Gearing Up
The implementation phase of the project began in January 2005 when Medsphere engineers embarked on customization and development work.

Medsphere's professional services team built roughly 30 interfaces to Midland legacy applications, including the hospital's Imagecast picture archiving and radiology information systems from IDX Systems Corporation (now part of GE Healthcare), the Clinivision respiratory services system from Puritan Bennett, and the Precision 2000 financial system from McKesson Corporation.

In June 2005, HP Professional Services began designing the hardware configuration, drawing on previous work with Medsphere OpenVista at a seven-facility long-term care organization in Oklahoma as well as years of providing support services for the VA's VistA system.

Installed two months later, the hardware infrastructure consists of a two-server Red Hat Linux-based HP ProLiant DL580 G2 cluster that runs the OpenVista system, a HP ProLiant DL380 server that functions as a quorum server for cluster administration, and an HP StorageWorks Enterprise Virtual Array 3000 for storing OpenVista data.

The clustered servers are equipped with HP ServiceGuard to provide the failover capabilities necessary to fulfill the hospital's stringent fault-tolerant requirements, and all servers are equipped with HP's Integrated Lights-Out Remote Management to enable troubleshooting from any location.

Midland also installed HP's OpenView Storage Operations Manager to manage the storage area network and an HP StorageWorks MSL5030 Tape Library for automated backup of all OpenVista data. Users access the OpenVista system from HP Compaq desktop PCs equipped with Medsphere's Computerized Patient Record System client software. (see Figure 1)

Going Live
The OpenVista rollout to users began in October 2005 with the in-patient medications component of the system's Pharmacy module, designed to provide a comprehensive record of the medications used during a given patient's hospital stay. Although Midland's legacy pharmacy application was not being "sunsetted," the IT team elected to replace it to gain maximum integration benefits from the OpenVista platform.

A month later, Midland went live with OpenVista Laboratory, a module that lets users access information on all the laboratory tests done anywhere on the two-hospital campus, respond to alerts, and order additional studies from the OpenVista interface. This module replaced a sunsetted application.

The rollout then proceeded with the OpenVista Clinical Information System, enabling order entry by all hospital departments including lab, pharmacy, radiology, respiratory, physical therapy, and dietary personnel.

Activation of the hospital's clinical units began in March 2006 with the same-day surgery unit, followed by other units every one to two weeks. This added functions such as nursing documentation, physician documentation, clinical alerts and reminders, physician order entry, and scanning of clinical-related paper documents received from outside healthcare providers.

This phased-in deployment was accompanied by a rolling training schedule that trained users in each department one to two weeks before their go-live date. The entire hospital was live on the bulk of the system by August 2006.

More work remains to be done. The roadmap includes building interfaces between OpenVista and other legacy applications, including Midland's surgery department management system from Per-Se Technologies and a perinatal monitoring system from GE Healthcare, as well as providing a means of remotely accessing the OpenVista database by physicians and other authorized providers who may not be on-site at the hospital. The hospital also will be deploying an OpenVista Bar Coding and Medication Administration module that helps reduce medication errors.

But Midland is already beginning to reap the benefits. Early on, for example, the exchange of information between the laboratory and pharmacy applications began proving useful for monitoring the effectiveness of drug administration. Users also began seeing faster access to lab results.

With a 2005 RAND Corporation report predicting that broad computerization of medical records will save $81 billion annually as well as improve patient care, and similar endorsements from other quarters, the healthcare community is actively looking for strategies to break its traditional dependence on paper charts. Midland's decision to embrace Open Source technology may pave the way for accelerating the migration to an electronic health record, in part by overcoming the cost hurdles of proprietary systems.

For that reason, this implementation will be closely watched in medical circles and potentially put Open Source on the medical map. It often takes only one believer to start a movement. Midland may play that role for open source EHRs.