New VistA Article in the news - Industry group meets to consider upgrading VA patient record system

[Eric]

Thought the group would be interested in this article about VistA.

Industry group meets to consider upgrading VA patient record system

http://www.nextgov.com/nextgov/ng_20091014_6336.php?oref=rss?zone=NGtoday

[Ben Mehling]

The meeting was well attended and experience was diverse. Very
interesting to see such tangible efforts being made by the VA
leadership to take VistA forward.

- Ben

[kdt...@gmail.com]

I have an idea for the name of the project: CoreFLS

Kevin

On Oct 15, 9:29 am, Eric <e_spen...@comcast.net> wrote:
> Thought the group would be interested in this article about VistA.
>
> Industry group meets to consider upgrading VA patient record system
>

> http://www.nextgov.com/nextgov/ng_20091014_6336.php?oref=rss?zone=NGt...

[Ben Mehling]

On Thu, Oct 15, 2009 at 12:26 PM, kdt...@gmail.com <kdt...@gmail.com> wrote:
>
> I have an idea for the name of the project:  CoreFLS

Amusing, but...

My read of the project is quite the opposite. The fact that you have
the CIO of the VA even discussing this, on the call, including talking
about open source, means quite a bit. ZDNet's Blankenhorn came to the
same conclusion:

http://healthcare.zdnet.com/?p=2836

- Ben

[Nancy Anthracite]

I am very concerned about what an bunch of industry folks who know nothing
about VistA will come up with. That is why it has the potential of becoming
Core FLS.

Do I think it is good the CIO is thinking of pushing VistA out there and open
source? Absolutely, but I question what the outcome will be given the
probable motivation of those "industry leaders". It may be AHLTA II. I doubt
Medsphere's knowledge of the problem will be able to trump other industry
leaders desires for a piece of the pie.

--
Nancy Anthracite

[Ben Mehling]

On Thu, Oct 15, 2009 at 5:09 PM, Nancy Anthracite
<nanth...@earthlink.net> wrote:
>
> I am very concerned about what an bunch of industry folks who know nothing
> about VistA will come up with.  That is why it  has the potential of becoming
> Core FLS.
>
> Do I think it is good the CIO is thinking of pushing VistA out there and open
> source?  Absolutely, but I question what the outcome will be given the
> probable motivation of those "industry leaders".  It may be AHLTA II.  I doubt
> Medsphere's knowledge of the problem will be able to trump other industry
> leaders desires for a piece of the pie.

The new VA leadership has recognized the value of VistA to their
organization. They are investigating (on various fronts, including
the IAC route) means to improve and reinvest in the system. They are
asking questions about open source. They are asking questions about
modernization.

What's the suggestion here?

[kdt...@gmail.com]

As long as the end product is open source, then I am in favor of
modernization. I am with Nancy, however, that this is never going to
come from a coalition of outside IT companies that are contracted to
do the work.

Kevin

On Oct 16, 1:23 am, Ben Mehling <ben.mehl...@medsphere.com> wrote:
> On Thu, Oct 15, 2009 at 5:09 PM, Nancy Anthracite
>

[kdt...@gmail.com]

(Though Medsphere might be able to accomplish this...)
Kevin

[Ben Mehling]

On Fri, Oct 16, 2009 at 6:45 AM, kdt...@gmail.com <kdt...@gmail.com> wrote:
>
> As long as the end product is open source, then I am in favor of
> modernization.  I am with Nancy, however, that this is never going to
> come from a coalition of outside IT companies that are contracted to
> do the work.

I think we should consider all opportunities. In order to get our
objectives out on the table, we need a seat at that table.

That also means going in "eyes wide open".

- Ben

PS... no single company could accomplish this -- as we know, one of
the lessons of VistA is about collaboration.

[OldMster]

Ok, let me get it straight. If the VA tries to replace Vista, then
they are evil and under the negative influence of outside IT companies
that are only out to get money.

If the VA embraces Vista, and wants to move it forward, then they are
evil and under the negative influence of outside IT companies that are
only out to get money.

If I was the VA, I'd probably decide to ignore this group.

Mark

[Nancy Anthracite]

There are ways to do the modernization that make a lot more sense than others
and I do think this group has the expertise to make those recommendations.

