I, along with over 300 others, many new to the world of VistA, attended the
first annual OSEHRA conference and heard the disturbing presentation about
iEHR and the plan to have iEHR virtually supplant VistA leaving VistA as a
complete, open source system mostly in a pile on the cutting room floor. In the view of the speaker, a few pieces of VistA could potentially used
in this new, largely closed source, system of services that would become
the EHR for the DOD and VA.
It became crystal clear what the plan was for VistA after I asked the
question about the role of VistA in iEHR and it was so clearly answered. As I sat down to the table after that shocking revelation, I heard someone
say, "Why are we here?"
I think that question could be asked by virtually everyone at the
conference with their various hats. Some were there looking to sell their
services or products for use with VistA, particularly looking for the
potential for government contracts. Some were there because they use
VistA. Some were there because they develop for VistA inside of the VA or
they manage the relationship with OSEHRA. Some were there because they
already implement and support VistA for business reasons and some of us
were there because we know VistA is a great thing and is used to improve
the lives of people around the world. Were the reasons they were there at
the conference now irrelevant? Some were there because they have great
ideas for ways to use their creations to improve and help the users of
VistA. Were their hopes and plans now meaningless and useless? Are they
on the cutting room floor as well? Is the VA going to abandon VistA and
does OSEHRA collapse like a house of cards?
To many at the meeting, VistA may be new to you. OSEHRA made it possible
for you to see what had been right there all along but largely ignored. For some of us it is the 30 plus year story of the passion of many to do
great things.
For some, like me, it is a much shorter story but nonetheless, a no less
passionate one.
You should also know this is not the first chapter in the history of the
attempts to destroy VistA. Attempts go all the way back to its near
beginnings when there was an arson attempt to destroy it. None of these
attempts so far have succeeded and frankly, some of them looked like they
had a lot more probability of succeeding than this iEHR plan.
VistA is not going to go away just because government contracts go away. It is being adopted around the world and it may become harder to do the
things that need to be done to maintain it and move it forward, but it
will not die.
Whether or not you feel in your view of it you fit into this moving forward
is up to you to decide. If OSEHRA is not swept aside by iEHR or politics,
it may become a major force in seeing that VistA moves forward more quickly
with more support. It would certainly provide a lot easier way to
coordinate efforts to move VistA forward, but it is not the only way
forward.
I am sure there are those out there who will benefit from the funds that
will be thrown at iEHR over the next few years, but keep in mind when you
do, that there is VistA and it will still be there and maybe you could have
a role to play in that scenario which would be more likely to be sustained
over the long term than iEHR.
The established VistA Community will be attending its 26th VistA Community
Meeting in January. The VistA Community meetings are actually a relatively
new thing but there have been 25 of them where people meet that have been
contributing to sustaining, modernizing and improving VistA (and VistA
derivatives) for many years. The momentum for the adoption of VistA has
been growing independently of OSEHRA and the VA so even if the VA abandons
VistA and OSEHRA falls by the wayside, VistA will survive.
The education community has also now learned the benefit of open source and
VistA. The momentum to use it in education is growing. Out of that I
expect a wave of young blood with forward looking ideas to join our
community.
Business certainly has a role in all of this and business can help make it
happen faster and better. The users of VistA can tell you the advantages
of open source, just like Robert Wentz did, and they are spreading the
word. The users of VistA worldwide outside of the US can also tell you. Ask the Jordanians and the three hospital systems in India.
I am hopeful that efforts will continue inside of the VA as well, but we
will be waiting for those inside of the VA to join us if iEHR displaces
them. Personally, I believe iEHR will be an extremely expensive failure and the sooner that the folly of it is recognized, the better for those of us who are tax payers and the better for VistA. Those resources could be so much better utilized to work to improve and modernize VistA to serve military, veteran, and civilian patient populations worldwide.
> I, along with over 300 others, many new to the world of VistA, attended the
> first annual OSEHRA conference and heard the disturbing presentation about
> iEHR and the plan to have iEHR virtually supplant VistA leaving VistA as a
> complete, open source system mostly in a pile on the cutting room floor.
> In the view of the speaker, a few pieces of VistA could potentially used
> in this new, largely closed source, system of services that would become
> the EHR for the DOD and VA.
> It became crystal clear what the plan was for VistA after I asked the
> question about the role of VistA in iEHR and it was so clearly answered.
> As I sat down to the table after that shocking revelation, I heard someone
> say, "Why are we here?"
> I think that question could be asked by virtually everyone at the
> conference with their various hats. Some were there looking to sell their
> services or products for use with VistA, particularly looking for the
> potential for government contracts. Some were there because they use
> VistA. Some were there because they develop for VistA inside of the VA or
> they manage the relationship with OSEHRA. Some were there because they
> already implement and support VistA for business reasons and some of us
> were there because we know VistA is a great thing and is used to improve
> the lives of people around the world. Were the reasons they were there at
> the conference now irrelevant? Some were there because they have great
> ideas for ways to use their creations to improve and help the users of
> VistA. Were their hopes and plans now meaningless and useless? Are they
> on the cutting room floor as well? Is the VA going to abandon VistA and
> does OSEHRA collapse like a house of cards?
> To many at the meeting, VistA may be new to you. OSEHRA made it possible
> for you to see what had been right there all along but largely ignored.
> For some of us it is the 30 plus year story of the passion of many to do
> great things.
> For some, like me, it is a much shorter story but nonetheless, a no less
> passionate one.
> You should also know this is not the first chapter in the history of the
> attempts to destroy VistA. Attempts go all the way back to its near
> beginnings when there was an arson attempt to destroy it. None of these
> attempts so far have succeeded and frankly, some of them looked like they
> had a lot more probability of succeeding than this iEHR plan.
> VistA is not going to go away just because government contracts go away.
> It is being adopted around the world and it may become harder to do the
> things that need to be done to maintain it and move it forward, but it
> will not die.
