The way VistA is used now as opposed to then

[Rob Kellock]

My understanding is that the bulk of VistA (the in-house Mumps part) was written in the 1980's and that CPRS appeared somewhere in the 1990's. The way things seemed to be done prior to CPRS is that medical staff and programmers would work together to implement some desired functionality on top of Fileman and the Kernel.  From my brief playing with Fileman it appears that clinician / programmer written programs could co-exist with pre-existing production code and globals. If it turned out that their new programs would be useful to others, then a formal process could be undertaken with head office to integrate their new code into VistA. Apparently, this approach worked well, but then GUI's took over, programming became a whole lot more challenging, CPRS appeared and the flexibility of Fileman retreated into the background. Is that the general progression from the 2000's onwards... coal face workers / local programmers being replaced by professional programmers, some of them continents away, writing the code?

In a modern day hospital can clinicians still request or create their own bespoke databases or has that time passed too?

[David Whitten]

In the earlier days, hospitals created various packages like the Police Package (called class 3).

We also created additions to the National packages (class 1) like laboratory or pharmacy.

Regional class 2 projects required to take less than 40 hours of development. 

Dave

On Thursday, June 5, 2025, Rob Kellock <credit...@gmail.com> wrote:

My understanding is that the bulk of VistA (the in-house Mumps part) was written in the 1980's and that CPRS appeared somewhere in the 1990's. The way things seemed to be done prior to CPRS is that medical staff and programmers would work together to implement some desired functionality on top of Fileman and the Kernel.  From my brief playing with Fileman it appears that clinician / programmer written programs could co-exist with pre-existing production code and globals. If it turned out that their new programs would be useful to others, then a formal process could be undertaken with head office to integrate their new code into VistA. Apparently, this approach worked well, but then GUI's took over, programming became a whole lot more challenging, CPRS appeared and the flexibility of Fileman retreated into the background. Is that the general progression from the 2000's onwards... coal face workers / local programmers being replaced by professional programmers, some of them continents away, writing the code?

In a modern day hospital can clinicians still request or create their own bespoke databases or has that time passed too?

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[Rob Kellock]

Thanks David for that confirmation. This collaborative aspect of VistA is why I keep coming back to have another look. Microsoft had a similar ecosystem that developed around Visual Basic 4/5/6. All kinds of third party controls were developed and amateur programmers were knocking out apps to do the things that they needed in their departments. Then Microsoft killed it overnight with dot Net. While I'm not suggesting that the VA killed VistA by moving to CPRS, I do think that the advent of GUI's and perhaps even more so the Web has removed the ability for local solutions. Every time software gets more centralized (I think the VA has moved most of its VistA instances into the cloud now), the ability to act locally slips further away.

On Sunday, June 8, 2025 at 3:36:47 AM UTC+12 David Whitten wrote:

In the earlier days, hospitals created various packages like the Police Package (called class 3).

We also created additions to the National packages (class 1) like laboratory or pharmacy.

Regional class 2 projects required to take less than 40 hours of development. 

Dave

On Thursday, June 5, 2025, Rob Kellock <credit...@gmail.com> wrote:

My understanding is that the bulk of VistA (the in-house Mumps part) was written in the 1980's and that CPRS appeared somewhere in the 1990's. The way things seemed to be done prior to CPRS is that medical staff and programmers would work together to implement some desired functionality on top of Fileman and the Kernel.  From my brief playing with Fileman it appears that clinician / programmer written programs could co-exist with pre-existing production code and globals. If it turned out that their new programs would be useful to others, then a formal process could be undertaken with head office to integrate their new code into VistA. Apparently, this approach worked well, but then GUI's took over, programming became a whole lot more challenging, CPRS appeared and the flexibility of Fileman retreated into the background. Is that the general progression from the 2000's onwards... coal face workers / local programmers being replaced by professional programmers, some of them continents away, writing the code?

In a modern day hospital can clinicians still request or create their own bespoke databases or has that time passed too?

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[Benjamin Irwin]

Rob,

I think I am hearing a misunderstanding in your comments regarding CPRS replacing VistA.  CPRS is the front end of The VistA backend.  When physicians talk about VistA they probably mean the VistA/CPRS pair.  The strength of VistA/CPRS came at a time in history when developers and physicians (or users) worked together to create a system.  I lived through that time in history and am grateful for it, it was a great time.  Physicians had a great interest in computers and were very supportive of developers and great things happened.  However, management, project management, and business processes changed.  Companies started outsourcing their IT departments.  The development was moved far away from the users with many unhelpful layers between the two and the process failed.  Also like today saying that MUMPS was an old language over and over again eventually sounded true.  One of the best current EHRs is still written in a MUMPS like version and many Banks still work with MUMPS as the background.  MUMPS isn't really a dead language, just people that don't know think it is.

Ben

[Rob Kellock]

Hi Ben,

I am aware that CPRS is built on top of VistA and that there is an API that it uses to communicate with the VistA back end. I guess what I'm musing about in this thread is that staff in many businesses today are becoming cogs in a machine and that machine is being run by computer software. If I ring my bank or insurance company their staffs' (when I eventually get to talk to a human) working lives are completely dominated by the software the organisation uses. They're hardly able to think for themselves. Perhaps I'm a Luddite, but I think we are having our humanity stripped away by large tech companies and the rush to AI will make it worse. Somehow we have to get back to when "Physicians had a great interest in computers and were very supportive of developers and great things happened".

Cheers,

Rob.

[Nancy Anthracite]

In the US, becuase of the EHR certification requirements and regulations forced on EHR users, it is almost impossible to have that happen.  Kevin Toppenberg is a rare bird because he uses and modifies VistA in for his office but has to take less reimbursement to do it.

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Nancy Anthracite

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[Rob Kellock]

I'm beginning to see why there's been so many failures by companies attempting to build EHR's. The health sector is a very hard nut to crack!

[Nancy Anthracite]

And there is much, much more.

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Nancy Anthracite

On Tuesday, June 10, 2025 6:59:17 PM CDT Rob Kellock wrote:

> I'm beginning to see why there's been so many failures by companies

> attempting to build EHR's. The health sector is a very hard nut to crack!

>

> On Monday, June 9, 2025 at 4:02:46 AM UTC+12 Nancy Anthracite wrote:

>

> > In the US, becuase of the EHR certification requirements and regulations

> > forced on EHR users, it is almost impossible to have that happen.  Kevin

> > Toppenberg is a rare bird because he uses and modifies VistA in for his

> > office but has to take less reimbursement to do it.

> >

> >

> > Nancy Anthracite