VistA(r) News-Aug. 18, 2006-Senate Calls for DoD to Adopt VistA(r)/VistA(r) at LinuxWorld.
Roger Maduro
VistA® News
Editor, Roger A. Maduro, LxIS
August 18, 2006. Vol. 1, No. 2
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TABLE OF CONTENTS
Introduction
Commentary
News
* Federal health services choose VA imaging standard
* Congress wants standard military e-health record
* DOD opposes adoption of VA's EHR architecture
* Vet committee chairmen say VA has edge on DOD e-health system
* US Senate: Supporting Our Veterans Through Better Healthcare
* Secretary Rumsfeld Remarks at Townhall Meeting, MacDill Air Force Base, FL
* Kussman: Testimony before the Senate Homeland Security Committee
* InterSystems to do DOD health care database
* VA blazes path to preventing drug errors
* Three Things the Government Has Done Right For Veterans
* Frist: Medical records remedy
* Frist: Let's Move Medicine Into the Information Age
* Carper: EHR's Value Proven at VA
* Carper: On President Bush's State of the Union Address
* Ensign: Accelerating the Adoption of Health Information Technology
* OSDL to Host Healthcare Day
* Can open source save your life?
* OASIS adopts info-sharing standard for emergency responders
* Defense Department Marches Towards Open Source
* Report: Health, welfare IT spending to top $12B
* Virginia governor creates health IT council
* Microsoft to Offer Software for Health Care Industry
Events
Resources
Editorial Policy Statement
Subscription and Contact Information
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COMMENTARY
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We report on several major developments in this issue of VistA® News. These range from a public call by the Senate for the Department of Defense (DoD) to adopt the U.S. Department of Veterans Affairs VistA® EHR software to a major breakthrough in recognition for VistA® in the open source community's LinuxWorld conference in San Francisco.
Congress Calls for DoD to Adpot VistA®
On July 21st, the Senate Committee on Appropriations released a proposed funding bill asking DoD to adopt VA's VistA® electronic health record software as their EHR platform. This follows a similar proposal in the House funding bill. While the final bill has to be worked out in conference later this year, the intent of Congress is clear. This would be a very positive step towards creating a fully-integrated health care system for active-duty American servicemen as well as veterans.
The need for a fully integrated EHR has become an urgent matter given the large number of wounded servicemen coming from Iraq into the VA medical system. Transferring their medical records from the Military Health System (MHS) to the VA Medical system has proven to be a challenge. Although major strides have been made by joint efforts of DoD and the VA, there is still a lot of work to be done. Having one EHR system solves the data transfer and registration issues. In this issue we cite some rather colorful statements from Secretary of Defense, Donald Rumsfeld, in this regard.
Integrating both systems makes even more sense when one looks behind the scenes. There is an excellent background testimony by Dr. Michael Kussman, the Principal Deputy Under Secretary of Health of the VA on the nature and history of both VistA® and DoD's EHR infrastructure and data sharing efforts. DoD's Composite Health Care System (CHCS) is actually a derivative of VistA®. Both systems have a great deal of internal similarities and run on the same advanced M Language-based multi-dimensional database system. In fact, as reported below, DoD just signed a contract with InterSystems to use Cache, their M-Language product, based on its demonstrable superior performance in comparison to Oracle's legacy database technology. Thus migrating DoD to use VistA® requires far less effort than one would suspect. Combining the efforts of both development teams will produce better code, faster, and at substantial savings.
As one can see in this issue's news clippings, bureaucrats at DoD are opposed to adopting VistA® as their EHR platform. Instead, they would like to spend several billion dollars in taxpayer's money in developing a new EHR, the Armed Forces Health Longitudinal Technology Application (AHLTA). The claim is that at some distant date in the future AHLTA will develop and grow to have the same functionality that VistA® already has today (the projected delivery date for AHLTA is 2011). The clincher, according to DoD bureaucrats, is that AHLTA would be supposedly "better adapted" than VistA® to DoD's mission.
One interesting observation here is that the private sector has already voted with their feet on this particular issue. Ignoring DoD's CHCS and AHLTA, a large number private sector hospitals, State hospitals and clinics, and even entire countries, are now actively implementing VistA®. A number of companies have emerged to carry out these private-sector implementations. Companies such as DSS, Medsphere, Perot Systems, and several others, have spent collectively over $100 million in total over the past three years adapting VistA® to the requirements of the private sector. They have also added additional capabilities and modules, and have assembled their implementation, support and training teams. These companies would not be doing this if it was not a sound business decision and if they did not think that VistA® was the EHR technology of the future.
VA and IHS A Model for Collaboration
In contrast to the foot-dragging from DoD bureaucrats, we have a story on the decision of the Indian Health Service (IHS) to test the VA's medical imaging system. Once the testing is completed, it will be deployed nationwide. This is just one more milestone in the long history of collaboration between the VA and the IHS.
Faced with the need to care for a large population of Native Americans on a meager budget, IHS concluded more than two decades ago that the best course of action to provide an EHR for their medical facilities would be to take VistA® from the VA and adapt it to their own particular needs. Thus an IHS derivative of VistA® named the Resource and Patient Management System (RPMS) was born. Over the years IHS came up with some major innovations to RPMS, as well as additional modules such as pediatrics and OB/GYN, that were not originally part of VistA®. The relevant software code was shared with the VA which then adapted those innovations to VistA® and added them to their code stream. This is one of the greatest examples of collaboration between two government agencies which unfortunately to this day remains a largely untold story.
The story does not end there, however. After 3 years of searching for an EHR in the commercial sector, the National Aeronautics and Space Administration (NASA), concluded that RPMS was the EHR that best met the needs for their 14 medical centers. RPMS could also serve as a platform for an occupational health module. NASA signed an inter-agency collaboration agreement with IHS in April of 2005. Through this agreement IHS provided NASA with RPMS. In exchange NASA will contribute the code they develop for the occupational health module back to IHS. In addition, going forward, both agencies will collaborate in the future operation, maintenance, and enhancement of their respective systems. At the same time, IHS will share the module and additional code they receive from NASA with the VA. The VA will incorporate these enhancements into VistA® and when all the testing is completed, this new version of VistA® will not only be released to the VA medical system, but through public domain releases, to the entire VistA® community.
Adding DoD to this thriving collaborative community would be significant. The Military Health System provides care for 9.2 million servicemen at 70 hospitals and 411 clinics. The Veterans Health Administration provides care for more than 5 million veterans at 163 hospitals and more than 800 clinics and other facilities. IHS runs 49 hospitals and 190 health centers. NASA runs 14 medical centers. In comparison, the largest private health care provider in the United States, Kaiser Permanente, only runs 30 hospitals and 431 clinics.
Congress Takes Leadership in EHR Efforts
The Senate's call for DoD to adopt VistA® is not coming in a vacuum. In this issue we have gathered multiple articles from several Senators discussing VistA®. These include articles by Senator Bill Frist (R-TN), a medical doctor and Senate Majority Leader, as well as Senator Tom Carper (D-DE). These are excellent articles and demonstrate that on this issue, some of the key elected officials in Washington are actually ahead of the curve and understand the role that technology can play in improving healthcare.
We have also included a link to the Senate Commerce Committee's Subcommittee on Technology, Innovation and Competitiveness hearings on June 21. The hearing was on the topic of Accelerating the Adoption of Health Information Technology, and the witnesses provided a thorough update on the development of health information technology as well as the activities of the American Health Information Community (AHIC).