> Whether or not you feel in your view of it you fit into this moving forward
> is up to you to decide. If OSEHRA is not swept aside by iEHR or politics,
> it may become a major force in seeing that VistA moves forward more quickly
> with more support. It would certainly provide a lot easier way to
> coordinate efforts to move VistA forward, but it is not the only way
> forward.
> I am sure there are those out there who will benefit from the funds that
> will be thrown at iEHR over the next few years, but keep in mind when you
> do, that there is VistA and it will still be there and maybe you could have
> a role to play in that scenario which would be more likely to be sustained
> over the long term than iEHR.
> The established VistA Community will be attending its 26th VistA Community
> Meeting in January. The VistA Community meetings are actually a relatively
> new thing but there have been 25 of them where people meet that have been
> contributing to sustaining, modernizing and improving VistA (and VistA
> derivatives) for many years. The momentum for the adoption of VistA has
> been growing independently of OSEHRA and the VA so even if the VA abandons
> VistA and OSEHRA falls by the wayside, VistA will survive.
> The education community has also now learned the benefit of open source and
> VistA. The momentum to use it in education is growing. Out of that I
> expect a wave of young blood with forward looking ideas to join our
> community.
> Business certainly has a role in all of this and business can help make it
> happen faster and better. The users of VistA can tell you the advantages
> of open source, just like Robert Wentz did, and they are spreading the
> word. The users of VistA worldwide outside of the US can also tell you.
> Ask the Jordanians and the three hospital systems in India.
> I am hopeful that efforts will continue inside of the VA as well, but we
> will be waiting for those inside of the VA to join us if iEHR displaces
> them. Personally, I believe iEHR will be an extremely expensive failure and
> the sooner that the folly of it is recognized, the better for those of us
> who
> are tax payers and the better for VistA. Those resources could be so much
> better utilized to work to improve and modernize VistA to serve military,
> veteran, and civilian patient populations worldwide.
I was there too, just a few tables from you, and it seems that we
attended different meetings. I don't share the "movie theater is on
fire" assessment. Quite the opposite. I think it was a very productive
meeting. Yes the goals and paths to get there are still not completely
clear, and there is quite a bit of fuzziness, but it was clear from
pretty much all speakers that the ultimate goal is open source health
IT solutions and that the VistA ecosystem will grow around an open
source core of VistA.
The iEHR project is a separate project from the VA's VistA project and
there was one, and only one session on the iEHR out of 23 sessions, so
whatever was presented there does not reflect the entire conference.
In addition, I was very impressed with how much time Barclay Butler
spent detailing how the iEHR is going to be open source. So my take
home from that session is that the iEHR folks got the message and are
trying to figure out how to do this as an open source project.
I do think that you made a good point at the conference when you got
up to the microphone to talk about the need for all continuing
development of the key VistA modules to be open source.
Peter Groen did a lot of tweeting from the conference and below is an
initial article. I just got the power points from Conrad Clyburn and
will be writing a whole series of detailed articles on the conference.
<nanthrac...@earthlink.net> wrote:
> I, along with over 300 others, many new to the world of VistA, attended the
> first annual OSEHRA conference and heard the disturbing presentation about
> iEHR and the plan to have iEHR virtually supplant VistA leaving VistA as a
> complete, open source system mostly in a pile on the cutting room floor.
> In the view of the speaker, a few pieces of VistA could potentially used
> in this new, largely closed source, system of services that would become
> the EHR for the DOD and VA.
> It became crystal clear what the plan was for VistA after I asked the
> question about the role of VistA in iEHR and it was so clearly answered.
> As I sat down to the table after that shocking revelation, I heard someone
> say, "Why are we here?"
> I think that question could be asked by virtually everyone at the
> conference with their various hats. Some were there looking to sell their
> services or products for use with VistA, particularly looking for the
> potential for government contracts. Some were there because they use
> VistA. Some were there because they develop for VistA inside of the VA or
> they manage the relationship with OSEHRA. Some were there because they
> already implement and support VistA for business reasons and some of us
> were there because we know VistA is a great thing and is used to improve
> the lives of people around the world. Were the reasons they were there at
> the conference now irrelevant? Some were there because they have great
> ideas for ways to use their creations to improve and help the users of
> VistA. Were their hopes and plans now meaningless and useless? Are they
> on the cutting room floor as well? Is the VA going to abandon VistA and
> does OSEHRA collapse like a house of cards?
> To many at the meeting, VistA may be new to you. OSEHRA made it possible
> for you to see what had been right there all along but largely ignored.
> For some of us it is the 30 plus year story of the passion of many to do
> great things.
> For some, like me, it is a much shorter story but nonetheless, a no less
> passionate one.
> You should also know this is not the first chapter in the history of the
> attempts to destroy VistA. Attempts go all the way back to its near
> beginnings when there was an arson attempt to destroy it. None of these
> attempts so far have succeeded and frankly, some of them looked like they
> had a lot more probability of succeeding than this iEHR plan.
> VistA is not going to go away just because government contracts go away.
> It is being adopted around the world and it may become harder to do the
> things that need to be done to maintain it and move it forward, but it
> will not die.
> Whether or not you feel in your view of it you fit into this moving forward
> is up to you to decide. If OSEHRA is not swept aside by iEHR or politics,
> it may become a major force in seeing that VistA moves forward more quickly
> with more support. It would certainly provide a lot easier way to
> coordinate efforts to move VistA forward, but it is not the only way
> forward.
> I am sure there are those out there who will benefit from the funds that
> will be thrown at iEHR over the next few years, but keep in mind when you
> do, that there is VistA and it will still be there and maybe you could have
> a role to play in that scenario which would be more likely to be sustained
> over the long term than iEHR.
> The established VistA Community will be attending its 26th VistA Community
> Meeting in January. The VistA Community meetings are actually a relatively
> new thing but there have been 25 of them where people meet that have been
> contributing to sustaining, modernizing and improving VistA (and VistA
> derivatives) for many years. The momentum for the adoption of VistA has
> been growing independently of OSEHRA and the VA so even if the VA abandons
> VistA and OSEHRA falls by the wayside, VistA will survive.
