‘A new breed’

“The patient is what drives health care,” asserted Oroville Hospital CEO Robert Wentz. “What we know about patients determines what we do for patients, and what’s available to patients. Is there anything more important than maintaining and communicating patient information? If we don’t have information, we have to start from scratch with everybody every time.”

If a person ended up in the emergency room on a weekend, Wentz pointed out, and her or his medical chart—an actual file of papers—was locked up inside a doctor’s office, potentially life-saving information would be inaccessible. Thus the need for readily accessed, accurate, electronically stored information about patients.

Besides, said Wentz, under the Affordable Care Act everyone has to get on an electronic health records system (EHR) by 2015. If health-care systems such as hospitals and primary-care clinics are not able to demonstrate “meaningful use” of a certified EHR system by the end of 2014, they will be subject to financial penalties that will increase over time.

It was the need to have a certified EHR system—and the fact that most EHR software is proprietary and thus costly and sometimes not adaptable to the particular needs of a user—that prompted Wentz to position Oroville Hospital as a pioneer in the world of open-source EHR software.

The hospital is poised to become the first in the United States to implement WorldVistA EHR 2.0, a nonproprietary records-managing software system adapted from the public-domain Veterans Health Information Systems and Technology Architecture (VistA), in collaboration with the nonprofit corporation WorldVistA.

In August, the hospital’s marketing director, Shanna Roelofson, announced that WorldVistA EHR 2.0 received meaningful-use EHR certification from the U.S. Department of Health and Human Services for ambulatory care, a step that followed on the heels of inpatient certification of the software.

“This puts Oroville Hospital right on track in proving meaningful use this year,” said Roelofson. Proving meaningful use sooner rather than later can bring in much-needed Medicare incentive funding, or, conversely, Medicare/Medicaid penalties for lack of timely compliance.

Dressed in a casual, navy-blue, fine-lined plaid shirt sans tie during a recent interview in his roomy office, Wentz fittingly had the appearance of a renegade-of-sorts in the suit-and-tie world of hospital administration.

“What do most health-care organizations and doctors’ offices have? [EHR] software owned by a company,” Wentz said. Most EHR software is owned by a particular company, he explained, such as Georgia-based McKesson Provider Technologies or Siemens Healthcare, headquartered in Germany.

Besides the up-front costs, proprietary software is also subject to periodic upgrades—which also cost money—as needed to keep up with the fast-changing world of EHR technology.

“Most hospitals have spent roughly $7 million already to implement their [proprietary] software,” said Wentz. “What if they wanted to change to a different provider? How much would it cost them to get out? And they would get no help transferring their data.”

Open-source EHRs, on the other hand, “can provide a lower-cost alternative to proprietary models, while still maintaining the same functionality as those systems, including functionality required for meaningful use,” according to Alison Muckle and Jason Goldwater, presenters at July’s O’Reilly Open Source Convention in Portland, Ore. They cited a recent University of Chicago study commissioned by the Office of the National Coordinator for Health Information Technology.

VistA software—from which WorldVistA 2.0 evolved—was first developed “in the 1960s and ’70s, the brainchild of the Veterans Administration,” Wentz said. “They wanted to create an architecture that could store all the information of these veterans; the VA is one of the largest health-care systems in the United States.”

At first, the software “wasn’t intuitive to a medical mind. Physicians worked with technicians to revise the system. Later, the government adopted a version modified by clinical people. They ended up with a software that was very intuitive for a clinical mind.”

This amenability to modification led to continuous improvements in the VistA software, said Wentz. “Good things continued to get better, and bad things continued to go away, kind of like a Darwinian fitness of software.”

By the 1990s, the VistA software became “one of the best electronic health-software programs in the country.”

By early 2011, Oroville Hospital was publicly announcing its adoption and adaptation of the medi-friendly VistA software for its own use.

“The real issue,” though, insisted Wentz, “is what is it going to do. I think we may be discounting the importance of what EHRs are going to do in the future.”

Wentz gets excited when he speaks of the possibilities of both his and other hospitals’ using the WorldVistA system, of “personalizing the software for our facility and communicating the data to those outside the facility.” With proprietary software, he pointed out, different systems may not be compatible for intercommunication.

Is Wentz on board with WorldVistA for purely altruistic reasons? Yes—and no, he admits. Wentz is part of a consultancy firm affiliated with Oroville Hospital—called the Tenzing Corp., after Tenzing Norgay, the intrepid sherpa who helped lead Sir Edmund Hillary to the summit of Mount Everest in 1953—that “can help implement the software. [The group] is designed to guide health-care facilities through this new environment.”

Acknowledging that he’s part of a “new breed” of health-care administrators, Wentz summed up: “We believe in public-domain software for patient records. And we’re going to submit it to the public domain rather than just sell it as a software.”