VistA point

How Oroville Hospital became a pioneer in the use of free electronic medical recording

With all the advances in medicine, you might be surprised at how many hospitals, clinics and doctors’ offices still perform an important function with medieval technology.

Your medical record—your “chart”—is probably a collection of papers in a manila folder. Actually, several folders: More than likely, you have multiple sets of records, one at each facility where you’ve ever received care. The charts overlap, but unless your primary-care physician has gotten CC’d on everything, odds are slim that definitive documentation of your health history exists.

Not everyone is stuck in the era of quills, ink and parchment. Computer systems have been around for decades. They don’t come cheap, though, and making software interchangeable and interactive hasn’t been a priority of companies in the medical-information business. So, even if one of your physicians is set up for EMR (electronic medical records), there’s a good chance another practitioner would be unable to open your documents.

However, a number of doctors and health-care professionals are looking beyond the limitations. They’re creating a universally applicable EMR system that anyone with a server and base software can operate—and they’re doing it in the public domain.

At the forefront of this movement stands Oroville Hospital, which has contributed five-dozen modifications to the macro-program and is poised to go completely paperless within a matter of months.

Robert Wentz, chief executive officer of Oroville Hospital, works in a windowless office that’s indistinct from most others apart from two prominent features: a rock wall lining one side of the room and a massive flat-screen monitor mounted at an angle above the back of his desk area. The former has been there for years; the latter is relatively new, part and parcel of the information-technology upgrades at his medical center.

It’s an unlikely setting for a breakthrough, but it’s precisely where Oroville Hospital’s EMR journey began. A few years ago, Dr. Matthew Fine attended a symposium where presenters discussed the electronic record-keeping system employed by the Veterans Administration. Standing in the doorway of Wentz’s office, the doctor told him, “I might have heard it wrong, but I think he said it was free.”

Free is a good word at Oroville Hospital, which cares for a great number of patients who are uninsured or receive public assistance. So Wentz went on Google, and sure enough he found a link to where the software—known as VistA, Veterans Health Information Systems and Technology Architecture—was available for download.

And, indeed, it was free. Still is, in fact; taxpayer dollars paid for its development, and it’s available under the Freedom of Information Act.

Zach Gonzales, the hospital’s database administrator, took an old piece of server equipment and used it to download VistA. Sure enough, the software worked.

It wasn’t perfectly suited to the needs of a private hospital. For starters, it had no component for billing, and patients got identified by their Social Security numbers. (Neither insurance companies nor identity theft were big concerns of the VA, considering how it runs its operation.) Still, the basis for an integrated records system sat right out in the open, ripe for adapting.

Oroville Hospital wasn’t the only place that saw VistA’s potential. In 2002, a nonprofit group called WorldVista formed in California with the mission “to improve healthcare worldwide by making medical information technology better and universally affordable.” Denise Lefevre, chief information officer at Oroville Hospital, sits on WorldVista’s board.

Nurse Manager Irene Walter, Dr. Narinder Singh and CEO Robert Wentz with a computer cart used in Oroville Hospital’s recovery ward.

Photo by Evan Tuchinsky

Electronic medical records are significant for several reasons. First, they happen to be an area of emphasis in the American Recovery and Reinvestment Act of 2009 (a.k.a. the stimulus package), so fiscal incentives have spurred implementation. Reducing the amount of paperwork in the health-care establishment makes fiscal as well as environmental sense.

Beyond material resources hovers a stronger impetus: patient safety. Errors happen in medicine. Practitioners are human. However, many errors can be avoided just by taking records out of human hands—literally. When a doctor scribbles a note that must be deciphered by a nurse before she calls a prescription into a pharmacy, there are several steps where a mistake can be made.

EMRs make a difference, Wentz says, because “a paper chart only receives data. An electronic chart can have algorithms in it, so it can prompt you to do things.” Indeed, the VistA system incorporates built-in checklists for specific diagnoses; the physician can skip a step or treatment, but “if it doesn’t happen, the system asks why.”

Some physicians bristle at this notion, Wentz said, calling it “cookbook medicine” and asking, “What do you need doctors for, then?”

His response: “There’s a lot to be said for the ‘art of medicine,’ and I believe intuition plays a big part in it. It’s just that if we know that the evidence is clear about doing something a certain way all the time, then why not do that? And you also can have intuition.”

Dr. Narinder Singh, an internal-medicine specialist who also serves as Oroville Hospital’s medical-information officer, wholeheartedly agrees. He had an EMR system in his private practice three years before the hospital began working with VistA. “I used a tablet [handheld computer] that I brought room to room, and sometimes it took patients three or four visits to notice we had gone away from paper charts,” Singh said.

So, when it came time to begin the transition, Singh played an active role in demonstrating the possibilities of the technology as well as allaying fears, such as concerns about privacy and security.

Moreover, he has contributed to the programming process. “Sometimes I can’t sleep at night thinking of something for the next project,” Singh said. The most recent addition is a module allowing physicians to transmit prescriptions directly to a pharmacy—a component available to hospitals in proprietary EMR systems but not an inherent function of VistA.

The next big step is making the software compatible with iPads and iPhones. As it is, Wentz says, Oroville Hospital has invested in acquiring a computer for every bed as well as laptops for physicians, mobile computer carts and terminals for nursing stations and lounges. Each of the hospital’s clinics is computer-equipped as well.

“It’s not that we saved money with VistA,” Wentz said. “We put it in other places.”

Oroville Hospital may seem an unlikely place for such pioneering work. But maybe not; as Wentz says, “Big hospitals that have a lot of money, it’s easier to just write a check. For us, that isn’t so easy.” Besides, he added, when it comes to adopting life-saving practices, “you don’t have to be the largest hospital in California to be the safest.”