> The education community has also now learned the benefit of open source and
> VistA. The momentum to use it in education is growing. Out of that I
> expect a wave of young blood with forward looking ideas to join our
> community.
> Business certainly has a role in all of this and business can help make it
> happen faster and better. The users of VistA can tell you the advantages
> of open source, just like Robert Wentz did, and they are spreading the
> word. The users of VistA worldwide outside of the US can also tell you.
> Ask the Jordanians and the three hospital systems in India.
> I am hopeful that efforts will continue inside of the VA as well, but we
> will be waiting for those inside of the VA to join us if iEHR displaces
> them. Personally, I believe iEHR will be an extremely expensive failure and
> the sooner that the folly of it is recognized, the better for those of us who
> are tax payers and the better for VistA. Those resources could be so much
> better utilized to work to improve and modernize VistA to serve military,
> veteran, and civilian patient populations worldwide.
There appeared to be recording equipment in the main room for all of the sessions so I suspect you will be able to see the panel presentation for iEHR yourself, soon.
In essence, iEHR is envisioned as an Enterprise service bus connecting at least 56 different services that will serve, ultimately, to provide the functions of a complete EHR, replacing ALTHA and CHCS entirely and perhaps, as I am hearing more recently, leaving VistA as a only a database, not an EHR, in the VAs. The 56 services will be awarded to the winners of 56 RFPs. So far, the Enterprise Service Bus will highly likely be WebSphere from IBM, and not the open source version. There is good reason to believe that few of the services will be open source either as the "best of breed" approach seems to be guiding the selection.
Folks have tried to reassurance me that open source software could be plugged into any one of these services to replace proprietary products because the interfaces will be defined and open and this includes the ESB. I have little optimism that the latter approach will happen or that if it did, that it would provide the functionality of VistA.
One potentially saving grace is that the iEHR development is "Agile" so that, presumably, they can change course in mid-stream if they decide that there is a better approach.
On Tuesday, October 23, 2012, JohnLeo Zimmer wrote:
> I'd like more details. . and good luck to us all. . . :-)
> On Oct 22, 2012 8:25 PM, "Nancy Anthracite" <nanthrac...@earthlink.net>
> wrote:
> > I, along with over 300 others, many new to the world of VistA, attended
> > the first annual OSEHRA conference and heard the disturbing presentation
> > about iEHR and the plan to have iEHR virtually supplant VistA leaving
> > VistA as a complete, open source system mostly in a pile on the cutting
> > room floor. In the view of the speaker, a few pieces of VistA could
> > potentially used in this new, largely closed source, system of services
> > that would become the EHR for the DOD and VA.
> > It became crystal clear what the plan was for VistA after I asked the
> > question about the role of VistA in iEHR and it was so clearly answered.
> > As I sat down to the table after that shocking revelation, I heard
> > someone say, "Why are we here?"
> > I think that question could be asked by virtually everyone at the
> > conference with their various hats. Some were there looking to sell
> > their services or products for use with VistA, particularly looking for
> > the potential for government contracts. Some were there because they
> > use VistA. Some were there because they develop for VistA inside of the
> > VA or they manage the relationship with OSEHRA. Some were there because
> > they already implement and support VistA for business reasons and some
> > of us were there because we know VistA is a great thing and is used to
> > improve the lives of people around the world. Were the reasons they were
> > there at the conference now irrelevant? Some were there because they
> > have great ideas for ways to use their creations to improve and help the
> > users of VistA. Were their hopes and plans now meaningless and useless?
> > Are they on the cutting room floor as well? Is the VA going to abandon
> > VistA and does OSEHRA collapse like a house of cards?
> > To many at the meeting, VistA may be new to you. OSEHRA made it possible
> > for you to see what had been right there all along but largely ignored.
> > For some of us it is the 30 plus year story of the passion of many to do
> > great things.
> > For some, like me, it is a much shorter story but nonetheless, a no less
> > passionate one.
> > You should also know this is not the first chapter in the history of the
> > attempts to destroy VistA. Attempts go all the way back to its near
> > beginnings when there was an arson attempt to destroy it. None of these
> > attempts so far have succeeded and frankly, some of them looked like they
> > had a lot more probability of succeeding than this iEHR plan.
> > VistA is not going to go away just because government contracts go away.
> > It is being adopted around the world and it may become harder to do the
> > things that need to be done to maintain it and move it forward, but it
> > will not die.
> > Whether or not you feel in your view of it you fit into this moving
> > forward is up to you to decide. If OSEHRA is not swept aside by iEHR or
> > politics, it may become a major force in seeing that VistA moves forward
> > more quickly with more support. It would certainly provide a lot easier
> > way to coordinate efforts to move VistA forward, but it is not the only
> > way forward.
> > I am sure there are those out there who will benefit from the funds that
> > will be thrown at iEHR over the next few years, but keep in mind when you
> > do, that there is VistA and it will still be there and maybe you could
> > have a role to play in that scenario which would be more likely to be
> > sustained over the long term than iEHR.
> > The established VistA Community will be attending its 26th VistA
> > Community Meeting in January. The VistA Community meetings are actually
> > a relatively new thing but there have been 25 of them where people meet
> > that have been contributing to sustaining, modernizing and improving
> > VistA (and VistA derivatives) for many years. The momentum for the
> > adoption of VistA has been growing independently of OSEHRA and the VA so
> > even if the VA abandons VistA and OSEHRA falls by the wayside, VistA
> > will survive.
> > The education community has also now learned the benefit of open source
> > and VistA. The momentum to use it in education is growing. Out of that
> > I expect a wave of young blood with forward looking ideas to join our
> > community.
> > Business certainly has a role in all of this and business can help make
> > it happen faster and better. The users of VistA can tell you the
> > advantages of open source, just like Robert Wentz did, and they are
> > spreading the word. The users of VistA worldwide outside of the US can
> > also tell you. Ask the Jordanians and the three hospital systems in
> > India.
