The search ultimately led them to an EMR-really an “electronic charting program” that the medical staff really liked, says Ackerman. It won rapid acceptance and use among the hospital's 230-plus clinical staff, who work with patients in a number of separate buildings on a 45-acre campus in New Canaan, Conn.
One favorite feature: “If you had a patient with major depression-it would provide for a drop down list of diagnostic symptoms-based on the DSM,” he explains. In addition to being well liked and accepted, he adds that “it wasn't very expensive-as these systems go.”
At the time, the new EMR was simply added to a growing cluster of specialized systems on the Silver Hill campus. “We for some time have had a perfectly functional business system-Eclipsys-a laboratory system which was also working just fine, and a pharmacy program, which was actually outsourced, that was working effectively.”
The goal was to blend the EMR into a seamless information system that, at the time, was already about “80 percent” paperless. This would entail a series of modifications to the EMR that would add computerized physician order entry (CPOE) as well as an interface to allow for the upload of business system data-recorded during admission and stored in the Eclipsys system.
The vision was to link a series of separate systems-laboratory, pharmacy, dietary, and the clinical/EMR into a shared database so all operations could share information in real time and become completely paperless (see Figure 1).
Deciding to “bite the bullet”
But alas, the plan didn't work as planned. The EMR would not accommodate the addition of a home-grown order-entry feature and the vendor's timetable for adding the feature was uncertain. The common database proved difficult to build. Ackerman and his colleagues realized that despite its attractive features, their two-year old EMR might just have to go.
“We got a lot from that system-training, acceptance, experience,” says Ackerman. But, faced with the hospital's longer-term IT vision, “we decided … that we would just bite the bullet, scrap the whole thing, and go to one system that would enable us to become paperless. We ultimately accepted that we had made a choice with some limitations that we couldn't deal with over the longer term.”
Quickly a project steering team was formed and project goals took shape. The new EMR would have to:
Interface with the existing Eclipsys business system to receive key demographic, admissions, administrative, and billing data.
Support CPOE and paperless operations.
Include functionality that would replace existing laboratory, dietary and pharmacy systems.
Provide attractive, usable behavioral health features, including assessments, scales, and function- or population-based order sets.
Robustly support a range of clinical and patient care requirements, while offering flexibility to make site-specific modifications.
After considering alternatives for several months, Silver Hill decided to adopt Medsphere's OpenVista, an open-source version of the well-known VistA system initially developed for use in Veterans' Administration hospitals across the United States. It was a system already well known to a number of Silver Hill's physicians who had used VistA during military or civilian residency programs.
The product selection team found that OpenVista offered a lot of the backbone functionality that they needed-a robust and proven database, built-in CPOE capabilities, and a proven EMR solution. Just as important, it offered the flexibility to work with the business system that Silver Hill already owned.
“The VA's system, VistA, has been around for over 20 years and is very robust,” says Ackerman. “It's not all that fancy or slick-it's not Windows based, for example-but it works very well.” Surprisingly, he explains, the psychiatry features of OpenVista “were pretty limited.” But this time, that wasn't a major concern, says Ackerman.
“We had a commitment from the company selling OpenVista that they would work with us to develop what was needed. I believe that the reason that they were able to offer this support was because of the open source structure of the system. If we worked with them to develop a key component for psychiatric facilities, we could use it and they could offer it to others who could use it as well. Conversely, if another group [contributed a feature], we could be the beneficiary of that.”
A fabulous creative process
This collaborative approach-what Medsphere calls a product “ecosytem”- struck a chord with the Silver Hill team. “It was appealing that we could contribute beyond our hospital something useful to others.” They got their chance.