--
Nancy Anthracite

[r...@rcresearch.us]

Mark;

I believe you may have made this situation a "this or that" set of
solutions. There is at least a third (and probably many more) solution,
that the VA move to push VistA forward, and improve communications with
the rest of the community. That is a real "win-win" solution in that
the VA gets input and testing (breaks can happen at non-VA sites and the
lessons get passed to the VA to repair before they happen at a VA
Medical Center (MC). They also get to colaborate with the community to
learn new techniques that others in the VA may not have consider. The
VA could see big advances in a short time at very little cost to the VA.
The community could advance with the years of experience that the VA
folks have to offer.

That all sounds pretty positive to me. As for the vendors, they need to
recognize that the real money is going to be in providing developers who
can work closely with the folks at the point of care. This is where the
real advantages of VistA of VistA get built. With the econfigurations
out there now, it is easy to setup a developement system isolated from
the rapid development and debugging. Once the application is ready, it
can be packaged and moved up to a testing configuration for integration
in to the production systems.

[OldMster]

My point wasn't whether what the VA was doing was bad or not (I don't
think so).
My point was that if this group is perceived as just complaining about
what they are doing, whatever it is, then we will be marginalized and
ignored. Your points are exactly what need to be made, and made in
that manner.
I don't think involving industry is a bad thing, but we need to make
our voices heard than any contributions they make that are paid for
with public funds need to be included in the FOIA release, not
proprietary additions.
Mark

[Joseph Dal Molin]

The recent VA initiative to solicit ideas from IAC for "modernizing"
VistA presents a landmark opportunity to gather together the wisdom and
experience of the VistA community and communicate it's insights to the
VA leadership. With this in mind, the central theme of the 30th VCM will
focus on this important subject. Community members are invited to
present and demonstrate their ideas, accomplishments etc. on a number of
topics....such as:

1. Refactoring - what needs it, how to do it, what's been done so far
2. GUI-fication - creating graphical user interfaces
3. New functionality
4. Tools for change - examples of new software development platfomr
5. Internationalization - strategies and implications etc.
7. other ideas.....send in your suggestions.

Senior VA management will be invited to attend the meeting and if
possible (volunteers needed) we will compile a white paper summarizing
the information presented at the meeting. If you are interested in
helping organize tracks etc. please contact me off line.

Joseph


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[K.S. Bhaskar]

GT.M - Rock solid. Lightning fast. No compromises.

On 10/16/2009 01:50 PM, Joseph Dal Molin wrote:
>
> The recent VA initiative to solicit ideas from IAC for "modernizing"
> VistA presents a landmark opportunity to gather together the wisdom and
> experience of the VistA community and communicate it's insights to the
> VA leadership. With this in mind, the central theme of the 30th VCM will

[KSB] I presume you mean the 20th VCM, Joseph. At the current rate of two VCMs per year, the 30th won't happen for
another five years!

Regards
-- Bhaskar

[Joseph Dal Molin]

Yes thank you, it's the 20th.... I must have had too much Turkish coffee
when I wrote that....

Joseph

[JohnLeo Zimmer]

Check your pulse, Joseph.

[Ben Mehling]

NextGov has picked up Joseph's VCM theme in a just posted article:

https://medsphere.org/blogs/inthenews/2009/10/20/whats-at-stake-in-vista-project

Very cool.

- Ben

[Ed Meagher]

Folks,
My name is Ed Meagher and I am chairing the ACT IAV VistA
Modernization group.
I would like to engage this group in our discussions.
I served as the deputy CIO and CTO at VA for 6 years.
I would appreciate your comments and suggestions.
Regards,
Ed

On Oct 15, 8:29 am, Eric <e_spen...@comcast.net> wrote:
> Thought the group would be interested in this article about VistA.
>
> Industry group meets to consider upgrading VA patient record system
>

> http://www.nextgov.com/nextgov/ng_20091014_6336.php?oref=rss?zone=NGt...

