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.
- 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.