American Samoa and VistA

Pago Pago 15 November 2005The Lyndon Baines Johnston (LBJ) Tropical Medical Center in American Samoa recently completed a highly successful collaborative project involving the acquisition and implementation of VistA, an electronic health record (EHR) system developed by the U.S. Department of Veterans Affairs (VA). LBJ Tropical Medical Center is located in Pago Pago and is the only medical facility in American Samoa. The facility is a 160-bed hospital that provides health care to approximately 70,000 people. It has services such as laboratory, pharmacy, dietetics, radiology, dialysis, and mental health services. Before they implemented the Veterans Health Administration Information Systems & Technology Architecture (VistA) system, LBJ had no computer system at all and all record keeping was paper-based, which resulted in a loss of revenue and duplication of many medical services.

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LBJ management knew they did not have the resources to develop their own system or to buy a commercial solution. Their CEO and board members went to Honolulu, Hawaii, and talked to the Director of the VA Medical Center about the possibility of acquiring and using the VistA system, a comprehensive health care information system that has been made available to other organizations for many years through the Freedom Of Information Act (FOIA). The VA recognized that military veterans would benefit from this initiative since the VA has no clinics in Samoa and all veterans are treated at the LBJ Tropical Medical Center. The Pacific Telehealth & Technology Hui (Hui) in Hawaii helped to coordinate the collaborative efforts of all parties that ultimately worked on making this project a success. Some of these other organizations included the Tripler Military Hospital, University of Hawaii, U.S. Air Force, National Guard, PEACESAT, WorldVistA, the Governor of Samoa, the American Samoa Congressional Delegate, and several corporations.

The VistA Patient Information Management System (PIMS) module was implemented first so basic demographic data on most patients could be entered into the computer data base. LBJ then proceeded to implement a series of clinical applications based on their relative importance to the organization. These included the Clinic Scheduling, Pharmacy, and Laboratory software modules. These were the areas that formed the foundation needed in order to then effectively implement the VA Computerized Patient Record System (CPRS). Over time, a prioritized list of additional software modules was developed for subsequent implemented in Samoa, e.g. Radiology, Dietetics, Billing, Surgery, Medicine, Nursing.

Overall, the implementation of the VistA system went quite well and the employees are enthusiastic about using the system. Very few calls have had to be made by the LBJ Tropical Medical Center to the Honolulu VA Medical Center for help or assistance. The small servers donated by the University of Hawaii have performed extremely well for the 50 or so simultaneous users of the VistA system installed and used by the LBJ Tropical Medical Center. This collaborative effort to implement the "free" suite of software modules that make up the VistA electronic health record (EHR) system was truly successful. It has been very rewarding to the staff to see patient care begin to improve almost immediately before their eyes once the system was implemented.

For example:

  • Use of the Patient Information Management module has led to improvements in tracking of discharges, admissions, and transfers (ADT) and the creation of up-to-date inpatient rosters.
  • Use of the Clinic Scheduling module has led to improvements including better coordination between clinics and medical records getting records to the clinic, identification and verification of LBJ patient names and ID, and improved reports on clinic workloads.
  • Use of the Laboratory module has led to more timely reports, improved tracking of historical lab results, and improved controls on identifying false LBJ patient ID numbers.
  • Use of the Radiology module has improved the legibility of the report for the physicians to read, now that results are typed. Also, workload reports can be readily produced for better management of the department
  • Use of the Pharmacy modules has improved its ability to process prescriptions in a timely manner and has also given them a tool to monitor drug usage and workload. The staff has also seen a significant reduction in duplicate prescriptions.
  • The Computerized Patient Record System (CPRS) module allows clinicians to now submit electronic orders to laboratory, radiology, and pharmacy. It also provides the ability to keep progress notes and other defined electronic digital documents associated with a patient, and to view all data associated with patient from lab results to medications that have been prescribed and dispensed.
  • Use of the Informatix (ILC) Billing/Accounts Receivable module has resulted in dramatic improvements in billing and/or cost recovery. This third party billing system was added in 2003. Due to the improvement of record keeping, the percentage of earnings from non-resident increased from 1 percent to 26 percent.

Currently there are no plans to further enhance the VistA system in America Samoa. The LBJ Tropical Medical Center will simply continue to use the standard system released by the VA and will keep it patched and up-to-date. The VA VistA and Computerized Patient Record System (CPRS) appear to be more than adequate to meet the long term needs of the center. However, over time, one would expect that VistA clinical imaging, wireless technology, and other cost effective enhancements may be made.

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Dr. Stanley M. Saiki, Jr., M.D., Norman Dodd, Peter Groen, and SandyIlloa

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