[r...@rcresearch.us]

The community has seen the article, but there are some questions that have
been raised in the article which should be addressed. I am speaking as a
rank and file member, but a long time user of VistA technology in the VA,
DoD, Indian Health Service and the US Public Health Service, as well as
community health systems in a number of community/county settings;

Here are your questions;

My answers in braces "[]";

--Is VistA a system that could be deployed to a wider community? If yes,
what is the most appropriate deployment model: open source code; cloud
computing; business process/methodology; other?

[Yes, perhaps all of these modes are available for specific purpose that
VistA might be used for. Currently, it is available via the FOIA, Open
Source (for free download), Virtualized for free download, implemented as
a Live CD (mostly for demo purposes), Business, easily done. IFCAP
(Integrated Funds Distribution, Control Point Activity, Accounting and
Procurement, an inventory and accounting package in VistA) has been raved
about by the Government Accounting Office in their publication last year,
(GAO Publication, GAO-08-976) over the current Finacial Management System
that the VA has been trying to replace IFCAP with. The efforts of divide
and conquer have been many to replace major hunks of VistA. Nearly all
such efforts have been total failures (Look up Core-FLS for example).]

--Should VistA be established as a national standard? What are the
implications of this action?

[Standards are wonderful things in that there are so many of them. It
would depend upon who is using VistA for what application. In healthcare,
there should be at least a minimun information set which can be implied.
Additional add-ons may also be standardized to include minimum sets of the
data which must be there. But the sky is the limit as far as what can be
added. There are cases where there should be nationally released standard
sets of nomenclature which should be freely available to the healthcare
community. These could be heald and maintained by the National Library of
Medicine with government-contracted organizations who keep the
nomenclature up to date. The implications are that the end users need to
be able to extend the model as their requirements dictate, not have
requirements dictated to them by a group who does not have to live with
the results. Any standards group needs to be driven by the end users, and
not corporate interests.]

--What is an appropriate strategy for modernizing VistA and transitioning
it to a more current and innovative architecture?

[First, one must categorize what is broken? Right now, the basic model is
designed to adapt to the needs of the end user and build on what others in
the organization already have built. So there is very little duplication
in the system. The MUMPS language is not the problem. The performance is
still very impressive even on the most austere machine. It is pre-adapted
to the onslaught of technology. The mainframes used to run large
hospitals are now eclipsed by the speed and capacity of even desk-top
computers. The bigger and faster machines means more users are serviced
with the available resources (disk and memory). The mean time to repair
is still very fast and easy to track in most cases. Webification of VistA
is around the corner. Internationalization was almost there back in 1993
when the Clinger-Cohen Act went into effect and disbanded the VA Kernel
Developers. We would be running a VistA now which could speak many
languages and service many patients who would otherwise not get proper
treatment. There is also work in progress that will make it possible to
gather up everything about a single patient and package it as a consistent
ball of information for accessioning to another VistA system losslessly.
That same mechanism could be used for formating that information into
records that the other databases might be able to handle. The basic issue
here is that in building this Holographic EMR, we are actually building
VistA-for-One (or a subset number) fro each collection also carries with
it the whole data dictionary of the source system for comparison with the
target system. As the military might be concerned, a graduating class
from boot camp could be gathered and sent as a single group record to be
accessioned onto the VistA system at their new assignments. But I
digress.]

--What are the opportunities and impact of modernizing and deploying VistA
on private industry, the health care community and other key groups?

[Let's first think about the possibility of improving healthcare and
building a life-long, cradle to grave record of the health and well being
of the population. If we can do that, I am sure business will find ways
of making money from the new infrastructure. There is a lot of value in
providing support and update facilities for the various VistA
configurations out there. New functionalisties will build upon the
ability to communicate between different systems. These VistA systems are
small enough to be on-line in the business arena fielding requests from
hospitals for additional supplies in a "just-in-time" fashion which has
been so popular with Japanese Auto Manufacturing. I can see hospital
inventories being managed by these VistA systems (remember that these
systems are very flexible and have as part of their very makeup, RPC, and
SMTP capabilities). VistA is a tool kit and the only thing that is
holding it back is politics and the idea that someone has not had yet.]

That should get you started; Chris Richardson

[r...@rcresearch.us]

Did I hear an echo??? Sorry guys, delete one of the copies. Basic
inattention to detail.