> > I am hopeful that efforts will continue inside of the VA as well, but we
> > will be waiting for those inside of the VA to join us if iEHR displaces
> > them. Personally, I believe iEHR will be an extremely expensive failure
> > and the sooner that the folly of it is recognized, the better for those
> > of us who
> > are tax payers and the better for VistA. Those resources could be so
> > much better utilized to work to improve and modernize VistA to serve
> > military, veteran, and civilian patient populations worldwide.
I agree with you that the vast majority of the conference was centered on moving VistA forward as open source, but I am afraid, in my view, the elephant in the room and the funding focus is not on what most of the conference was about. I struggle, as I suspect OSEHRA is struggling, to understand how OSEHRA is going to server both masters. I don't think it has to make a decision at this point, but eventually, when it is cut loose to be self funding, it will likely have to make that decision and I hope it is one that will support the open source community.
In the meantime, what I believe is the biggest promise for OSEHRA has not been realized which is to have the government users and developers and even patients working on projects together with volunteers, contractors and funded contributors to enhance VistA. I am not surprised that there are barriers that are keeping that from happening, but perhaps they can be overcome.
On Tuesday, October 23, 2012, Roger A. Maduro wrote:
> Nancy,
> I was there too, just a few tables from you, and it seems that we
> attended different meetings. I don't share the "movie theater is on
> fire" assessment. Quite the opposite. I think it was a very productive
> meeting. Yes the goals and paths to get there are still not completely
> clear, and there is quite a bit of fuzziness, but it was clear from
> pretty much all speakers that the ultimate goal is open source health
> IT solutions and that the VistA ecosystem will grow around an open
> source core of VistA.
> The iEHR project is a separate project from the VA's VistA project and
> there was one, and only one session on the iEHR out of 23 sessions, so
> whatever was presented there does not reflect the entire conference.
> In addition, I was very impressed with how much time Barclay Butler
> spent detailing how the iEHR is going to be open source. So my take
> home from that session is that the iEHR folks got the message and are
> trying to figure out how to do this as an open source project.
> I do think that you made a good point at the conference when you got
> up to the microphone to talk about the need for all continuing
> development of the key VistA modules to be open source.
> Peter Groen did a lot of tweeting from the conference and below is an
> initial article. I just got the power points from Conrad Clyburn and
> will be writing a whole series of detailed articles on the conference.
> On Mon, Oct 22, 2012 at 8:25 PM, Nancy Anthracite
> <nanthrac...@earthlink.net> wrote:
> > I, along with over 300 others, many new to the world of VistA, attended
> > the first annual OSEHRA conference and heard the disturbing presentation
> > about iEHR and the plan to have iEHR virtually supplant VistA leaving
> > VistA as a complete, open source system mostly in a pile on the cutting
> > room floor. In the view of the speaker, a few pieces of VistA could
> > potentially used in this new, largely closed source, system of services
> > that would become the EHR for the DOD and VA.
> > It became crystal clear what the plan was for VistA after I asked the
> > question about the role of VistA in iEHR and it was so clearly answered.
> > As I sat down to the table after that shocking revelation, I heard
> > someone say, "Why are we here?"
> > I think that question could be asked by virtually everyone at the
> > conference with their various hats. Some were there looking to sell
> > their services or products for use with VistA, particularly looking for
> > the potential for government contracts. Some were there because they
> > use VistA. Some were there because they develop for VistA inside of the
> > VA or they manage the relationship with OSEHRA. Some were there because
> > they already implement and support VistA for business reasons and some
> > of us were there because we know VistA is a great thing and is used to
> > improve the lives of people around the world. Were the reasons they were
> > there at the conference now irrelevant? Some were there because they
> > have great ideas for ways to use their creations to improve and help the
> > users of VistA. Were their hopes and plans now meaningless and useless?
> > Are they on the cutting room floor as well? Is the VA going to abandon
> > VistA and does OSEHRA collapse like a house of cards?
> > To many at the meeting, VistA may be new to you. OSEHRA made it possible
> > for you to see what had been right there all along but largely ignored.
> > For some of us it is the 30 plus year story of the passion of many to do
> > great things.
> > For some, like me, it is a much shorter story but nonetheless, a no less
> > passionate one.
> > You should also know this is not the first chapter in the history of the
> > attempts to destroy VistA. Attempts go all the way back to its near
> > beginnings when there was an arson attempt to destroy it. None of these
> > attempts so far have succeeded and frankly, some of them looked like they
> > had a lot more probability of succeeding than this iEHR plan.
> > VistA is not going to go away just because government contracts go away.
> > It is being adopted around the world and it may become harder to do the
> > things that need to be done to maintain it and move it forward, but it
> > will not die.
> > Whether or not you feel in your view of it you fit into this moving
> > forward is up to you to decide. If OSEHRA is not swept aside by iEHR or
> > politics, it may become a major force in seeing that VistA moves forward
> > more quickly with more support. It would certainly provide a lot easier
> > way to coordinate efforts to move VistA forward, but it is not the only
> > way forward.
> > I am sure there are those out there who will benefit from the funds that
> > will be thrown at iEHR over the next few years, but keep in mind when you
> > do, that there is VistA and it will still be there and maybe you could
> > have a role to play in that scenario which would be more likely to be
> > sustained over the long term than iEHR.
> > The established VistA Community will be attending its 26th VistA
> > Community Meeting in January. The VistA Community meetings are actually
> > a relatively new thing but there have been 25 of them where people meet
> > that have been contributing to sustaining, modernizing and improving
> > VistA (and VistA derivatives) for many years. The momentum for the
> > adoption of VistA has been growing independently of OSEHRA and the VA so
> > even if the VA abandons VistA and OSEHRA falls by the wayside, VistA
> > will survive.
> > The education community has also now learned the benefit of open source
> > and VistA. The momentum to use it in education is growing. Out of that
> > I expect a wave of young blood with forward looking ideas to join our
> > community.
> > Business certainly has a role in all of this and business can help make
> > it happen faster and better. The users of VistA can tell you the
> > advantages of open source, just like Robert Wentz did, and they are
> > spreading the word. The users of VistA worldwide outside of the US can
> > also tell you. Ask the Jordanians and the three hospital systems in
> > India.
