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: So you don’t need a chaperone leaning over your shoulder to help you select a system.
SA: I don’t need them to tell me how my system did or what should be in the system. They don’t even need to tell me about security; I wouldn’t buy a system that didn’t have security. I’m not a fool. That would not escape me. So their requirements have become restrictive, so that the big guys who pay them lots of money have a bigger say in getting their system certified, and they’re excluding the little guys from playing.
The big and little argument isn't exactly accurate; it’s the haves and have-nots – but some vendors are trying to exclude other vendors. Every hospital knows how to buy a system. We don’t need a CCHIT on the inpatient side.
AG: The last time I looked (as of June 1) there was only one 2008 certified inpatient system — Epic.
SA: Yes. The other thing is that, when I went looking for this in ’05 or ’06, there was no vendor that had both inpatient and outpatient. That’s in 2006. There are people who say they have. Epic started in one side of the business and Eclipsys started on the other side of the business, but neither of them had both, although they both say they do. So VistA was probably the only system that had both inpatient and outpatient back then in ’06. So, today, we still have outpatient and inpatient. The other guys are catching up, but in terms of certification, let the buyer beware – let me pick my system.
AG: You make some good points there. Let me play devil’s advocate and ask you about the limitations that people say VistA has. The first thing would be that it was designed initially or mainly for clinical use and therefore it does not do billing, especially to deal with a multiple payer environment.
SA: That is correct, it does not do billing. It is not a billing system. I didn’t buy them to be my billing system. I’m using the McKesson STAR for billing and McKesson STAR for registration. I send a registration to VistA, VistA knows where the patient is, we treat the patient. It sends charges from VistA to the billing system and the billing system bills. I have not changed my billing process because, frankly, I don’t want to lose a day of billing. That may be a downside for a doctor’s office that needs to do billing as part of their medical record, but I don’t see it that way.
AG: I haven't heard anyone suggesting that this is a good solution for a practice.
SA: Right, exactly. So from my point of view, anybody who is going to buy this thing, they're buying it because they want a clinical record, and they want to have a record that they always have and they never lose.
AG: Second thing would be that going with this type of solution requires a sophisticated, mature, robust IT shop within the hospital because there’s quite a bit of work that must be done after the download.
SA: I’m pretty robust. I consider my shop okay. We’re not silly, but we needed more than to be robust. We needed someone who had product knowledge and understood how to put the thing together. So I had to go out and hire Medsphere to do this. I could not do it myself, and I don’t think anybody is making the argument you should download it yourself and put it together yourself. The only people I think that can possibly put it together themselves is somebody who actually worked in the VA and is a programmer.
AG: Let’s stipulate that you would need an organization like a Medsphere, for example, but in addition to that, would you still need a decent-sized IT shop within the hospital?
SA: No. Medsphere will do everything for you. You need somebody who knows how to build templates, which is a tool like when we’re processing a document on building forms or something, you need somebody who knows how to build the forms so that somebody can add eye color to a form that wasn’t on it before, and that kind of stuff. That way, you don’t have to go back to the vendor after every one of those little things you want to do.