Most interesting is that during these hearings VistA® took center place. It started with the testimony of Newt Gingrich, former Speaker of the House and the founder of the Center for Health Transformation. Gingrich began his testimony with a discussion of the success of the VA and VistA® in safeguarding the medical records of all of their patients during Hurricane Katrina. He contrasted that with the fact that the medical records of more than a million Americans in the Gulf region had been completely destroyed and are lost forever.
Gingrich was followed by Phillip T. Ragon, Founder and CEO of InterSystems Corporation who detailed the success of the key M Language technology that drives not only VistA®, but also a substantial portion of the world's successful healthcare IT systems. Subcommittee Chairman John Ensign (R-NV) asked multiple questions about VistA® in the Q&A period. Ensign asked Ragon to tell him the history of VistA® and then requested more details on the savings made by using VistA® at the VA. A full webcast of the hearing is available at the Committee's web site and it's well worth watching.
A discussion of what the Senate has done in regards to EHR's would not be complete without mention of the efforts of several Senators who have quietly labored to make it happen. We are thinking in particular of Senator Daniel K. Inouye (D-HI). Senator Inouye, a senior member of the Senate, is a highly-decorated World War II combat veteran who earned the nation's highest award for military valor, the Medal of Honor. Over the past decade Dr. Inouye has secured funding for the Pacific Telehealth and Technology Hui in Hawaii ( www.pacifichui.org) for research into telemedicine and advanced medical technologies.
Under the direction of Dr. Stanley M. Saiki, the Hui has funded several projects that have been of critical importance to the adaptation of VistA® to the private sector. This includes the porting of the VA's VistA® code base to run on the Linux operating system as well as an ASP version of VistA®. The Hui also financed some of the key early implementations of VistA® outside of the VA, including the implementation of VistA® in American Samoa and in several clinics in Hawaii.
VistA® at LinuxWorld's Open Source in Healthcare Day
The rapid emergence of VistA® as an open source application/platform has finally caught the attention of the open source community at large. The Open Source Development Labs (OSDL) sponsored a full day session at the LinuxWorld Conference in San Francisco this week dedicated to the topic of open source in healthcare. The keynote speaker was Ken Kizer, former undersecretary of the VHA and CEO of Medsphere. Kizer was one of the key leaders that transformed the VA's hospital system into the best hospital system in the country (as documented by every standard measure of quality). Kizer gave an excellent presentation on the state of healthcare in America and how VistA® and open source can play a role in fixing many of the systemic problems, including the high death toll due to medical errors (as outlined by Kizer, medical errors are the third leading cause of death in the United States today).
Several other well-known members of the VistA® community also spoke at the conference, including K.S. Bhaskar, Vice President for Engineering at Fidelity National Information Services & COO of WorldVistA, Joseph Dal Molin, WorldVistA's Interim President and VP of Business Development, and Frank Pecaitis, Medsphere's VP of Sales and Marketing. Scott and Steve Shreeve, founders of Medsphere, were in the audience as well as Mike Ginsburg from DSS, and Chris Richardson from WorldVistA. Two of the original developers of VistA®, and card-carrying members of the Underground Railroad, George Timson and Wally Fort were also in the audience. They received a strong ovation from the audience when they were introduced.
VistA® News will have more details on the session presentations in the next issue of the newsletter. Several of the presentations, including Dr. Kizer's, can be seen at the event wiki--< http://www.osdl.org/wiki/dcl_health_care_day/index.php/Main_Page>.
Microsoft Enters the EHR Market
The open source community is not the only one that sees the value of VistA®. Microsoft also sees the potential for fully integrated EHR and has purchased a product, Azyxxi, so that it can compete head on with VistA® and other EHR's. Azyxxi is what is called a "health intelligence" application that can integrate data from hundreds of sources and make it available to doctors electronically. It was developed by doctors at the emergency department of Medstar Health's Washington Hospital Center in Washington, D.C. Although it only has a small subset of the functionality of VistA® today, Azyxxi does hold promise as it grows and develops over the next decade in particular when compared to commercial EHR products that lack VistA®'s integration and capabilities.
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NEWS CLIPPINGS
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Federal health services choose VA imaging standard
The major federal health services may standardize on the VA's VistA system
Bob Brewin, Govt. Health IT, July 10 ,2006
http://www.govhealthit.com/article95198-07-10-06-Print
Two major federal health services expect to standardize on a medical imaging
system that the Department of Veterans Affairs developed and already uses.
The Indian Health Service will test the VA's medical imaging system this
summer in its Portland, Ore., area office before deploying it nationwide, top
IHS officials said.
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Congress wants standard military e-health record
DOD, VA move a step closer to a common health record for vets, active-duty military
Bob Brewin, Govt. Health IT, Aug. 7, 2006
http://www.govhealthit.com/article95540-08-07-06-Print
Congress is poised to ask the Defense Department and the Department of Veterans Affairs to use one electronic health records system. DOD and the VA treat a similar pool of patients, so a common military EHR would be useful and logical, industry and health care experts say.
The House and Senate adopted similar language in appropriations bills in which they urge the VA and DOD to use a common EHR system. Differences in the bills must be resolved in conference later this year.
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DOD opposes adoption of VA's EHR architecture
Bob Brewin, Govt. Health IT, August 14, 2006
http://www.govhealthit.com/article95661-08-14-06-Web
The Defense Department opposes congressional guidance to adopt the Department
of Veterans Affairs' electronic health records (EHR) architecture or use
identical software platforms, data standards and data repositories, Dr.
Stephen Jones, principal deputy assistant secretary of Defense for health
affairs, wrote in a letter to Federal Computer Week.
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Vet committee chairmen say VA has edge on DOD e-health system
Bob Brewin, Govt. Health IT, August 18, 2006
http://www.govhealthit.com/article95720-08-18-06-Web
The chairmen of the Senate and House Veterans' Affairs committees praised the
Department of Veterans Affairs for fielding an established electronic health
records system and sharply criticized the Defense Department for failing to
deploy a similar EHR across the Military Health System and resisting an EHR
shared by the two departments.
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Supporting Our Veterans Through Better Healthcare
US Senate Report 109–286. Committee on Appropriations. July 20, 2006.
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_reports&docid=f:sr286.109.pdf
[Text of Senate report addressing Electronic Health Records for the VA and DoD—ed.]
"Electronic Health Records"
"The VA is at the forefront of developing a comprehensive electronic health record system, called HealtheVet-Vista. This system will revolutionize the entire healthcare system through the use of information technology by making a veteran's healthcare record accessible on-line for VA healthcare
clinicians. At no time was it more valuable than during the hurricanes of the 2005 season when veterans from Louisiana were evacuated to Texas and needed medical care. When the evacuation took place, there was no time to gather paper healthcare records. The VA relocated the records to a server in
Houston, and doctors throughout Texas could access them. This is a monumental tribute to the VA and the electronic healthcare records they used."
"The Committee is supportive of this valuable national project and encourages the Department to move forward with nationwide implementation. In addition, the Committee understands the Department of Veterans Affairs is working with the Department of Defense on the Bi-directional Health Information Exchange, a secure exchange of medical records between the two Departments. However, this cooperation is not moving at a pace suitable to the importance of the men and women in uniform. With significant numbers of military service persons transitioning from the active duty ranks to the VA rolls, the sharing of medical records is even more important. The Committee urges the Department of Defense to adopt the VA's architecture and hasten the shared use of such a valuable system. The Committee believes the VA is leading the Nation, both in government and private industry, in healthcare delivery, and the electronic health records are a large part of that service."