> > I am hopeful that efforts will continue inside of the VA as well, but we
> > will be waiting for those inside of the VA to join us if iEHR displaces
> > them. Personally, I believe iEHR will be an extremely expensive failure
> > and the sooner that the folly of it is recognized, the better for those
> > of us who are tax payers and the better for VistA. Those resources
> > could be so much better utilized to work to improve and modernize VistA
> > to serve military, veteran, and civilian patient populations worldwide.
I am going to restrict my comments to technical opinions. My concern is that the proposed approach may move VistA to a stovepipe architecture.
In the old days, applications with stovepipe architectures were written in languages such as COBOL that read and produced flat files (and occasionally other types of files using different "access methods") to shovel data around. The "state" of the application (or the state of the customer, or patient, or assembly being manufactured) was "fuzzy" and potentially inconsistent between the applications.
Although there are still many such applications around (and many still work well), new applications created since the 1970s tend to use a customer-centric / patient-centric (centered around the entities critical to the success of the organization) real-time database with integrated applications that operate on the state of the database. So, the state of the mission-critical entities at any point in time is "crisp" because databases have well-defined state.
VistA embodies such an integrated architecture with a patient-centric database.
The real danger to VistA is centrifugal forces resulting from contracts funded piecemeal that are likely to move it towards a stovepipe architecture. Enterprise buses are dressed up stovepipes and applications running in a J2EE application server / container are today's version of data-shoveling COBOL applications of yesteryear.
In my opinion, it would be appropriate to create a white paper documenting VistA's patient-centric architecture, and requiring that any re-engineering maintain that architectural integrity. This has nothing to do with how the Government should conduct VistA business and everything to do with architecture.
Note that maintaining architectural integrity goes beyond software. There are many towns and cities where buildings new and remodeled are required to maintain the architectural integrity of that community.
On Tuesday, October 23, 2012 4:19:34 PM UTC-4, Nancy Anthracite wrote:
> There appeared to be recording equipment in the main room for all of the > sessions so I suspect you will be able to see the panel presentation for > iEHR > yourself, soon.
> In essence, iEHR is envisioned as an Enterprise service bus connecting at > least 56 different services that will serve, ultimately, to provide the > functions of a complete EHR, replacing ALTHA and CHCS entirely and > perhaps, as I am hearing more recently, leaving VistA as a only a > database, > not an EHR, in the VAs. The 56 services will be awarded to the winners of > 56 > RFPs. So far, the Enterprise Service Bus will highly likely be WebSphere > from > IBM, and not the open source version. There is good reason to believe > that > few of the services will be open source either as the "best of breed" > approach > seems to be guiding the selection.
> Folks have tried to reassurance me that open source software could be > plugged > into any one of these services to replace proprietary products because the > interfaces will be defined and open and this includes the ESB. I have > little > optimism that the latter approach will happen or that if it did, that it > would > provide the functionality of VistA.
> One potentially saving grace is that the iEHR development is "Agile" > so that, presumably, they can change course in mid-stream if they decide > that > there is a better approach.
> -- > Nancy Anthracite
> On Tuesday, October 23, 2012, JohnLeo Zimmer wrote: > > I'd like more details. . and good luck to us all. . . :-) > > On Oct 22, 2012 8:25 PM, "Nancy Anthracite" <nanth...@earthlink.net<javascript:>>
> > wrote: > > > I, along with over 300 others, many new to the world of VistA, > attended > > > the first annual OSEHRA conference and heard the disturbing > presentation > > > about iEHR and the plan to have iEHR virtually supplant VistA leaving > > > VistA as a complete, open source system mostly in a pile on the > cutting > > > room floor. In the view of the speaker, a few pieces of VistA could > > > potentially used in this new, largely closed source, system of > services > > > that would become the EHR for the DOD and VA.
> > > It became crystal clear what the plan was for VistA after I asked the > > > question about the role of VistA in iEHR and it was so clearly > answered. > > > As I sat down to the table after that shocking revelation, I heard > > > someone say, "Why are we here?"
> > > I think that question could be asked by virtually everyone at the > > > conference with their various hats. Some were there looking to sell > > > their services or products for use with VistA, particularly looking > for > > > the potential for government contracts. Some were there because they > > > use VistA. Some were there because they develop for VistA inside of > the > > > VA or they manage the relationship with OSEHRA. Some were there > because > > > they already implement and support VistA for business reasons and some > > > of us were there because we know VistA is a great thing and is used to > > > improve the lives of people around the world. Were the reasons they > were > > > there at the conference now irrelevant? Some were there because they > > > have great ideas for ways to use their creations to improve and help > the > > > users of VistA. Were their hopes and plans now meaningless and > useless? > > > Are they on the cutting room floor as well? Is the VA going to > abandon > > > VistA and does OSEHRA collapse like a house of cards?
> > > To many at the meeting, VistA may be new to you. OSEHRA made it > possible > > > for you to see what had been right there all along but largely > ignored. > > > For some of us it is the 30 plus year story of the passion of many to > do > > > great things.
> > > For some, like me, it is a much shorter story but nonetheless, a no > less > > > passionate one.
> > > You should also know this is not the first chapter in the history of > the > > > attempts to destroy VistA. Attempts go all the way back to its near > > > beginnings when there was an arson attempt to destroy it. None of > these > > > attempts so far have succeeded and frankly, some of them looked like > they > > > had a lot more probability of succeeding than this iEHR plan.
> > > VistA is not going to go away just because government contracts go > away. > > > It is being adopted around the world and it may become harder to do > the > > > things that need to be done to maintain it and move it forward, but it > > > will not die.
> > > Whether or not you feel in your view of it you fit into this moving > > > forward is up to you to decide. If OSEHRA is not swept aside by iEHR > or > > > politics, it may become a major force in seeing that VistA moves > forward > > > more quickly with more support. It would certainly provide a lot > easier > > > way to coordinate efforts to move VistA forward, but it is not the > only > > > way forward.
