front end over VA Vista
Nitin Pandey
I have been playing around with VA Vista for quite some time trying to
figure out how everything works. I sincerely wish there were a more
appealing GUI. I mean CPRS is just great but I guess I spend a lot of
time on internet and have developed this bad habbit of doing things
with the click of a button. Is there a group which is working to
create a JAVA or Vb .net based GUI over Vista? Is it really possible?
Can Mumps database be accessed using these technology?Can we do it by
using the existing Mumps code of VA Vista. If we are doing it I would
like to contribute my 2 cents worth to this community. If my questions
were too insane..Just forget that I exist :)
~Cheers
Nitin
Pete Theisen
> Greetings everyone
>
> I have been playing around with VA Vista for quite some time trying to
> figure out how everything works. I sincerely wish there were a more
> appealing GUI. I mean CPRS is just great but I guess I spend a lot of
> time on internet and have developed this bad habbit of doing things
> with the click of a button.
Hi Nick!
I have spent a lot of time with doctors, and I have worked as a doctor
myself prior to forced retirement (car accident). The vast majority of
them do NOT use any computer in their work, not even for such as email.
I have met a fair number who can't even type.
I think point and click will be essential to appeal to a broad medical
audience. If you have been following my other thread about installing
VistA I think what I have done thus far just trying to get VistA on my
computer would have stopped EVERY doctor I have ever met. Have a look at
this stuff while I am switching from Mepis to Debian, might be a while.
http://pycon.blip.tv/file/1947542/
http://dabodev.com/
The dabo framework builds upon Python. The resulting app is quite small,
could be written to work on a pda or smartphone. I have been thinking
along those lines. On the server you would need a conversion layer to
present VistA data in Python, or maybe even a rewrite of VistA in Python
- BUT, you would have point and click and a lot of other new stuff.
Is there a group which is working to
--
Regards,
Nancy Anthracite
Thus, it may not have all of the features that those of us who are not so
impaired would appreciate, but it has a lot going for it.
Nancy Anthracite
Ben Mehling
<nitin....@googlemail.com> wrote:
>
> Greetings everyone
>
> I have been playing around with VA Vista for quite some time trying to
> figure out how everything works. I sincerely wish there were a more
> appealing GUI. I mean CPRS is just great but I guess I spend a lot of
> time on internet and have developed this bad habbit of doing things
> with the click of a button. Is there a group which is working to
> create a JAVA or Vb .net based GUI over Vista? Is it really possible?
Community member, Wally Cash, was toying with using Laszlo as a
front-end to VistA: http://medsphere.org/community/project/lzvista
OpenVista CIS is a cross-platform, .net front-end for VistA:
http://medsphere.org/community/project/openvista-cis
The community has worked to gather a list of all front-ends that could
work with VistA: http://medsphere.org/docs/DOC-1195
- Ben
I, Valdes
medicine. Another is that the hospital management where I work is
rightly or wrongly quite happy that CPRS is NOT browser-based. This is
for many reasons, one of which is that they do not want to support web
browsing at all at work with what they perceive as all of the
productivity, privacy, and security joys that it entails.
-- IV
On May 15, 12:00 am, Nitin Pandey <nitin.pand...@googlemail.com>
wrote:
K.S. Bhaskar
>
> Nitin Pandey wrote:
> > Greetings everyone
> >
> > I have been playing around with VA Vista for quite some time trying to
> > figure out how everything works. I sincerely wish there were a more
> > appealing GUI. I mean CPRS is just great but I guess I spend a lot of
> > time on internet and have developed this bad habbit of doing things
> > with the click of a button.
>
> Hi Nick!
>
> I have spent a lot of time with doctors, and I have worked as a doctor
> myself prior to forced retirement (car accident). The vast majority of
> them do NOT use any computer in their work, not even for such as email.
> I have met a fair number who can't even type.
>
> I think point and click will be essential to appeal to a broad medical
> audience. If you have been following my other thread about installing
> VistA I think what I have done thus far just trying to get VistA on my
> computer would have stopped EVERY doctor I have ever met. Have a look at
> this stuff while I am switching from Mepis to Debian, might be a while.
[KSB] For what it's worth, I don't think most doctors should be
installing VistA on a PC; or even installing an operating system on a
PC; or, come to think of it, managing VistA on a PC.
[That's not to say that some set of doctors are not capable of doing it.
I am just saying that majority should not be doing it any more than I
should be practicing medicine. Doctors don't even treat themselves - my
uncle, a nephrologist, says, "A doctor who treats himself has a fool for
a patient."]