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Secretary Rumsfeld Remarks at Townhall Meeting, MacDill Air Force Base, Florida
Presenter: Secretary of Defense Donald H. Rumsfeld, Oct. 11, 2005
http://www.defenselink.mil/transcripts/2005/tr20051013-secdef4063.html
QUESTION: Hi, Mr. Secretary. I'm Staff Sergeant Rennen Heart from 6th Dental Squadron, 6th Medical Group. With the ever-increasing cohesiveness between our branches of service and the ever-increasing policies that are similar between all our branches of medical service, do you foresee the possibility of a Joint Forces Medical Command versus the separate medical services that we have today?
SECRETARY RUMSFELD: I always promise myself I won't blurt out an answer from a pinnacle of near-perfect ignorance. [Laughter]. Then occasionally I fail and I do it anyway.
I had occasion this week to go out to the Veterans Administration for a meeting of the Cabinet. And I looked at the system they have for medical records for everybody who's been brought into the Veterans Administration system. And it's electronic. The man sat there with his mouse moving it around and this fellow -- he was older than I was, and he managed that thing, he was fully digital, he was moving it around. He pulled up all the x-rays this person's ever had, all the medicines they get,
everything's bar coded so that it's all connected to something else. And I go to a Navy hospital at Bethesda or Walter Reed and they're walking around getting a hernia carrying a written record that thick and they don't even have the x-rays or the MRIs or the CAT scans or anything in there and it
would take them a half hour or an hour just to find something. I can't imagine why we aren't joint. I can't imagine why we don't do a better job in terms of training and systematizing this.
There isn't any reason somebody who goes -- everyone who gets wounded over in Iraq or Afghanistan, if they're Navy or Marine they go to Bethesda unless they've got a need for a prosthetic of some kind and Walter Reed is the best for that, and they end up getting transferred over there. I'll bet you their systems don't even talk to each other. You can't pull up an x-ray at Walter Reed from anybody at Bethesda. It's crazy! It's inexcusable. Why don't you get it fixed! You're in that business! [Laughter and Applause].
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Testimony before the Senate Homeland Security Committee
Subcommittee on Federal Financial Management, Government Information, and International Security
Michael Kussman, M.D. Principal Deputy Under Secretary of Health
June 22, 2006
http://www.va.gov/oca/testimony/other/060622MK.html
"Good afternoon, Chairman Coburn, Ranking Member Carper, and members of the Subcommittee. On behalf of the Department of Veterans Affairs (VA), I am pleased to take this opportunity to discuss the comprehensive electronic medical record used by VA to provide world-class medical care and support to our veterans. I also am pleased to discuss the significant progress VA has made toward the development of secure, interoperable health technologies that support health data sharing with the Department of Defense (DoD). VA and DoD are currently working closely together to ensure the seamless transition of medical services for our men and women returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Not only do these technologies allow us to deliver world-class medical care where and when it is needed, but they also permit the secure transfer of supporting medical data in a manner that protects the personal health information of our beneficiaries..."
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InterSystems to do DOD health care database
Doug Beizer, Washington Technology, August 8, 2006
http://www.washingtontechnology.com/news/1_1/daily_news/29098-1.html
InterSystems Corp. was selected to deliver its Cache post-relational database software for the Defense Department's Composite HealthCare System. The contract is worth $14.7 million, with options that could eventually total $63 million. It will put InterSystems database software at the core of health care delivery at 70 hospitals and more than 400 clinics serving more than 8 million people.
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Nicholson: VA blazes path to preventing drug errors
R. James Nicholson, secretary, U.S. Department of Veterans Affairs, Washington
Letter to the Editor, USA Today, July 31, 2006
http://www.usatoday.com/news/opinion/editorials/2006-07-31-letters-va_x.htm
USA TODAY's editorial on the recent Institute of Medicine report on prescription drug errors and the importance of electronic prescription systems was right on target (" Rx for medication errors?" Wednesday).
The Department of Veterans Affairs remains a world leader in patient safety and the use of technology in preventing errors associated with prescription drugs.
All VA medical centers utilize a bar-coded wrist band system to make sure the right patient gets the right medication in the right dose at the right time. This system is integrated with VA's electronic health records, and the results are stunning. VA prescribes medication to patients with an accuracy
rate of 99.993%, a standard that simply does not exist anywhere else in American health care. And we maintained this standard of excellence while filling 231 million prescriptions in 2005.
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Three Things the Government Has Done Right For Veterans
Jim Strickland, VA Watchdog dot Org, Aug. 1, 2006
http://vawatchdog.org/newsflash/newsflash08-01-2006-6.htm
Turn on the TV if you dare. You'll only hear the bad news about our government. Too much of this, not enough of that. It's true, when our government makes a mistake it's usually spectacular. But when we get it right, it's a wonder and a joy to behold. I want to share with you three things we've done right for Veterans.
My HealtheVet is a portal to a healthcare website designed specifically for Veterans. Visit the site and register…it takes about 5 minutes…and you open the door to health information, links to Federal and VA benefits and resources, your Personal Health Journal & the most recent added value for the busy Veteran, online VA prescription refill. Gather your prescriptions together, sign on, click a few buttons and you're done. It's instantly transmitted to your Consolidated Mail Outpatient Pharmacy (CMOP) and the status of your prescriptions are updated each time you sign in.
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Frist: Medical records remedy
Senator Bill Frist, Washington Times, August 2, 2006
http://washingtontimes.com/commentary/20060801-093445-1772r.htm
"...Last month, the Institute of Medicine announced thousands still die each year due to easily avoidable drug interaction errors. Without an effective way to track patient care, many fall through the cracks. One study from the University of Michigan and Rand Corp. showed that, on average, patients get only 55 percent of the care experts agree they should. Of course, without good information, there's almost no way to track which doctors and hospitals do well and which fail their patients. Without better information technology, we will soon face a real health care cost crisis.
But we can avert it. The Veterans Affairs Department hospital system -- once widely loathed -- has almost entirely turned itself around, thanks largely to a well designed computer system called Vista. When the New England Journal of Medicine used 11 measures to compare VA patients with Medicare
patients treated on a fee-for-service basis, the VA's patients were in better health and received more appropriate treatment, though Medicare-paid care, on average, actually costs more than services from VA hospitals. District-area hospitals have also gotten into the act, developing their own recordkeeping
software, Azyxxi, that's so impressive Microsoft bought it in July."
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First: Let's Move Medicine Into the Information Age
Senator Bill Frist, The American Enterprise, July/August 2006
http://www.taemag.com/issues/articleid.19231/article_detail.asp
At a Department of Veterans Affairs Medical Center just a few miles from my office in the U.S. Capitol, you can glimpse a piece of American medicine's future. Sitting at an ordinary desktop computer, Dr. Ned Evans hits a few keys on the keyboard and clicks his mouse a few times. Sample patient data spill out: X-ray images, lab notes, and blood pressure numbers. "Everything I might want, everything I need, I can see right here," he says. "It's a seamless part of life. It lets me do just about everything better."
And when the New England Journal of Medicine used 11 measures to compare VA patients with Medicare patients treated on a fee-for-service basis, the VA's patients were in better health and received more of the treatments professionals believe they should. According to the VA's own medical professionals, a computer system called Vista is the key to their success. "I'm proud of what we do here, but it isn't that we have more resources," explains Sanford Garfunkel, the director of the Washington VA Medical Center. "The difference is information."
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Carper: EHR's Value Proven at VA
Senator Tom Carper (D-DE), Health Care's Most Wired Magazine, Nov. 27, 2005
http://www.hhnmostwired.com/hhnmostwired/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/PubsNewsArticleMostWired/data/060118MW_Online_Carper&domain=HHNMOSTWIRED
With the Wired for Health Care Quality Act, providers struggling with the EHR decision have a new source of guidance and funding.
