin