Fernando Telesca asks (from VistA-based Client Applications):
By
the way, I´ve seen some threads on VistA related lists, stating that
they don´t understand why people keep asking for a GUI patient
registration, as bedside applications like OpenVistaCIS and CPRS
shouldn´t need it. That´s correct, but it´s
still extremely important because it´s the front door for the whole HIS
solution. It´s the very first step for patient workflow and a
"commodity" in commercial HIS. What is the first screen you show when
presenting a demo ? I think it´s a must for OpenVista stack.
Which registration system to use depends on your facility's requirements. My opinions are:
1) Some groups feel that the existing "terminal-based" registration and ADT system is sufficient for this purpose.
This solution works within the VA, but is highly tuned to their workflow and processes. The way the VA does billing is different than most commercial hospitals. While this may be workable at some sites, the workflow would probably require a number of manual steps and depending on patient load, this may make the process too unwieldy.
2) Kevin Toppenberg has done a nice job modifying CPRS to includes a function where a patient can be registered and demographic data added/updated.
This solution no doubt works fine in a private practice or small physician office where you wouldn't want a heavy-weight workflow enforced to manage patient data and movement throughout the facility.
3) Others (such as the VistA Outreach group) felt a web-based registration front-end (to the VistA module) was required.
I have only seen a demo of this front-end (which I believe uses the VA's Reg/ADT system as the back-end). I would imagine this setup would work fine in a small to medium sized clinic, assuming they have some other means to drop a bill. I do not know if this includes any scheduling functionality, so the clinic might also need to use the FOIA VistA scheduling module.
4) Small to medium sized hospitals require ADT, registration and revenue cycle management functionality that the FOIA VistA cannot provide.
In the hospital market this solution does not handle the workflow, business rules and revenue cycle requirements, however in most commercial hospitals this is the first electronic system installed and thus they already have one in place and working. In this case, an interface between the two systems may suffice.
The larger question may be -- Should the open source community take up a project to modernize the ADT/Registration (and Billing) systems in VistA? The commercial world is generations ahead in this area (again, because it was the first automated system hospitals were installing) and it would be a large project to undertake. Also the requirements differ by facility type and this may make the project cumbersome as different groups expand the requirements to satisfy every different type of organization. We tend to think the clinicals of VistA are strong as that's the roots of the system and that's the area we focus our attention.
Opinions?