This year, Americans will spend almost $2 trillion on health care, easily more than any other country. Last year, America ranked 27th in the world in preventing infant mortality, and almost 100,000 people died because of routine medical mistakes. Given the premium we put on quality in this country and the money we're spending on health care, we're clearly not getting the most bang for our buck.
But health care can recover. The adoption of information technology, such as the widespread use of electronic health records, could save billions of dollars a year in health care costs and cut down the number of mistakes made every day in doctors' offices and hospitals across the country.
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Carper: On President Bush's State of the Union Address
Senator Tom Carper (D-DE), on the floor of the Senate, Feb. 1, 2006
http://carper.senate.gov/acrobat%20files/06StateofUnion.pdf
"...We had hearings this morning on Katrina, a follow up to what went wrong and what didn't go wrong on the heels of Katrina in New Orleans. When most people were evacuated--and we spent a fair amount of time this morning talking in our hearing about the evacuation of people who were in nursing homes and how it didn't go well. A lot of times people who were in nursing homes ended up in places outside Louisiana. Frankly, the people who received them in other nursing homes and other hospitals did not have a clue what medicines these folks were taking, they didn't know what their lab tests were, they didn't know the condition they were in. They had no real record of their x-rays or their MRIs. Basically, all these older people were dumped in the laps of these nursing homes and hospitals outside the gulf coast. It was a mess."
"Compare and contrast that with the folks who are veterans and are being cared for by the VA in VA nursing homes and hospitals in the same area. When they were transferred to their new sites and other States surrounding the gulf coast, going with them, figuratively and literally, were their electronic health records. When they ended up in a new hospital or nursing home, the receiving entity knew they had the medical history of this veteran. They knew what medicines they were taking. They knew what their lab tests were, MRIs, x-rays. They had a running history of the health care provided to these veterans. The veterans had an electronic health care record..."
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Ensign: Accelerating the Adoption of Health Information Technology
Senate Commerce Committee's Subcommittee on Technology, Innovation and Competitiveness
June 21, 2006
http://commerce.senate.gov/public/index.cfm?FuseAction=Hearings.Hearing&Hearing_ID=1762
The Senate Commerce Committee's Subcommittee on Technology, Innovation and Competitiveness will hold a hearing on the topic of Accelerating the Adoption of Health Information Technology, over which Subcommittee Chairman John Ensign (R-Nevada) will preside. This hearing will provide an update on the development of health information technology.
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OSDL to Host Healthcare Day
Linux Electrons, Tommy, July 19, 2006
http://www.linuxelectrons.com/article.php/20060719064820871
BEAVERTON, Ore. – The Open Source Development Labs (OSDL) has said that it will host the first ever Healthcare Day at LinuxWorld San Francisco on August 15, 2006. The event is in response to an expected increase in healthcare IT spending in the near term and the growing role of open source software in the healthcare industry.
...Medsphere CEO Kenneth W. Kizer, MD MPH, will deliver the Day's keynote. Medsphere is a leading provider of open source software for the healthcare industry, including OpenVista, a portfolio of open source products and services based on the highly successful VistA electronic medical-records
system used by the U.S. Department of Veteran's Affairs.
"Linux and open source software are changing the way that healthcare IT is created and delivered by today's major IT vendors," Dr. Kizer said. "The cost savings and efficiencies inherent in the open source model are creating significant market opportunities for vendors and developers involved in the
healthcare market."
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Can open source save your life?
Dana Blankenhorn, Open Source Blog ZDNet, June 5, 2006
http://blogs.zdnet.com/open-source/?p=670
"...For nearly 25 years the Veterans Administration has been fighting this paperwork battle. And it's been winning with a home-grown system called VistA. A few years ago Scott Shreeve, a former ER doctor, decided to build an open source business around it under the name Medsphere, with his brother
Steve. (Kenneth Kizer, a former VA official, is CEO.) Medsphere's version is based on a Sourceforge project called OpenVista, built on a Linux stack."
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OASIS adopts info-sharing standard for emergency responders
Michael Arnone, Government Health IT News, June 20, 2006
http://www.govhealthit.com/article94971-06-20-06-Web
Emergency responders in the field now have a data-sharing standard that provides role-based information sharing in a crisis, an international standards organization announced today.
The Organization for the Advancement of Structured Information Standards, a nonprofit, international consortium, has approved the Emergency Data Exchange Language Distribution Element (EDXL-DE) Version 1.0 as an OASIS standard, officials said in a statement.
EDXL-DE facilitates emergency information sharing and data exchange across local, regional, tribal, national and international organizations in the public and private sectors, OASIS officials said.
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Defense Department Marches Towards Open Source
DoD Teams with OSSI, ISVs, and 'Non-Traditional Companies'
Jacqueline Emigh, LinuxPlanet, July 31, 2006
http://www.linuxplanet.com/linuxplanet/reports/6289/1/
In a new initiative to spur more use of open source software (OSS) within the US Defense Department, the department's Office of Advanced Systems and Concepts (AS&C) has begun teaming up with Red Hat, Novell, IBM, Hewlett-Packard, Intel, and AMD--along with big systems integrators and
"non-traditional" open source companies--to glean insights that will help shorten the learning curve to deployment.
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Report: Health, welfare IT spending to top $12B
Nancy Ferris, Govt. Health IT, Aug. 4, 2006
http://www.govhealthit.com/article95533-08-04-06-Web
New efforts to consolidate administration of health and welfare benefit programs will keep state and local government spending on information technology for those programs growing in the next five years, according to a new forecast from IT market researchers at Input.
They said spending will grow from $7.6 billion this year to $12.2 billion in 2011.
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Virginia governor creates health IT council
Nancy Ferris, Govt. Health IT, Aug. 3, 2006
http://www.govhealthit.com/article95531-08-03-06-Web
Virginia Gov. Timothy Kaine has established a Health Information Technology Council to promote interoperable electronic health records and select the recipients of grant funding for local health IT projects.
Kaine said he will appoint 15 members to the council, which the commonwealth's technology and health and human resources secretaries will lead. The governor issued an executive order Aug. 3 to create the council.
Meanwhile, the commonwealth plans to issue a request for information to look for community and regional health IT projects that want state funding. The legislature approved $1.5 million in funding for such projects this year.
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Microsoft to Offer Software for Health Care Industry
Steve Lohr, New York Times, July 27, 2006
http://www.nytimes.com/2006/07/27/technology/27soft.html?ex=1154664000&en=dea773fe12adbf85&ei=5070&emc=eta1
Microsoft plans to offer software tailored for the health care industry, a change from its usual strategy of encouraging others to create industry-specific products using its operating system and programming tools.
The company's first step, announced yesterday, is to purchase clinical health care software developed by doctors and researchers at a nonprofit hospital in Washington, D.C. Microsoft is also hiring two of the three doctors who created the software system, and 40 members of the development team at
Washington Hospital Center.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
EVENTS
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
August 15, 2006. San Francisco, CA
Rise in Healthcare IT Spending Spells Opportunity for IT Managers, Profit for Open Source Vendors
OSDL to Host First Ever Full-Day Event Dedicated to Healthcare IT at LinuxWorld San Francisco
Medsphere CEO Kenneth W. Kizer to Deliver Keynote
http://biz.yahoo.com/prnews/060719/sfw021.html?.v=60
August 21–23, 2006. Nashville, TN
Veterans Affairs E-Health Conference & Exposition 2006
A Decade of Impact on Healthcare for Veterans
https://www.technologyforums.com/6VE/agenda.asp
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
KEY RESOURCES
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
VistA Software Alliance (www.vistasoftware.org )
WorldVistA (www.worldvista.org )
HardHats (www.hardhats.org)
LinuxMedNews (www.linuxmednews)
VA VistA Innovations Site ( www.innovations.va.gov )
VistA Monograph Home (www.va.gov/vista_monograph )
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
EDITORIAL POLICY STATEMENT
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While the underlying basis for publishing this newsletter is the publisher's belief in the potential of VistA® to vastly improve the quality of healthcare in the US and its potential to make affordable healthcare IT technology available to the developing world, the editorial policy is to be independent and, to this end, the newsletter will not promote vendor products or services. As an expression of its independence, the newsletter may, from time to time, include information that may reflect negatively on VistA®. The newsletter may include information about future events that the editor feels are relevant to the communities for which the newsletter is intended but such information in no way endorses such events.