> > > I am sure there are those out there who will benefit from the funds > that > > > will be thrown at iEHR over the next few years, but keep in mind when > you > > > do, that there is VistA and it will still be there and maybe you could > > > have a role to play in that scenario which would be more likely to be > > > sustained over the long term than iEHR.
> > > The established VistA Community will be attending its 26th VistA > > > Community Meeting in January. The VistA Community meetings are > actually > > > a relatively new thing but there have been 25 of them where people > meet > > > that have been contributing to sustaining, modernizing and improving > > > VistA (and VistA derivatives) for many years. The momentum for the > > > adoption of VistA has been growing independently of OSEHRA and the VA > so > > > even if the VA abandons VistA and OSEHRA falls by the wayside, VistA > > > will survive.
> > > The education community has also now learned the benefit of open > source > > > and VistA. The momentum to use it in education is growing. Out of > that > > > I expect a wave of young blood with forward looking ideas to join our > > > community.
> > > Business certainly has a role in all of this and business can help > make > > > it happen faster and better. The users of VistA can tell you the > > > advantages of open source, just like Robert Wentz did, and they are > > > spreading the word. The users of VistA worldwide outside of the US can > > > also tell you. Ask the Jordanians and the three hospital systems in > > > India.
> > > I am hopeful that efforts will continue inside of the VA as well, but > we > > > will be waiting for those inside of the VA to join us if iEHR > displaces > > > them. Personally, I believe iEHR will be an extremely expensive > failure > > > and the sooner that the folly of it is recognized, the better for > those > > > of us who > > > are tax payers and the better for VistA. Those resources could be so > > > much better utilized to work to improve and modernize VistA to serve > > > military, veteran, and civilian patient populations worldwide.
Or to put it simply.... are any of the major proprietary vendors of EHRs
a best of breed conglomerate of proprietary components? Epic sure
isn't.... which has a lot to do with why it is so successful in spite of
its astronomical price tag.
> I am going to restrict my comments to technical opinions. My concern
> is that the proposed approach may move VistA to a stovepipe architecture.
> In the old days, applications with stovepipe architectures were
> written in languages such as COBOL that read and produced flat files
> (and occasionally other types of files using different "access
> methods") to shovel data around. The "state" of the application (or
> the state of the customer, or patient, or assembly being manufactured)
> was "fuzzy" and potentially inconsistent between the applications.
> Although there are still many such applications around (and many still
> work well), new applications created since the 1970s tend to use a
> customer-centric / patient-centric (centered around the entities
> critical to the success of the organization) real-time database with
> integrated applications that operate on the state of the database.
> So, the state of the mission-critical entities at any point in time
> is "crisp" because databases have well-defined state.
> VistA embodies such an integrated architecture with a patient-centric
> database.
> The real danger to VistA is centrifugal forces resulting from
> contracts funded piecemeal that are likely to move it towards a
> stovepipe architecture. Enterprise buses are dressed up stovepipes
> and applications running in a J2EE application server / container are
> today's version of data-shoveling COBOL applications of yesteryear.
> In my opinion, it would be appropriate to create a white paper
> documenting VistA's patient-centric architecture, and requiring that
> any re-engineering maintain that architectural integrity. This has
> nothing to do with how the Government should conduct VistA business
> and everything to do with architecture.
> Note that maintaining architectural integrity goes beyond software.
> There are many towns and cities where buildings new and remodeled are
> required to maintain the architectural integrity of that community.
> Regards
> -- Bhaskar
> On Tuesday, October 23, 2012 4:19:34 PM UTC-4, Nancy Anthracite wrote:
> There appeared to be recording equipment in the main room for all
> of the
> sessions so I suspect you will be able to see the panel
> presentation for iEHR
> yourself, soon.
> In essence, iEHR is envisioned as an Enterprise service bus
> connecting at
> least 56 different services that will serve, ultimately, to
> provide the
> functions of a complete EHR, replacing ALTHA and CHCS entirely and
> perhaps, as I am hearing more recently, leaving VistA as a only a
> database,
> not an EHR, in the VAs. The 56 services will be awarded to the
> winners of 56
> RFPs. So far, the Enterprise Service Bus will highly likely be
> WebSphere from
> IBM, and not the open source version. There is good reason to
> believe that
> few of the services will be open source either as the "best of
> breed" approach
> seems to be guiding the selection.
> Folks have tried to reassurance me that open source software could
> be plugged
> into any one of these services to replace proprietary products
> because the
> interfaces will be defined and open and this includes the ESB. I
> have little
> optimism that the latter approach will happen or that if it did,
> that it would
> provide the functionality of VistA.
> One potentially saving grace is that the iEHR development is "Agile"
> so that, presumably, they can change course in mid-stream if they
> decide that
> there is a better approach.
> -- > Nancy Anthracite
> On Tuesday, October 23, 2012, JohnLeo Zimmer wrote:
> > I'd like more details. . and good luck to us all. . . :-)
> > On Oct 22, 2012 8:25 PM, "Nancy Anthracite"
> <nanth...@earthlink.net <javascript:>>
> > wrote:
> > > I, along with over 300 others, many new to the world of VistA,
> attended
> > > the first annual OSEHRA conference and heard the disturbing
> presentation
> > > about iEHR and the plan to have iEHR virtually supplant VistA
> leaving
> > > VistA as a complete, open source system mostly in a pile on
> the cutting
> > > room floor. In the view of the speaker, a few pieces of VistA
> could
> > > potentially used in this new, largely closed source, system of
> services
> > > that would become the EHR for the DOD and VA.
> > > It became crystal clear what the plan was for VistA after I
> asked the
> > > question about the role of VistA in iEHR and it was so clearly
> answered.
> > > As I sat down to the table after that shocking revelation, I
> heard
> > > someone say, "Why are we here?"
