Implementing VistA Internationally:Myth-Busting Lessons From JordanNuffield Trust, LondonJuly 5, 2012Joseph Dal MolinPresi...
Agenda   Background and Context   Why VistA   Jordans Leapfrog Approach   Achievements                             2   2
Background and Context                         3          3
Jordans Health System Population   6 million 46+   Hospitals, 800+ Clinics Ministry   of Health Royal   Medical Servic...
Jordans Health System Challenges Significant   concerns about patient safety and health outcomes Significant   waste (dr...
Why VistA?             6    6
Chronic Failure of Traditional Health IT                     Approaches    Existing            ICT solutions could not su...
VA Top Performer:        VistA Enables Dramatically Lower CostsThe cost per patient hasremained low and stayedsteady for t...
VA Top Clinical Performance                                            VA         VA    COMMERCIAL    MEDICARE   MEDICAIDI...
Model for Radical Transformation:Transition to More Effective Care Settings          Source: Perlin et al., 2004, American...
VistA Has Produced a Huge ROI: $3.09 billionThe potential value of the VA’s health IT investments is estimated at$3.09 bil...
VistA Can Scale!                        File Entries Dec 09        Daily File Entry Dec 09Orders                  2.30 bil...
Jordans Leapfrog Approach                             13            13
Leapfrog over this                     Photo credit: www.ericmackonline.com        14                                  14
.....to this               Photo credit: Wikipedia   15     15
...and iterate to this                  Photo credit: Marianna Day Massey, Zuma Press          16                         ...
Critical Questions to Address Can   it be adapted? Will it be accepted by clinical staff? Can we learn how to enhance i...
Iterative Implementation Model Assessment     Phase First Iteration National Implementation Strategy Pilot Site Selecti...
Technology Strategy FollowVA development standards Minimal (Minspec) changes to WorldVistA EHR   – Arab language support...
Benefits of Phased Implementation Approach Establish local capacity and sustainability in parallel to seed  site implemen...
Asessment = Road Trip                        21          21
Assessing the Health Ecosystem                                 22              22
What We Found:                High Leverage OpportunitiesThe following areas represented up to 30% annual “hard” costsavin...
What We Found:        Business Process Transformation Supply  chain – drugs, other consumables availability Unit dose pa...
Scope of Implementation National   roll-out to 46 hospitals and 1000 clinics Pilot   Sites    – King Hussein Cancer Cent...
Selected WorldVistA EHR Deliverable   of HHS/CMS funded VistA Office EHR initiative Certified    – CCHIT certified 2007 ...
Achievements               27     27
Achievements:        Affordable, Sustainable, It Works! Established a new, health stakeholder run, non-profit Establishe...
Achievements:      Community Based, Rapid, Open InnovationCollaborative Successes     IHS Graphical scheduling interface ...
Achievement: Patient Number One               30                 30
Thank You!             31    31
WorldVistA and the VistA Community Incorporated  in 2002 as 501c 3 Established the open source VistA community Ported V...
International Deployments WorldVistA     EHR     Jordan – 2 live, planned 44 inpatient, 800 ambulatory     Mexico - Ins...
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Joseph Dal Molin: Implementing VistA internationally: Myth-busting lessons from Jordan

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In this slideshow Joseph Dal Molin, President of the E-cology Corporation and Chairman of WorldVistA, outlines Jordan’s health system and its approach to implementing VistA.

Joseph Dal Molin presented at the Nuffield Trust seminar: Sharing international experience: Is implementing the VA's electronic health record system an option for the NHS? in July 2012.

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Joseph Dal Molin: Implementing VistA internationally: Myth-busting lessons from Jordan