Opinions expressed in the newsletter and the identity of the person or organization expressing such opinions will either be clear from the context or will be explicitly stated.
Note: VistA® is a registered trademark of the Department of Veterans Affairs. It stands for "Veterans Health Information Systems and Technology Architecture."
Roger A. Maduro is the publisher and editor-in-chief of VistA® News. He is a leading expert in the application of open source software and concepts to improve information technology systems. In the past 5 years he has focused on solutions in healthcare, in particular the migration of VistA® from an application specific to the Department of Veterans Affairs to one that can run everywhere from the private sector clinics and hospitals to national health systems. He is one of the founders of the VistA Software Alliance (VSA) and currently a board member. He is also a member of the WorldVistA organization.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
SUBSCRIPTION AND CONTACT INFORMATION
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you wish to subscribe to this newsletter, please send an email to subs...@lxis.com. If you wish to cancel a subscription, please send an email to unsub...@lxis.com.
email: rama...@lxis.com
phone: (571) 217-6921
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
VistA® News| P.O. Box 6201 | Leesburg | VA | 20178
Wolfgang Giere
I have been especially pleased to hear that Georg Timson and Wally Fort
received the applaus they deserve.
What about the Gentleman who financed the initial PDPs for the decentralized
development (Right now I forgot his name, it is on my tongue)?
A "card-holding" honorary member of the underground railroad
(This is the honor I like most!)
Wolfgang Giere
Am Montag, 21. August 2006 18:51 schrieb Roger Maduro:
> ========================================================================
>
> VistA(r) News
> We report on several major developments in this issue of VistA(r) News.
> These range from a public call by the Senate for the Department of Defense
> (DoD) to adopt the U.S. Department of Veterans Affairs VistA(r) EHR
> software to a major breakthrough in recognition for VistA(r) in the open
> source community's LinuxWorld conference in San Francisco.
>
> Congress Calls for DoD to Adpot VistA(r)
>
> On July 21st, the Senate Committee on Appropriations released a proposed
> funding bill asking DoD to adopt VA's VistA(r) electronic health record
> software as their EHR platform. This follows a similar proposal in the
> House funding bill. While the final bill has to be worked out in conference
> later this year, the intent of Congress is clear. This would be a very
> positive step towards creating a fully-integrated health care system for
> active-duty American servicemen as well as veterans.
>
> The need for a fully integrated EHR has become an urgent matter given the
> large number of wounded servicemen coming from Iraq into the VA medical
> system. Transferring their medical records from the Military Health System
> (MHS) to the VA Medical system has proven to be a challenge. Although major
> strides have been made by joint efforts of DoD and the VA, there is still a
> lot of work to be done. Having one EHR system solves the data transfer and
> registration issues. In this issue we cite some rather colorful statements
> from Secretary of Defense, Donald Rumsfeld, in this regard.
>
> Integrating both systems makes even more sense when one looks behind the
> scenes. There is an excellent background testimony by Dr. Michael Kussman,
> the Principal Deputy Under Secretary of Health of the VA on the nature and
> history of both VistA(r) and DoD's EHR infrastructure and data sharing
> efforts. DoD's Composite Health Care System (CHCS) is actually a derivative
> of VistA(r). Both systems have a great deal of internal similarities and
> run on the same advanced M Language-based multi-dimensional database
> system. In fact, as reported below, DoD just signed a contract with
> InterSystems to use Cache, their M-Language product, based on its
> demonstrable superior performance in comparison to Oracle's legacy database
> technology. Thus migrating DoD to use VistA(r) requires far less effort
> than one would suspect. Combining the efforts of both development teams
> will produce better code, faster, and at substantial savings.
>
> As one can see in this issue's news clippings, bureaucrats at DoD are
> opposed to adopting VistA(r) as their EHR platform. Instead, they would
> like to spend several billion dollars in taxpayer's money in developing a
> new EHR, the Armed Forces Health Longitudinal Technology Application
> (AHLTA). The claim is that at some distant date in the future AHLTA will
> develop and grow to have the same functionality that VistA(r) already has
> today (the projected delivery date for AHLTA is 2011). The clincher,
> according to DoD bureaucrats, is that AHLTA would be supposedly "better
> adapted" than VistA(r) to DoD's mission.
>
> One interesting observation here is that the private sector has already
> voted with their feet on this particular issue. Ignoring DoD's CHCS and
> AHLTA, a large number private sector hospitals, State hospitals and
> clinics, and even entire countries, are now actively implementing VistA(r).
> A number of companies have emerged to carry out these private-sector
> implementations. Companies such as DSS, Medsphere, Perot Systems, and
> several others, have spent collectively over $100 million in total over the
> past three years adapting VistA(r) to the requirements of the private
> sector. They have also added additional capabilities and modules, and have
> assembled their implementation, support and training teams. These companies
> would not be doing this if it was not a sound business decision and if they
> did not think that VistA(r) was the EHR technology of the future.
>
> VA and IHS A Model for Collaboration
>
> In contrast to the foot-dragging from DoD bureaucrats, we have a story on
> the decision of the Indian Health Service (IHS) to test the VA's medical
> imaging system. Once the testing is completed, it will be deployed
> nationwide. This is just one more milestone in the long history of
> collaboration between the VA and the IHS.
>
> Faced with the need to care for a large population of Native Americans on a
> meager budget, IHS concluded more than two decades ago that the best course
> of action to provide an EHR for their medical facilities would be to take
> VistA(r) from the VA and adapt it to their own particular needs. Thus an
> IHS derivative of VistA(r) named the Resource and Patient Management System
> (RPMS) was born. Over the years IHS came up with some major innovations to
> RPMS, as well as additional modules such as pediatrics and OB/GYN, that
> were not originally part of VistA(r). The relevant software code was shared
> with the VA which then adapted those innovations to VistA(r) and added them
> to their code stream. This is one of the greatest examples of
> collaboration between two government agencies which unfortunately to this
> day remains a largely untold story.
>
> The story does not end there, however. After 3 years of searching for an
> EHR in the commercial sector, the National Aeronautics and Space
> Administration (NASA), concluded that RPMS was the EHR that best met the
> needs for their 14 medical centers. RPMS could also serve as a platform for
> an occupational health module. NASA signed an inter-agency collaboration
> agreement with IHS in April of 2005. Through this agreement IHS provided
> NASA with RPMS. In exchange NASA will contribute the code they develop for
> the occupational health module back to IHS. In addition, going forward,
> both agencies will collaborate in the future operation, maintenance, and
> enhancement of their respective systems. At the same time, IHS will share
> the module and additional code they receive from NASA with the VA. The VA
> will incorporate these enhancements into VistA(r) and when all the testing
> is completed, this new version of VistA(r) will not only be released to the
> VA medical system, but through public domain releases, to the entire
> VistA(r) community.
>
> Adding DoD to this thriving collaborative community would be significant.