IMHO*, the best way to deploy VistA at the primary care level is to
package it as an appliance, with a service contract (maybe like a
sterilizer, EKG machine, fire extinguisher, or photo copier). Practices
are accustomed to dealing with appliances and service contracts. A
practice signs up for VistA, a vendor configures it on an inexpensive PC
(set up with encrypted file systems or encrypted databases, in case it
gets stolen) and ships it to the practice. They plug it in, connect it
to the LAN, and turn it on - it's ready for use (since it comes
preconfigured with user ids, access codes, etc.). Maybe someone from
the vendor goes out for half a day to set up and hold the hand of anyone
that needs a hand held.
The VistA appliance calls home via a secure connection over the
Internet. The vendor has an environment to which the practice's
database is streamed so it is current to within millibleems of the
database at the practice. All administration of VistA at the practice
is done remotely by the vendor.% There is excellent response because
VistA is being accessed on the LAN.
In the event the appliance dies, the practices switches to VistA in the
vendor's environment in seconds to minutes (there are multiple ways to
do this). Now, they have exactly the same VistA environment and
database that they had a few moments before, but it is just slightly
less responsive because the connection is over the Internet rather than
on the LAN. The vendor sends a replacement (PCs are cheap enough) with
a copy of the practice's environment from the vendor's data center. The
practice plugs it in and it catches up. At a mutually convenient time,
the roles are switched so that the appliance at the practice is once
more the primary and that in the vendor's data center is once more a
secondary.
The vendor charges a fee for the service (whether it is $10/month,
$100/month or $1000/month - that will be determined by the market). The
practice has a predictable monthly cost and the vendor has predictable
revenue.
The practice never sees the roll and scroll interface unless it breaks
the glass. The vendor does, of course, but that's OK. That's what the
vendor does.
All of this can be done today. Comments are welcome.
Regards
-- Bhaskar
* Isn't it interesting that In My Humble Opinion and In My Hubristic
Opinion have the same acronym?
% It's trivial to implement an electronic "break the glass" to give the
practice access to the data without the cooperation of the vendor if &
when they need it (vendor goes out of business, contract dispute,
whatever), but to also record that the glass was broken.
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Pete Theisen
>
> > I have spent a lot of time with doctors, and I have worked as a doctor
> > myself prior to forced retirement (car accident). The vast majority of
> > them do NOT use any computer in their work, not even for such as email.
Hi Bhaskar!
> The vendor charges a fee for the service (whether it is $10/month
You hit the crucial point, money. If the government forces the adoption
of EMR right now the government is going to have to fund it as well.
Most of the patients are not rich enough to pay very much and the third
party reimbursement is downright insulting. If I hadn't had the accident
that forced me out I would have eventually gone broke, since I was
losing money on every treatment I gave.
--
Regards,
I, Valdes
proprietary since proprietary generally has a much better offense and
better packaging than Free/Open Source. Free/Open Source defense is
okay but Americans like shiny or the perception of shiny.
Unfortunately, it can be argued that the 'country' has 'chosen'
proprietary by default even though it looks like proprietary vendors
and their lobbyists where and are the real ones driving the 'choice'.
The tragedy of this is that it will probably end up being just a
wealth transfer into government and proprietary vendor private hands
and simply further increase the overall cost of health care at
physician and society's expense.
-- IV
K.S. Bhaskar
thought VistA could be packaged to (a) meet user expectations and skill
set and (b) to succeed against proprietary software in the primary care
space were both laments about the current state of American health care.
How can we light a candle instead of curse the darkness?
Regards
-- Bhaskar
I, Valdes
Vipen Mahajan
Good overview concept. Some questions, :
1. How does the doctor get trained to use VistA, or CPRS? Can we put
this training intop say Moodle, with screen shots, and a narrative to
explain
2. How about the reservations of providers, to touching/the keyboard
even. Esp for the the older ones.
3. How reliable is the virtual machine/appliance, the file system etc
for a production environment, now?
4. Is the Vendors' server on the cloud? EC2?
5. How about the conversion of the older charts etc.
Regards,
Vipen
Vipen Mahajan
Principal
Leo Systems
Chicago/Boston/Munich/New Delhi.
Skype - vmahajan
US +1-630-303- 9881. with voice mail facility
EMail/Skype/US Phone numbers are the best way to contact me. I travel
a lot but check the Internet every 12 hours atleast!.
K.S. Bhaskar
>
> Hi Bhaskar,
> Good overview concept. Some questions, :
> 1. How does the doctor get trained to use VistA, or CPRS? Can we put
> this training intop say Moodle, with screen shots, and a narrative to
> explain
[KSB] This could go into Moodle. Or it could be part of the marketing /
selling additional services that the vendor provides.
> 2. How about the reservations of providers, to touching/the keyboard
> even. Esp for the the older ones.