> > > I think that question could be asked by virtually everyone at the
> > > conference with their various hats. Some were there looking
> to sell
> > > their services or products for use with VistA, particularly
> looking for
> > > the potential for government contracts. Some were there
> because they
> > > use VistA. Some were there because they develop for VistA
> inside of the
> > > VA or they manage the relationship with OSEHRA. Some were
> there because
> > > they already implement and support VistA for business reasons
> and some
> > > of us were there because we know VistA is a great thing and is
> used to
> > > improve the lives of people around the world. Were the reasons
> they were
> > > there at the conference now irrelevant? Some were there
> because they
> > > have great ideas for ways to use their creations to improve
> and help the
> > > users of VistA. Were their hopes and plans now meaningless
> and useless?
> > > Are they on the cutting room floor as well? Is the VA going
> to abandon
> > > VistA and does OSEHRA collapse like a house of cards?
> > > To many at the meeting, VistA may be new to you. OSEHRA made
> it possible
> > > for you to see what had been right there all along but largely
> ignored.
> > > For some of us it is the 30 plus year story of the passion of
> many to do
> > > great things.
> > > For some, like me, it is a much shorter story but nonetheless,
> a no less
> > > passionate one.
> > > You should also know this is not the first chapter in the
> history of the
> > > attempts to destroy VistA. Attempts go all the way back to
> its near
> > > beginnings when there was an arson attempt to destroy it.
> None of these
> > > attempts so far have succeeded and frankly, some of them
> looked like they
> > > had a lot more probability of succeeding than this iEHR plan.
> > > VistA is not going to go away just because government
> contracts go away.
> > > It is being adopted around the world and it may become harder
> to do the
> > > things that need to be done to maintain it and move it
> forward, but it
> > > will not die.
> > > Whether or not you feel in your view of it you fit into this
> moving
> > > forward is up to you to decide. If OSEHRA is not swept aside
> by iEHR or
> > > politics, it may become a major force in seeing that VistA
> moves forward
> > > more quickly with more support. It would certainly provide a
> lot easier
> > > way to coordinate efforts to move VistA forward, but it is not
> the only
> > > way forward.
> > > I am sure there are those out there who will benefit from the
> funds that
> > > will be thrown at iEHR over the next few years, but keep in
> mind when you
> > > do, that there is VistA and it will still be there and maybe
> you could
> > > have a role to play in that scenario which would be more
> likely to be
> > > sustained over the long term than iEHR.
> > > The established VistA Community will be attending its 26th VistA
> > > Community Meeting in January. The VistA Community meetings
> are actually
> > > a relatively new thing but there have been 25 of them where
> people meet
> > > that have been contributing to sustaining, modernizing and
> improving
> > > VistA (and VistA derivatives) for many years. The momentum for
> the
> > > adoption of VistA has been growing independently of OSEHRA and
> the VA so
> > > even if the VA abandons VistA and OSEHRA falls by the wayside,
> VistA
> > > will survive.
> > > The education community has also now learned the benefit of
> open source
> > > and VistA. The momentum to use it in education is growing.
> Out of that
> > > I expect a wave of young blood with forward looking ideas to
> join our
> > > community.
> > > Business certainly has a role in all of this and business can
> help make
> > > it happen faster and better. The users of VistA can tell you the
> > > advantages of open source, just like Robert Wentz did, and
> they are
> > > spreading the word. The users of VistA worldwide outside of
> the US can
> > > also tell you. Ask the Jordanians and the three hospital
> systems in
> > > India.
On Tuesday, October 23, 2012 5:11:27 PM UTC-4, K.S. Bhaskar wrote:
> I am going to restrict my comments to technical opinions. My concern is > that the proposed approach may move VistA to a stovepipe architecture.
> In the old days, applications with stovepipe architectures were written in > languages such as COBOL that read and produced flat files (and occasionally > other types of files using different "access methods") to shovel data > around. The "state" of the application (or the state of the customer, or > patient, or assembly being manufactured) was "fuzzy" and potentially > inconsistent between the applications.
> Although there are still many such applications around (and many still > work well), new applications created since the 1970s tend to use a > customer-centric / patient-centric (centered around the entities critical > to the success of the organization) real-time database with integrated > applications that operate on the state of the database. So, the state of > the mission-critical entities at any point in time is "crisp" because > databases have well-defined state.
> VistA embodies such an integrated architecture with a patient-centric > database.
> The real danger to VistA is centrifugal forces resulting from contracts > funded piecemeal that are likely to move it towards a stovepipe > architecture. Enterprise buses are dressed up stovepipes and applications > running in a J2EE application server / container are today's version of > data-shoveling COBOL applications of yesteryear.
> In my opinion, it would be appropriate to create a white paper documenting > VistA's patient-centric architecture, and requiring that any re-engineering > maintain that architectural integrity. This has nothing to do with how the > Government should conduct VistA business and everything to do with > architecture.
> Note that maintaining architectural integrity goes beyond software. There > are many towns and cities where buildings new and remodeled are required to > maintain the architectural integrity of that community.
> Regards > -- Bhaskar
> On Tuesday, October 23, 2012 4:19:34 PM UTC-4, Nancy Anthracite wrote:
>> There appeared to be recording equipment in the main room for all of the >> sessions so I suspect you will be able to see the panel presentation for >> iEHR >> yourself, soon.
>> In essence, iEHR is envisioned as an Enterprise service bus connecting at >> least 56 different services that will serve, ultimately, to provide the >> functions of a complete EHR, replacing ALTHA and CHCS entirely and >> perhaps, as I am hearing more recently, leaving VistA as a only a >> database, >> not an EHR, in the VAs. The 56 services will be awarded to the winners >> of 56 >> RFPs. So far, the Enterprise Service Bus will highly likely be WebSphere >> from >> IBM, and not the open source version. There is good reason to believe >> that >> few of the services will be open source either as the "best of breed" >> approach >> seems to be guiding the selection.
>> Folks have tried to reassurance me that open source software could be >> plugged >> into any one of these services to replace proprietary products because >> the >> interfaces will be defined and open and this includes the ESB. I have >> little >> optimism that the latter approach will happen or that if it did, that it >> would >> provide the functionality of VistA.
>> One potentially saving grace is that the iEHR development is "Agile" >> so that, presumably, they can change course in mid-stream if they decide >> that >> there is a better approach.
