Lutheran Medical Center (LMC) is part of Brooklyn, N.Y.-based Lutheran HealthCare, an organization which also includes the Lutheran Family Health Centers network and Lutheran Augustana Center for Extended Care & Rehabilitation. LMC is a 476-bed Level I Trauma Center providing ambulatory surgery, cardiac care, neuroscience services, obstetrics/gynecology, spinal surgery, perinatology (maternal/fetal medicine) and oncology (cancer diagnosis and treatment). Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Steve Art about his facility’s plans to implement the VA’s VistA open-source software supported by MedSphere.
AG: And that knocked your socks off?
SA: That knocked my socks off. I and two other guys started downloading the Veterans software because there was no charge, and there’s a Web site where anybody can download it. I started downloading, but the software is so big that you would download for two hours, and the connection would break and you had to start over again. I can't tell you how big these files were – they're just huge, huge files. So I was doing it at home and I was doing it on weekends and there are three of us – literally around the clock. I would have three downloads going on all at the same time but we never could do it. It was an absolute nightmare.
Then I read that there was a place you can send a check, and I believe the check was $47.16 to get the software on disks. I sent my personal check because – and this is a good one – I couldn’t get the hospital to write me a check to the government for that much money. It was just too much paperwork here to get that done. I wrote my own personal check, which I got reimbursed for, sent it off to an office of the government (which I can give you the address if you need it), and they sent me the six or eight CDs, DVDs, whatever they were that had all the software on it. I said, ‘Oh my God, I've got it all.’
My head tech guy and I sat down and we loaded the software up and, sure enough, we got it working. It was perfect. It was gorgeous. It had everything in it. Think about it – the VA spent, over the course of 16 years or something between $6 and $8 billion building the system for all of the VAs. That was the basis for the Freedom of Information release, taxpayer money had paid for it, so therefore, we should get it for free, and that’s what a guy won on (in court).
This thing had everything in it because they had a lot of money to spend and they spent it wisely. They actually built and bought a good system. And way it was built was, in the early days, every VA had to have the basic product, but anybody in any VA could develop a new product to tack on and have it used only locally, or they could take that add‑on product and send it to some central place where they would then send it out to everybody and make it part of the main product. It was almost like an open-source sharing arrangement in VA. That’s how they built the product. And when people come up with a new template or a new whatever, they would send it in, get it part of the product and the product grew and grew and, of course, from then had vendors working on it at the same time. So this thing was gorgeous. I can’t say anything bad about it. It is just a gorgeous product, and it looks as good as, or better than, any product we saw on the marketplace and it’s free.
The problem was we didn’t know how to use it. How do you get data into it, how do you get patients into it, how do you hook it up to your ADT system, how do you hook it to your billing system, how do you do this, how do you do that. It created more questions than we had answers for. So we said to ourselves, ‘Who is going to help us put this in?’ One option was to find an ex-VA guy who knows the whole system, but there aren’t any because the VA guys knew the piece that they worked on and they knew how to use it, but not how to install it. That’s because it got installed over so many years, it wasn’t a single group that installed it. It came in pieces over time and you just added to it.
So we looked around and found a couple of companies that were in this space that would help implement it and eventually Medsphere (Carlsbad, Calif.) came through to me as the one that was going to help, and that was history. We struck a deal with them that they would make the changes I needed to the system and, of course, some of the changes were fundamental. For example, the VA uses social security numbers to track patients. We, in the commercial space, use medical record numbers and account numbers. What we call a nursing system, the VA calls a ward, so some of that terminology had to change. And then I needed a bunch of interfaces to work with the systems I was still keeping. My dictation system and my PACS system and my lab system and then those things had to get done and integrated with the system.