[KSB] Maybe dictation / transcription / electronic signature (they will
at least have to touch the PC for that last).
> 3. How reliable is the virtual machine/appliance, the file system etc
> for a production environment, now?
[KSB] I am not talking about a virtual machine at the practice - I am
talking about an appliance which is a real Linux PC on which VistA runs.
They can see it, touch it and feel it, just as they can a sterilizer,
photo copier, EKG machine, etc.
But I have become more comfortable with virtual machines for production
use. For example, with QEMU/kvm, you can create a virtual disk with
something like "-drive file=myVistA.qcow,index=0,media=disk,cache=none"
or cache=writethrough. So, while it is the business of the universe to
be imperfect, I think using one of these options is fine for production,
especially in a logical multi-site configuration.
> 4. Is the Vendors' server on the cloud? EC2?
[KSB] It can be. But I don't think a cloudy machine is economical if
you run it 24x7. It would be better to get a hosted virtual machine
from an ISP such as linode.com.
As a practical matter, since a vendor will make money not on a single
practice, but on volume, I suspect it will be most cost effective for
vendors to have their own servers (probably hosted at an ISP).
In any case, the economics of hosting servers is not VistA specific. I
was only focusing on that part of the business that was specific to VistA.
> 5. How about the conversion of the older charts etc.
[KSB] Whatever solution works for VistA works for my proposed packaging
and deployment. There are scanning solutions for documents that have
been connected with VistA.
Regards
-- Bhaskar
Pete Theisen
> It's interesting that the two responses to my description of how I
> thought VistA could be packaged to (a) meet user expectations and skill
> set and (b) to succeed against proprietary software in the primary care
> space were both laments about the current state of American health care.
>
> How can we light a candle instead of curse the darkness?
Hi Bhaskar!
Run for office, win, then change it. Just off the top of my head :-)
Pete Theisen
Hi Vipen!
> 1. How does the doctor get trained to use VistA, or CPRS? Can we put
> this training intop say Moodle, with screen shots, and a narrative to
> explain
To begin with, the government might mandate how some of this stuff is
done, or not. Or the bill might not even pass.
These methods you mention could all be done. From what I can see of it
so far, there as quite a lot for the doc to learn in some systems.
> 2. How about the reservations of providers, to touching/the keyboard
> even. Esp for the the older ones.
Older ones! By the time the doc is seeing patients he/she is thirty,
LOL. I attended med school 15 years ago with some young people who would
not touch a computer even though I had personally set up a computer in
every treatment room and class room. The older ones took to the computer
more readily than the kids did!
I am 64. When I took computer classes in undergrad college we used punch
cards for memory. I think the older docs might surprise you, some have
40 years or more of computer use behind them.
Suppose we simplify it? Break it down to what each person *has* to do.
Most of the doc's entry is his prescriptions, test orders and his/her
notes.
I wonder if voice and handwriting recognition is up to filling in these
chart parts? What are we looking at, three fields that the doc
completes?
> 3. How reliable is the virtual machine/appliance, the file system etc
> for a production environment, now?
Does VistA and CPRS use a data back end such as MySQL, PostgresQL, or
whatever or is the data stored differently?
> 4. Is the Vendors' server on the cloud? EC2?
There was a meeting recently of *many* providers. From that group it
looks like it could be either in the cloud or in the clinic/hospital's
back room, depending on the vendor/client relationship. It could even be
in the back room most of the time and every now and then be sychronized
on the cloud.
> 5. How about the conversion of the older charts etc.
Just scan them into fields that can take scanned data? If the
handwriting can be transcribed to text so much the better. OTH, the old
data could be left as is and only new data taken into the system.
There is more than one way to do most anything.
I, Valdes
of time. Bad handwriting only now it is laboriously scanned onto a
computer bad handwriting that is no longer straight with page edges
missing. Need I say more? -- IV
Pete Theisen
Hi Valdes!
Well, I was *going* to set up a set of questions that I used to ask my
patients all the time in boolian format, and put the significance of the
answer in another field of the same record. Then point and click of the
"yes" would write to the report, or not write - if it was "no".
Then I got rear-ended really hard and I am just now getting back to
where I can work on it again. My work is open source so you can use my
ideas all you like if you think they are any good.
Joseph Dal Molin
> 1. How does the doctor get trained to use VistA, or CPRS? Can we put
> this training intop say Moodle, with screen shots, and a narrative to
> explain
Take the CPRS Tab by Tab Course on VEHU.... it is superb.... no need to
reinvent the wheel if you know where to find one
Vipen Mahajan
be freely copied or are there any copyrights etc issues?
Thanks,
Vipen