Implementing VistA Internationally: Myth-Busting Lessons From Jordan

Transcription

1 Implementing VistA Internationally: Myth-Busting Lessons From Jordan Nuffield Trust, London July 5, 2012 Joseph Dal Molin President, e-cology corporation Chairman, WorldVistA 1 1

2 Agenda Background and Context Why VistA Jordan's Leapfrog Approach Achievements 2 2

3 Background and Context 3 3

4 Jordan's Health System Population million Hospitals, 800+ Clinics Ministry Royal of Health Medical Services University King Hospitals Hussein Cancer Centre 4 4

5 Jordan's Health System Challenges Significant concerns about patient safety and health outcomes Significant waste (drugs, tests, imaging) across the system Spiralling cost drivers e.g. chronic disease Impossible to share medical information and provide clinical decision support Difficult to impossible to measure clinical effectiveness and ROI of health policies and investment 5 5

6 Why VistA? 6 6

7 Chronic Failure of Traditional Health IT Approaches Existing ICT solutions could not support transformation via implementation of evidence based, best practices Proprietary solutions too expensive to implement Lock-in Sustainability Pitfalls > capacity building, code stewardship experienced in other countries: UK, Canada, US There was compelling evidence that the US Veterans Administration and VistA stood out as positive example of how to successfully leverage IT 7 7

8 VA Top Performer: VistA Enables Dramatically Lower Costs The cost per patient has remained low and stayed steady for the VA since the system went digital. By comparison, costs for Medicare patients and the medical consumer price index have remained high and are increasing. SOURCE: The Washington Post, April 10,

9 VA Top Clinical Performance INDICATOR Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening LDL Cholesterol <100 after AMI,PTCA,CABG Diabetes: CM control HbA1c < 9.0% Diabetes: LDL-C<100 Diabetes: eye Exam Diabetes: Renal Exam Diabets: BP < 140/90 Smoking Cessation Counseling Smoking: Medications Offered Smoling: Referral/Strategies Immunizations: Influenza Immunizations: Pneumococcal VA % 92% 80% 67% 98% 69% 88% 95% 80% 96% 90% 96% 83% 95% VA % 92% 79% 66% 97% 68% 86% 93% 78% 89% 84% 92% 84% 94% COMMERCIAL % 80% 59% 60% 89% 46% 57% 82% 66% 77% 54% 50% n/a n/a MEDICARE % n/a 53% 57% 88% 49% 61% 88% 60% n/a n/a n/a 71% 67% MEDICAID % 66% n/a 40% 81% 34% 53% 77% 57% 69% 41% 41% n/a n/a Source: VHA,

10 Model for Radical Transformation: Transition to More Effective Care Settings Source: Perlin et al., 2004, American Journal of Managed Care 10 10

11 VistA Has Produced a Huge ROI: $3.09 billion The potential value of the VA s health IT investments is estimated at $3.09 billion in cumulative benefits NET of investment costs. Source: Health Affairs 29, NO. 4 (2010):

12 VistA Can Scale! File Entries Dec '09 Daily File Entry Dec '09 Orders 2.30 billion 1,23 million Images 1.40 billion 1.70 million TIU Documents 1.35 billion 952 thousand Medication Admin 1.24 billion 708 thousand Vital Signs 1,56 billion 977 thousand Source: Dr. Ross Fletcher, Chief of Staff, Washington DC VAMC 12 12

13 Jordan's Leapfrog Approach 13 13

14 Leapfrog over this Photo credit:

15 ...to this 15 Photo credit: Wikipedia 15

16 ...and iterate to this 16 Photo credit: Marianna Day Massey, Zuma Press 16

17 Critical Questions to Address Can it be adapted? Will it be accepted by clinical staff? Can we learn how to enhance it? Can we build capacity to reduce cost and risk? Can we afford it and will it cost less than comparable approaches? Will it work? 17 17