  1. 1. Implementing VistA Internationally:Myth-Busting Lessons From JordanNuffield Trust, LondonJuly 5, 2012Joseph Dal MolinPresident, e-cology corporationChairman, WorldVistA 1 1
  2. 2. Agenda Background and Context Why VistA Jordans Leapfrog Approach Achievements 2 2
  3. 3. Background and Context 3 3
  4. 4. Jordans Health System Population 6 million 46+ Hospitals, 800+ Clinics Ministry of Health Royal Medical Services University Hospitals King Hussein Cancer Centre 4 4
  5. 5. Jordans 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. 6. Why VistA? 6 6
  7. 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 > capacity building, code stewardship  Pitfalls experienced in other countries: UK, Canada, US There was compelling evidence that the US VeteransAdministration and VistA stood out as positive example of how to successfully leverage IT 7 7
  8. 8. VA Top Performer: VistA Enables Dramatically Lower CostsThe cost per patient hasremained low and stayedsteady for the VA sincethe system went digital.By comparison, costs forMedicare patients andthe medical consumerprice index haveremained high and areincreasing.SOURCE: The WashingtonPost, April 10, 2007 8 8
  9. 9. VA Top Clinical Performance VA VA COMMERCIAL MEDICARE MEDICAIDINDICATOR 2009 2008 2008 2008 2008Breast Cancer Screening 87% 87% 70% 68% 51%Cervical Cancer Screening 92% 92% 80% n/a 66%Colorectal Cancer Screening 80% 79% 59% 53% n/aLDL Cholesterol <100 after AMI,PTCA,CABG 67% 66% 60% 57% 40%Diabetes: CM control HbA1c < 9.0% 98% 97% 89% 88% 81%Diabetes: LDL-C<100 69% 68% 46% 49% 34%Diabetes: eye Exam 88% 86% 57% 61% 53%Diabetes: Renal Exam 95% 93% 82% 88% 77%Diabets: BP < 140/90 80% 78% 66% 60% 57%Smoking Cessation Counseling 96% 89% 77% n/a 69%Smoking: Medications Offered 90% 84% 54% n/a 41%Smoling: Referral/Strategies 96% 92% 50% n/a 41%Immunizations: Influenza 83% 84% n/a 71% n/aImmunizations: Pneumococcal 95% 94% n/a 67% n/a Source: VHA, 2009 9 9
  10. 10. Model for Radical Transformation:Transition to More Effective Care Settings Source: Perlin et al., 2004, American Journal of Managed Care 10 10
  11. 11. VistA Has Produced a Huge ROI: $3.09 billionThe 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): 629–638 11 11
  12. 12. VistA Can Scale! File Entries Dec 09 Daily File Entry Dec 09Orders 2.30 billion 1,23 millionImages 1.40 billion 1.70 millionTIU Documents 1.35 billion 952 thousandMedication Admin 1.24 billion 708 thousandVital Signs 1,56 billion 977 thousand Source: Dr. Ross Fletcher, Chief of Staff, Washington DC VAMC 12 12
  13. 13. Jordans Leapfrog Approach 13 13
  14. 14. Leapfrog over this Photo credit: www.ericmackonline.com 14 14
  15. 15. .....to this Photo credit: Wikipedia 15 15
  16. 16. ...and iterate to this Photo credit: Marianna Day Massey, Zuma Press 16 16
  17. 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. 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. 19. Technology Strategy FollowVA 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. 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. 21. Asessment = Road Trip 21 21
  22. 22. Assessing the Health Ecosystem 22 22
  23. 23. What We Found: High Leverage OpportunitiesThe following areas represented up to 30% annual “hard” costsavings which in total have the potential to fund nationaldeployment of WorldVistA EHR.Medication management – stop polypharmacy  Estimated savings 30 – 50 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. 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. 25. Scope of Implementation National roll-out to 46 hospitals and 1000 clinics Pilot Sites – King Hussein Cancer Centre – Prince Hamzah Hospital (MoH) – Amman Comprehensive Clinic 25 25
  26. 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  Womens health  Registration  E-Prescribing  CCR/CCD export and import  HTML 5 web interface Implementations – Jordan, Mexico, US hospitals and primary care 26 26
  27. 27. Achievements 27 27
  28. 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. 29. Achievements: Community Based, Rapid, Open InnovationCollaborative Successes  IHS Graphical scheduling interface  WHO standard based pediatric growth charts  EDIS – emergency room package  Support for internationalizationCurrent Innovations  Web enabling of VistA – EWD and HTML5  Harvard SMART program – “App” development platform 29 29
  30. 30. Achievement: Patient Number One 30 30
  31. 31. Thank You! 31 31
  32. 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. 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

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