> The Military Health System provides care for 9.2 million servicemen at 70
> hospitals and 411 clinics. The Veterans Health Administration provides care
> for more than 5 million veterans at 163 hospitals and more than 800 clinics
> and other facilities. IHS runs 49 hospitals and 190 health centers. NASA
> runs 14 medical centers. In comparison, the largest private health care
> provider in the United States, Kaiser Permanente, only runs 30 hospitals
> and 431 clinics.
>
> Congress Takes Leadership in EHR Efforts
>
> The Senate's call for DoD to adopt VistA(r) is not coming in a vacuum. In
> this issue we have gathered multiple articles from several Senators
> discussing VistA(r). These include articles by Senator Bill Frist (R-TN), a
> medical doctor and Senate Majority Leader, as well as Senator Tom Carper
> (D-DE). These are excellent articles and demonstrate that on this issue,
> some of the key elected officials in Washington are actually ahead of the
> curve and understand the role that technology can play in improving
> healthcare.
>
> We have also included a link to the Senate Commerce Committee's
> Subcommittee on Technology, Innovation and Competitiveness hearings on June
> 21. The hearing was on the topic of Accelerating the Adoption of Health
> Information Technology, and the witnesses provided a thorough update on the
> development of health information technology as well as the activities of
> the American Health Information Community (AHIC).
>
> Most interesting is that during these hearings VistA(r) took center place.
> It started with the testimony of Newt Gingrich, former Speaker of the House
> and the founder of the Center for Health Transformation. Gingrich began his
> testimony with a discussion of the success of the VA and VistA(r) in
> safeguarding the medical records of all of their patients during Hurricane
> Katrina. He contrasted that with the fact that the medical records of more
> than a million Americans in the Gulf region had been completely destroyed
> and are lost forever.
>
> Gingrich was followed by Phillip T. Ragon, Founder and CEO of InterSystems
> Corporation who detailed the success of the key M Language technology that
> drives not only VistA(r), but also a substantial portion of the world's
> successful healthcare IT systems. Subcommittee Chairman John Ensign (R-NV)
> asked multiple questions about VistA(r) in the Q&A period. Ensign asked
> Ragon to tell him the history of VistA(r) and then requested more details
> on the savings made by using VistA(r) at the VA. A full webcast of the
> hearing is available at the Committee's web site and it's well worth
> watching.
>
> A discussion of what the Senate has done in regards to EHR's would not be
> complete without mention of the efforts of several Senators who have
> quietly labored to make it happen. We are thinking in particular of Senator
> Daniel K. Inouye (D-HI). Senator Inouye, a senior member of the Senate, is
> a highly-decorated World War II combat veteran who earned the nation's
> highest award for military valor, the Medal of Honor. Over the past decade
> Dr. Inouye has secured funding for the Pacific Telehealth and Technology
> Hui in Hawaii (www.pacifichui.org) for research into telemedicine and
> advanced medical technologies.
>
> Under the direction of Dr. Stanley M. Saiki, the Hui has funded several
> projects that have been of critical importance to the adaptation of
> VistA(r) to the private sector. This includes the porting of the VA's
> VistA(r) code base to run on the Linux operating system as well as an ASP
> version of VistA(r). The Hui also financed some of the key early
> implementations of VistA(r) outside of the VA, including the implementation
> of VistA(r) in American
> Samoa and in several clinics in Hawaii.
>
> VistA(r) at LinuxWorld's Open Source in Healthcare Day
>
> The rapid emergence of VistA(r) as an open source application/platform has
> finally caught the attention of the open source community at large. The
> Open Source Development Labs (OSDL) sponsored a full day session at the
> LinuxWorld Conference in San Francisco this week dedicated to the topic of
> open source in healthcare. The keynote speaker was Ken Kizer, former
> undersecretary of the VHA and CEO of Medsphere. Kizer was one of the key
> leaders that transformed the VA's hospital system into the best hospital
> system in the country (as documented by every standard measure of quality).
> Kizer gave an excellent presentation on the state of healthcare in America
> and how VistA(r) and open source can play a role in fixing many of the
> systemic problems, including the high death toll due to medical errors (as
> outlined by Kizer, medical errors are the third leading cause of death in
> the United States today).
>
> Several other well-known members of the VistA(r) community also spoke at
> the conference, including K.S. Bhaskar, Vice President for Engineering at
> Fidelity National Information Services & COO of WorldVistA, Joseph Dal
> Molin, WorldVistA's Interim President and VP of Business Development, and
> Frank Pecaitis, Medsphere's VP of Sales and Marketing. Scott and Steve
> Shreeve, founders of Medsphere, were in the audience as well as Mike
> Ginsburg from DSS, and Chris Richardson from WorldVistA. Two of the
> original developers of VistA(r), and card-carrying members of the
> Underground Railroad, George Timson and Wally Fort were also in the
> audience. They received a strong ovation from the audience when they were
> introduced.
>
> VistA(r) News will have more details on the session presentations in the
> next issue of the newsletter. Several of the presentations, including Dr.
> Kizer's, can be seen at the event wiki--<
> http://www.osdl.org/wiki/dcl_health_care_day/index.php/Main_Page>.
>
> Microsoft Enters the EHR Market
>
> The open source community is not the only one that sees the value of
> VistA(r). Microsoft also sees the potential for fully integrated EHR and
> has purchased a product, Azyxxi, so that it can compete head on with
> VistA(r) and other EHR's. Azyxxi is what is called a "health intelligence"
> application that can integrate data from hundreds of sources and make it
> available to doctors electronically. It was developed by doctors at the
> emergency department of Medstar Health's Washington Hospital Center in
> Washington, D.C. Although it only has a small subset of the functionality
> of VistA(r) today, Azyxxi does hold promise as it grows and develops over
> the next decade in particular when compared to commercial EHR products that
> lack VistA(r)'s integration and capabilities.
> VA VistA Innovations Site (www.innovations.va.gov )
> VistA Monograph Home (www.va.gov/vista_monograph )
>
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> EDITORIAL POLICY STATEMENT
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
> While the underlying basis for publishing this newsletter is the
> publisher's belief in the potential of VistA(r) to vastly improve the
> quality of healthcare in the US and its potential to make affordable
> healthcare IT technology available to the developing world, the editorial
> policy is to be independent and, to this end, the newsletter will not
> promote vendor products or services. As an expression of its independence,
> the newsletter may, from time to time, include information that may reflect
> negatively on VistA(r). The newsletter may include information about future
> events that the editor feels are relevant to the communities for which the
> newsletter is intended but such information in no way endorses such events.
>
> Opinions expressed in the newsletter and the identity of the person or
> organization expressing such opinions will either be clear from the context
> or will be explicitly stated.
>
> Note: VistA(r) is a registered trademark of the Department of Veterans
> Affairs. It stands for "Veterans Health Information Systems and Technology
> Architecture."
>
> Roger A. Maduro is the publisher and editor-in-chief of VistA(r) News. He
> is a leading expert in the application of open source software and concepts
> to improve information technology systems. In the past 5 years he has
> focused on solutions in healthcare, in particular the migration of VistA(r)
> from an application specific to the Department of Veterans Affairs to one
> that can run everywhere from the private sector clinics and hospitals to
> national health systems. He is one of the founders of the VistA Software
> Alliance (VSA) and currently a board member. He is also a member of the
> WorldVistA organization.
>
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> SUBSCRIPTION AND CONTACT INFORMATION
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
> If you wish to subscribe to this newsletter, please send an email to
> subs...@lxis.com. If you wish to cancel a subscription, please send an
> email to unsub...@lxis.com.