>> -- >> Nancy Anthracite
>> On Tuesday, October 23, 2012, JohnLeo Zimmer wrote: >> > I'd like more details. . and good luck to us all. . . :-) >> > On Oct 22, 2012 8:25 PM, "Nancy Anthracite" <nanth...@earthlink.net>
>> > wrote: >> > > I, along with over 300 others, many new to the world of VistA, >> attended >> > > the first annual OSEHRA conference and heard the disturbing >> presentation >> > > about iEHR and the plan to have iEHR virtually supplant VistA leaving >> > > VistA as a complete, open source system mostly in a pile on the >> cutting >> > > room floor. In the view of the speaker, a few pieces of VistA could >> > > potentially used in this new, largely closed source, system of >> services >> > > that would become the EHR for the DOD and VA.
>> > > It became crystal clear what the plan was for VistA after I asked the >> > > question about the role of VistA in iEHR and it was so clearly >> answered. >> > > As I sat down to the table after that shocking revelation, I heard >> > > someone say, "Why are we here?"
>> > > I think that question could be asked by virtually everyone at the >> > > conference with their various hats. Some were there looking to sell >> > > their services or products for use with VistA, particularly looking >> for >> > > the potential for government contracts. Some were there because they >> > > use VistA. Some were there because they develop for VistA inside of >> the >> > > VA or they manage the relationship with OSEHRA. Some were there >> because >> > > they already implement and support VistA for business reasons and >> some >> > > of us were there because we know VistA is a great thing and is used >> to >> > > improve the lives of people around the world. Were the reasons they >> were >> > > there at the conference now irrelevant? Some were there because they >> > > have great ideas for ways to use their creations to improve and help >> the >> > > users of VistA. Were their hopes and plans now meaningless and >> useless? >> > > Are they on the cutting room floor as well? Is the VA going to >> abandon >> > > VistA and does OSEHRA collapse like a house of cards?
>> > > To many at the meeting, VistA may be new to you. OSEHRA made it >> possible >> > > for you to see what had been right there all along but largely >> ignored. >> > > For some of us it is the 30 plus year story of the passion of many to >> do >> > > great things.
>> > > For some, like me, it is a much shorter story but nonetheless, a no >> less >> > > passionate one.
>> > > You should also know this is not the first chapter in the history of >> the >> > > attempts to destroy VistA. Attempts go all the way back to its near >> > > beginnings when there was an arson attempt to destroy it. None of >> these >> > > attempts so far have succeeded and frankly, some of them looked like >> they >> > > had a lot more probability of succeeding than this iEHR plan.
>> > > VistA is not going to go away just because government contracts go >> away. >> > > It is being adopted around the world and it may become harder to do >> the >> > > things that need to be done to maintain it and move it forward, but >> it >> > > will not die.
>> > > Whether or not you feel in your view of it you fit into this moving >> > > forward is up to you to decide. If OSEHRA is not swept aside by iEHR >> or >> > > politics, it may become a major force in seeing that VistA moves >> forward >> > > more quickly with more support. It would certainly provide a lot >> easier >> > > way to coordinate efforts to move VistA forward, but it is not the >> only >> > > way forward.
>> > > I am sure there are those out there who will benefit from the funds >> that >> > > will be thrown at iEHR over the next few years, but keep in mind when >> you >> > > do, that there is VistA and it will still be there and maybe you >> could >> > > have a role to play in that scenario which would be more likely to be >> > > sustained over the long term than iEHR.
>> > > The established VistA Community will be attending its 26th VistA >> > > Community Meeting in January. The VistA Community meetings are >> actually >> > > a relatively new thing but there have been 25 of them where people >> meet >> > > that have been contributing to sustaining, modernizing and improving >> > > VistA (and VistA derivatives) for many years. The momentum for the >> > > adoption of VistA has been growing independently of OSEHRA and the VA >> so >> > > even if the VA abandons VistA and OSEHRA falls by the wayside, VistA >> > > will survive.
>> > > The education community has also now learned the benefit of open >> source >> > > and VistA. The momentum to use it in education is growing. Out of >> that >> > > I expect a wave of young blood with forward looking ideas to join our >> > > community.
>> > > Business certainly has a role in all of this and business can help >> make >> > > it happen faster and better. The users of VistA can tell you the >> > > advantages of open source, just like Robert Wentz did, and they are >> > > spreading the word. The users of VistA worldwide outside of the US >> can >> > > also tell you. Ask the Jordanians and the three hospital systems in >> > > India.
>> > > I am hopeful that efforts will continue inside of the VA as well, but >> we >> > > will be waiting for those inside of the VA to join us if iEHR >> displaces >> > > them. Personally, I believe iEHR will be an extremely expensive >> failure >> > > and the sooner that the folly of it is recognized, the better for >> those >> > > of us who >> > > are tax payers and the better for VistA. Those resources could be so >> > > much better utilized to work to improve and modernize VistA to serve >> > > military, veteran, and civilian patient populations worldwide.
Nor will RPMS, I expect. We canąt afford the rocks.
---------------------------------------
Floyd Dennis
fbden...@comcast.net
From: Chris <chris.uyeh...@gmail.com>
Reply-To: <hardhats@googlegroups.com>
Date: Tue, 23 Oct 2012 18:16:44 -0700 (PDT)
To: <hardhats@googlegroups.com>
Cc: <nanthrac...@earthlink.net>
Subject: [Hardhats] Re: Will VistA be dashed on the rocks?
On Wednesday, October 24, 2012, Floyd Dennis wrote:
> Nor will RPMS, I expect. We canąt afford the rocks.
> ---------------------------------------
> Floyd Dennis
> fbden...@comcast.net
> From: Chris <chris.uyeh...@gmail.com>
> Reply-To: <hardhats@googlegroups.com>
> Date: Tue, 23 Oct 2012 18:16:44 -0700 (PDT)
> To: <hardhats@googlegroups.com>
> Cc: <nanthrac...@earthlink.net>
> Subject: [Hardhats] Re: Will VistA be dashed on the rocks?