18 Iterative Implementation Model Assessment Phase First Iteration National Implementation Strategy Pilot Site Selection Establish Public Sector Non-Profit Proof of Concept Seed Site Implementation Evaluation Second Iteration National Implementation Strategy 18 18

19 Technology Strategy Follow VA development standards Minimal (Minspec) changes to WorldVistA EHR Arab language support for Registration, Medication Labels, Patient information Registration gui Scheduling gui Test centralized and decentralized architecture Collaborate with community 19 19

20 Benefits of Phased Implementation Approach Establish local capacity and sustainability in parallel to seed site implementation Minimum specifications for customization and adaptation Implementation path is bottom up, evolutionary and guided by learning Create contagious buy-in and support Early validation of clinical and financial business case 20 20

21 Asessment = Road Trip 21 21

22 Assessing the Health Ecosystem 22 22

23 What We Found: High Leverage Opportunities The following areas represented up to 30% annual hard cost savings which in total have the potential to fund national deployment of WorldVistA EHR. Medication management stop polypharmacy Estimated savings m JD per year Clinical benefits of avoiding errors and interactions Better data for purchasing decisions id. Substitutes and cost savings Imaging Cost of PACS software savings Cost of film savings Telemedicine support savings through remote consultation Laboratory Avoid duplication of tests 23 23

24 What We Found: Business Process Transformation Supply chain drugs, other consumables availability Unit dose packaging Standardized bar coding of medications Electronic signature Controlled substances Integration with national unique identifier database Alignment of roles and responsibilities, e.g. nurses and nursing assistants with best practices 24 24

25 Scope of Implementation National Pilot roll-out to 46 hospitals and 1000 clinics Sites King Hussein Cancer Centre Prince Hamzah Hospital (MoH) Amman Comprehensive Clinic 25 25

26 Selected WorldVistA EHR Deliverable of HHS/CMS funded VistA Office EHR initiative Certified CCHIT certified 2007 Meaningful Use Full Inpatient and Ambulatory Certification, 2011 Enhancements Pediatrics growth charts, demographics Women's health Registration E-Prescribing CCR/CCD export and import HTML 5 web interface Implementations care Jordan, Mexico, US hospitals and primary 26 26

27 Achievements 27 27

28 Achievements: Affordable, Sustainable, It Works! Established a new, health stakeholder run, non-profit Established 98% self-reliance in 18 months Successful adaptation and configuration Confirmed affordability Successful go-live of full implementation, including imaging and bar code medication administration in late Fall 2011 Given green light for national implementation 28 28

29 Achievements: Community Based, Rapid, Open Innovation Collaborative Successes IHS Graphical scheduling interface WHO standard based pediatric growth charts EDIS emergency room package Support for internationalization Current Innovations Web enabling of VistA EWD and HTML5 Harvard SMART program App development platform 29 29

30 Achievement: Patient Number One 30 30

31 Thank You! 31 31

32 WorldVistA and the VistA Community Incorporated in 2002 as 501c 3 Established the open source VistA community Ported VistA to full open source software stack: Linux + GT.M 2005 CMS funded VistA Office EHR initiative 2007 CCHIT and 2011 Full Inpatient and Ambulatory Meaningful Use Certification 2007 Jordan adopts WorldVistA EHR for national deployment 2007 Wired Magazine Rave Award for Medicine 32 32

33 International Deployments WorldVistA EHR Jordan 2 live, planned 44 inpatient, 800 ambulatory Mexico - Instituto Mexicano del Seguro Social (50+ hospitals) Thailand Queen Sirikit Medical Center Cardiovascular Clinic India Rajiv Ghandi Cancer Center, Max Health, hospital network FOIA VistA American Samoa (FOIA) Egypt, Cairo - National Cancer Institute (FOIA) Uganda, Kampala - Nakasero Blood Bank (FOIA) Nigeria - Obafemi Awolowo University and eight (8) Teaching Hospitals (FOIA) Pakistan - SKM Cancer Hospital and Research Centre (FOIA) 33 33