>
> email: rama...@lxis.com
> phone: (571) 217-6921
>
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
> VistA(r) News| P.O. Box 6201 | Leesburg | VA | 20178
>
>
>
James Abbott
I have a few issues with some of the statements made in the commentary about AHLTA. AHLTA and VistA serve very different purposes, and different patient populations. What works for one will not always work for the other. Here are just a few comments on some of the articles. I work with AHLTA daily, and so admittedly I have a bias (but not any more so than that of the writer(s) below). Feel free to take my comments for what they are worth.
1. AHLTA and VistA are not equivalent products. AHLTA and CPRS is a better comparison. It isn’t a perfect one, but better than comparing AHLTA and VistA. There is a lot of functionality in VistA that is not accessible in the CPRS. AHLTA has a similar dependency on CHCS. However, AHLTA does have some functionality outside of CHCS (as opposed to CPRS, which is just a GUI on top of VistA).
2. The DoD didn’t decide to use Cache based on it’s performance compared to Oracle. It is simply easier to port the database between differing implementations of the same language.
3. The DoD is not spending several billion dollars developing AHLTA. They are spending several billion dollars implementing and maintaining AHLTA. Development is only one part of implementation. The implementation budget also includes all of the hardware required to change the dumb terminals in every clinic over to a PC, as well as all of the servers, routers, and other hardware upgrades needed. The ‘several billion’ covers the entire life cycle of the product. This is strictly semantics, but an important point none-the-less. We are spending millions (not billions) on the software side.
4. Once a note is completed in AHLTA, it is available worldwide. Our soldiers who are PCSing don’t have to worry about the records catching up to them electronically eventually. The average DoD beneficiary is much more mobile than the average VA beneficiary. There are some valid points why we are building something different.
5. Speaking of Katrina, the information from Keesler AFB was available to those patients when they were sent to other DoD facilities. This was due to AHLTA. It was not their entire record, but it was all of their meds, labs, x-ray reports, and some notes as well.
6. AHLTA is being used to generate over 80k encounters a day right now. The 2011 date is for when the funding for CHCS dries up (and so must be replaced by other products meeting that functionality).
There is clearly a need for our veteran’s health information to be available across the spectrum of care. Adopting the same EHR is only one way of achieving that goal. Building software that can exchange data back and forth in a secure, reliable, standards based manner is another solution. A benefit to that solution is that we can share data with *any* system that also shares those standards. That is what we are trying to build in AHLTA. There are problems right now sharing data back and forth with the VA, but these are technical problems that aren’t insurmountable. Once we have systems that talk together when needed to share data about common patients, we will have what congress wants (and our veterans deserve).
I am in no way trying to say VistA is not a wonderful product. There are some things that I wish AHLTA did more like CPRS. However, I also see several advantages to the AHLTA interface over CPRS. Both products could learn from some of the civilian products out there.
Here’s the bottom line (at least according to insignificant me): We don’t all need to use the same product. The data on our patients is what really matters, and we need to be able to share data between all the different EHRs out there (when needed).
Dr. James Abbott
Maj, USAF, MC
(This is not meant in any way to be an official statement of DoD or Air Force policy. Just my two cents.)
-----Original Message-----
Subject: [Hardhats] VistA(r)
News-Aug. 18, 2006-Senate Calls for DoD to Adopt VistA(r)/VistA(r) at
LinuxWorld.
========================================================================
VistA® News
Editor, Roger A. Maduro, LxIS
August 18, 2006. Vol. 1, No. 2
=========================================================================
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
COMMENTARY
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We report on several major developments in this issue of VistA® News. These
range from a public call by the Senate for the Department of Defense (DoD) to
adopt the U.S. Department of Veterans Affairs VistA® EHR software to a
major breakthrough in recognition for VistA® in the open source community's
LinuxWorld conference in San Francisco.
Congress Calls for DoD to Adpot VistA®
On July 21st, the Senate Committee on Appropriations released a proposed
funding bill asking DoD to adopt VA's VistA® electronic health record
software as their EHR platform. This follows a similar proposal in the House
funding bill. While the final bill has to be worked out in conference later
this year, the intent of Congress is clear. This would be a very positive step
towards creating a fully-integrated health care system for active-duty American
servicemen as well as veterans.
The need for a fully integrated EHR has become an urgent matter given the large
number of wounded servicemen coming from Iraq into the VA medical system.
Transferring their medical records from the Military Health System (MHS) to the
VA Medical system has proven to be a challenge. Although major strides have
been made by joint efforts of DoD and the VA, there is still a lot of work to
be done. Having one EHR system solves the data transfer and registration
issues. In this issue we cite some rather colorful statements from Secretary of
Defense, Donald Rumsfeld, in this regard.
Integrating both systems makes even more sense when one looks behind the
scenes. There is an excellent background testimony by Dr. Michael Kussman, the
Principal Deputy Under Secretary of Health of the VA on the nature and history
of both VistA® and DoD's EHR infrastructure and data sharing efforts. DoD's
Composite Health Care System (CHCS) is actually a derivative of VistA®.
Both systems have a great deal of internal similarities and run on the same
advanced M Language-based multi-dimensional database system. In fact, as
reported below, DoD just signed a contract with InterSystems to use Cache,
their M-Language product, based on its demonstrable superior performance in
comparison to Oracle's legacy database technology. Thus migrating DoD to use
VistA® requires far less effort than one would suspect. Combining the
efforts of both development teams will produce better code, faster, and at
substantial savings.
As one can see in this issue's news clippings, bureaucrats at DoD are opposed
to adopting VistA® as their EHR platform. Instead, they would like to spend
several billion dollars in taxpayer's money in developing a new EHR, the Armed
Forces Health Longitudinal Technology Application (AHLTA). The claim is that at
some distant date in the future AHLTA will develop and grow to have the same
functionality that VistA® already has today (the projected delivery date
for AHLTA is 2011). The clincher, according to DoD bureaucrats, is that AHLTA
would be supposedly "better adapted" than VistA® to DoD's
mission.
One interesting observation here is that the private sector has already voted
with their feet on this particular issue. Ignoring DoD's CHCS and AHLTA, a
large number private sector hospitals, State hospitals and clinics, and even
entire countries, are now actively implementing VistA®. A number of
companies have emerged to carry out these private-sector
implementations. Companies such as DSS, Medsphere, Perot Systems, and
several others, have spent collectively over $100 million in total over the
past three years adapting VistA® to the requirements of the private sector.
They have also added additional capabilities and modules, and have assembled
their implementation, support and training teams. These companies would not be
doing this if it was not a sound business decision and if they did not think
that VistA® was the EHR technology of the future.
Gregory Woodhouse
I have a few issues with some of the statements made in the commentary about AHLTA. AHLTA and VistA serve very different purposes, and different patient populations. What works for one will not always work for the other. Here are just a few comments on some of the articles. I work with AHLTA daily, and so admittedly I have a bias (but not any more so than that of the writer(s) below). Feel free to take my comments for what they are worth.
Chris Richardson
Gregory Woodhouse
I agree with Greg, these packages should not be competeing, but merge into interoperable applications.
Nancy Anthracite
interoperable with anything before there are some consistent standards for
interoperability and I think AHIC will eventually provide those, but until
they exist, I don't see a whole lot of point in criticizing or praising any
EMR for its interoperability. The interoperabilty solution for the VA and
DOD is going to be nice but limited to them until such standards are chosen
and both move to use them.
I invite the AHLTA user to take a look at what has been done to extend the GUI
for the military by Emory Fry and his compatriots at Balboa. That same
development tract could be easily adapted to rapidly give VistA different
GUIs for the military side if VistA were used there. CPRS need not be your
GUI or could be one of them. Emory joined Terry Wiechmann to give a talk at
the last WorldVistA meeting. Unfortunately, Terry's portion was not
captured, but Emory's was and it has the audio and PPT here:
http://downloads.opensourcevista.net/EsiObjects
Please don't take this to mean that I think VistA is perfect and the solution
for all problems or that it doesn't have problems. I certainly don't, but the
budgets of the VA and the DOD would be better spent if they were working
toward one solution, not two, and it has seemed to me from the beginning that
VistA should have been used to do it.
I also don't think that working toward one central medical record is the
solution. Everyone needs to be able to operate in a stand alone mode from
the level of a small clinic or or handheld a patient's side in a home or a
battle right on up the ladder and then to be able to merge the data as needed
and as the capability exists and but not to rely on that single central
record to provide everything. I think solutions that can do both are needed
for speed and continuity of care at the local level as well as for
enterprise wide management. I believe both the VA and the DOD are working/
or will be working, at this in their own ways. The VA is working hard to
standardize its terminology to bring up the central record that hopefully
will not be expected to be the only record. I think the DOD will soon
figure out that it will need more than one central database to provide the
continuity and speed it needs.
Gregory Woodhouse
gregory....@sbcglobal.net
--
Nancy Anthracite
James Abbott
reason I started playing with VistA is to understand what is probably the
most common EHR that military docs have had an exposure to. Understanding
teir frame of reference helps me adapt what I do.
I do have one very large praise for VistA. The programmers are responsive
to the users. Having a fast turn-around on new functionality (in response
to user requests) helps to make VistA what it is. AHLTA, over the last 18
months, has not advanced much while a major change in architecture took
place. Now that we have broken through that barrier, it will advance
quickly. There are many upcoming features that will make it much more
acceptable to the end users. Having it not advance much recently has
certainly hurt its creditability.
As far as what AHLTA does that CHCS doesn't do, it provides a single
world-wide database. As opposed to the last article I saw posted (Health
Data Bottleneck on Military.com) the notes from Landstuhl Regional Medical
Center in Germany *are* viewable at any other MTF. That is not the case
with CHCS, but it is with AHLTA. Also, the ability to complete notes (with
coding included) isn't a part of CHCS, but it is an integral part of AHLTA.
Line item billing can't be done in ADM (part of CHCS), but is a piece of
cake in AHLTA. This is essential for billing purposes.
One thing that AHLTA will soon do (hopefully next three months, but I'm not
holding my breath) is allow me to see all meds a patient is taking, whether
they get them at a DoD facility, the VA, the Mail Order pharmacy or a
downtown local pharmacy. I don't think VistA gives it's users that level of
detail, and I don't know if VistA shows PDTS data (civilian network med data
for DoD patients). As a primary care doc, seeing the list of meds my
patients are taking (as opposed to their guessing when they don't bring
their pills) will help me take much better care of them. I know you can
enter all of a patient's meds into VistA, but it would be much better to
receive that information electronically. That is an example of data sharing
that will have huge benefits to our patients today.
The DoD decision to do AHLTA as opposed to VistA was made way above my pay
grade. It will be very expensive now to change systems. As more data is
shared between the two systems, critics will have less to complain about.
Heck, just seeing the difficulties we are having now with sharing data
between the two systems makes me wonder how hard it would be to place all of
the historic data from either system into the other. Our patients are
better treated with the electronic data we have than trying to start with a
clean slate. As much as users complain when they have to change their ways
of doing anything, they would complain more if we changed yet again without
giving them the historic data we have right now.
I am starting to ramble. I am notorious at work for my "War & Peace"
e-mails!
Have a great week all.
v/r
James Abbott, M.D.
Nancy Anthracite
v/r
James Abbott, M.D.
--
Nancy Anthracite
Chris Richardson
world, VistA and I believe CPRS does do remote data views on patient records
at other facilities around the country, Puerto Rico, and the Phillipines.
That is about as far as we stretch. It would be good to see what
functionalility might also be added to VistA/AHLTA. That is interesting
though. Any other items you can think of?
----- Original Message -----
From: "James Abbott" <ja...@i-shmoo.net>
To: <Hard...@googlegroups.com>
Sent: Sunday, August 27, 2006 6:31 PM
Subject: [Hardhats] Re: VistA(r) News-Aug. 18, 2006-Senate Calls for DoD to
Adopt VistA(r)/VistA(r) at LinuxWorld.
James Abbott
AHLTA, when first developed, stored everything in one big database as you
went along. The note that I was only half-finished with in AHLTA was stored
the same place all of the complete notes went. Every transaction was
between the local client and the big database. If you are trying to connect
to it from, say, Korea, each of those trips back and forth started to really
add up. Now, each of the incomplete notes are stored 'locally,' and only
once completed do they get sent to the big database. Locally is defined as
where the local CHCS server is located at.
That one change (notes staying local but available on all local machines
until they are completed) has taken the programmers 18 months to do
successfully. I may be over simplifying it, but I'm afraid not by much.
JRA
Chris Richardson
That was very eloquently stated. Thank you. We are discovering that
taking the data away from the point of care seems to be not such a good
idea. It seems as though there is an all or nothing quality of this whole
thing. The best care seems to be in both positions, centralized and
decentralized. They do not have to be mutually exclusive.
----- Original Message -----
From: "James Abbott" <ja...@i-shmoo.net>
To: <Hard...@googlegroups.com>
Sent: Monday, August 28, 2006 3:57 PM
Subject: [Hardhats] Re: VistA(r) News-Aug. 18, 2006-Senate Calls for DoD to
Adopt VistA(r)/VistA(r) at LinuxWorld.
David Sommers
I'll feel comfortable with my reply at this point...
I don't think it's a secret, but having worked with the VA - we've also
worked with the DOD. In that capacity, I've been honored to view both
architectures and they are different. From one stand-point, you have
the fundamental infrastructure. As James pointed out, the entire MTF
and CDR/LCS database replication process is "unique". In addition, the
underlying technology (Oracle/MSSQL vs M/Cache) - the long running DB
battle. And then you have UI and front end differences, CPRS (Delphi)
vs "AHLTA" (VB/.NET). So the areas to compare are difficult, even for
a Senator.
But you have to admit that the goals (no matter how many egos, budgets,
and committees are involved) is a great goal for us - the tax payers.
Instead of spending $X million, one lot here and another budget there -
combine the two. How many barcode medication projects should one
government have to implement? Is it a 3-year project or even a 5-year
project, maybe. But you have to start somewhere.
Once you start the process of combining, migrating, or scratching code
- then we'll be on our way to meeting the needs of every American.
(Go Army).
/David.
Chris Farley
systems. They each have strong points and weak points. A project that
endeavors to take the best of both worlds and combine them into one system
would provide tremendous financial savings as well as improve the care for
both veterans and active military.
IMHO, VistA beats the CDR/LCS, but AHLTA beats out CPRS.
I even think it would be appropriate to use both Cache and Oracle. Each of
them has strong points and combining the two would provide tremendous
benefits.
I also disagree with the idea that the two methodologies of care are that
different. VistA focuses on preventative medicine and chronic care, but
AHLTA focuses on readiness, which is a very similar paradigm. The first
goal of both is to take proactive measures to keep the patient healthy.
Chris Farley
Independent Consultant
-----Original Message-----
From: Hard...@googlegroups.com [mailto:Hard...@googlegroups.com] On Behalf
Of David Sommers
Sent: Wednesday, August 30, 2006 1:20 PM
To: Hardhats
Subject: [Hardhats] Re: VistA(r) News-Aug. 18, 2006-Senate Calls for DoD to
Adopt VistA(r)/VistA(r) at LinuxWorld.