I have been especially pleased to hear that Georg Timson and Wally Fort
received the applaus they deserve.
What about the Gentleman who financed the initial PDPs for the decentralized
development (Right now I forgot his name, it is on my tongue)?
A "card-holding" honorary member of the underground railroad
(This is the honor I like most!)
Wolfgang Giere
Am Montag, 21. August 2006 18:51 schrieb Roger Maduro:
> ========================================================================
>
> VistA(r) News
> We report on several major developments in this issue of VistA(r) News.
> These range from a public call by the Senate for the Department of Defense
> (DoD) to adopt the U.S. Department of Veterans Affairs VistA(r) EHR
> software to a major breakthrough in recognition for VistA(r) in the open
> source community's LinuxWorld conference in San Francisco.
>
> Congress Calls for DoD to Adpot VistA(r)
>
> On July 21st, the Senate Committee on Appropriations released a proposed
> funding bill asking DoD to adopt VA's VistA(r) electronic health record
> software as their EHR platform. This follows a similar proposal in the
> House funding bill. While the final bill has to be worked out in conference
> later this year, the intent of Congress is clear. This would be a very
> positive step towards creating a fully-integrated health care system for
> active-duty American servicemen as well as veterans.
>
> The need for a fully integrated EHR has become an urgent matter given the
> large number of wounded servicemen coming from Iraq into the VA medical
> system. Transferring their medical records from the Military Health System
> (MHS) to the VA Medical system has proven to be a challenge. Although major
> strides have been made by joint efforts of DoD and the VA, there is still a
> lot of work to be done. Having one EHR system solves the data transfer and
> registration issues. In this issue we cite some rather colorful statements
> from Secretary of Defense, Donald Rumsfeld, in this regard.
>
> Integrating both systems makes even more sense when one looks behind the
> scenes. There is an excellent background testimony by Dr. Michael Kussman,
> the Principal Deputy Under Secretary of Health of the VA on the nature and
> history of both VistA(r) and DoD's EHR infrastructure and data sharing
> efforts. DoD's Composite Health Care System (CHCS) is actually a derivative
> of VistA(r). Both systems have a great deal of internal similarities and
> run on the same advanced M Language-based multi-dimensional database
> system. In fact, as reported below, DoD just signed a contract with
> InterSystems to use Cache, their M-Language product, based on its
> demonstrable superior performance in comparison to Oracle's legacy database
> technology. Thus migrating DoD to use VistA(r) requires far less effort
> than one would suspect. Combining the efforts of both development teams
> will produce better code, faster, and at substantial savings.
>
> As one can see in this issue's news clippings, bureaucrats at DoD are
> opposed to adopting VistA(r) as their EHR platform. Instead, they would
> like to spend several billion dollars in taxpayer's money in developing a
> new EHR, the Armed Forces Health Longitudinal Technology Application
> (AHLTA). The claim is that at some distant date in the future AHLTA will
> develop and grow to have the same functionality that VistA(r) already has
> today (the projected delivery date for AHLTA is 2011). The clincher,
> according to DoD bureaucrats, is that AHLTA would be supposedly "better
> adapted" than VistA(r) to DoD's mission.
>
> One interesting observation here is that the private sector has already
> voted with their feet on this particular issue. Ignoring DoD's CHCS and
> AHLTA, a large number private sector hospitals, State hospitals and
> clinics, and even entire countries, are now actively implementing VistA(r).
> A number of companies have emerged to carry out these private-sector
> implementations. Companies such as DSS, Medsphere, Perot Systems, and
> several others, have spent collectively over $100 million in total over the
> past three years adapting VistA(r) to the requirements of the private
> sector. They have also added additional capabilities and modules, and have
> assembled their implementation, support and training teams. These companies
> would not be doing this if it was not a sound business decision and if they
> did not think that VistA(r) was the EHR technology of the future.
>
> VA and IHS A Model for Collaboration
>
> In contrast to the foot-dragging from DoD bureaucrats, we have a story on
> the decision of the Indian Health Service (IHS) to test the VA's medical
> imaging system. Once the testing is completed, it will be deployed
> nationwide. This is just one more milestone in the long history of
> collaboration between the VA and the IHS.
>
> Faced with the need to care for a large population of Native Americans on a
> meager budget, IHS concluded more than two decades ago that the best course
> of action to provide an EHR for their medical facilities would be to take
> VistA(r) from the VA and adapt it to their own particular needs. Thus an
> IHS derivative of VistA(r) named the Resource and Patient Management System
> (RPMS) was born. Over the years IHS came up with some major innovations to
> RPMS, as well as additional modules such as pediatrics and OB/GYN, that
> were not originally part of VistA(r). The relevant software code was shared
> with the VA which then adapted those innovations to VistA(r) and added them
> to their code stream. This is one of the greatest examples of
> collaboration between two government agencies which unfortunately to this
> day remains a largely untold story.
>
> The story does not end there, however. After 3 years of searching for an
> EHR in the commercial sector, the National Aeronautics and Space
> Administration (NASA), concluded that RPMS was the EHR that best met the
> needs for their 14 medical centers. RPMS could also serve as a platform for
> an occupational health module. NASA signed an inter-agency collaboration
> agreement with IHS in April of 2005. Through this agreement IHS provided
> NASA with RPMS. In exchange NASA will contribute the code they develop for
> the occupational health module back to IHS. In addition, going forward,
> both agencies will collaborate in the future operation, maintenance, and
> enhancement of their respective systems. At the same time, IHS will share
> the module and additional code they receive from NASA with the VA. The VA
> will incorporate these enhancements into VistA(r) and when all the testing
> is completed, this new version of VistA(r) will not only be released to the
> VA medical system, but through public domain releases, to the entire
> VistA(r) community.
>
> Adding DoD to this thriving collaborative community would be significant.
> The Military Health System provides care for 9.2 million servicemen at 70
> hospitals and 411 clinics. The Veterans Health Administration provides care
> for more than 5 million veterans at 163 hospitals and more than 800 clinics
> and other facilities. IHS runs 49 hospitals and 190 health centers. NASA
> runs 14 medical centers. In comparison, the largest private health care
> provider in the United States, Kaiser Permanente, only runs 30 hospitals
> and 431 clinics.
>
> Congress Takes Leadership in EHR Efforts
>
> The Senate's call for DoD to adopt VistA(r) is not coming in a vacuum. In
> this issue we have gathered multiple articles from several Senators
> discussing VistA(r). These include articles by Senator Bill Frist (R-TN), a
> medical doctor and Senate Majority Leader, as well as Senator Tom Carper
> (D-DE). These are excellent articles and demonstrate that on this issue,
> some of the key elected officials in Washington are actually ahead of the
> curve and understand the role that technology can play in improving
> healthcare.
>
> We have also included a link to the Senate Commerce Committee's
> Subcommittee on Technology, Innovation and Competitiveness hearings on June
> 21. The hearing was on the topic of Accelerating the Adoption of Health
> Information Technology, and the witnesses provided a thorough update on the
> development of health information technology as well as the activities of
> the American Health Information Community (AHIC).
>
> Most interesting is that during these hearings VistA(r) took center place.
> It started with the testimony of Newt Gingrich, former Speaker of the House
> and the founder of the Center for Health Transformation. Gingrich began his
> testimony with a discussion of the success of the VA and VistA(r) in
> safeguarding the medical records of all of their patients during Hurricane
> Katrina. He contrasted that with the fact that the medical records of more
> than a million Americans in the Gulf region had been completely destroyed
> and are lost forever.
>
> Gingrich was followed by Phillip T. Ragon, Founder and CEO of InterSystems
> Corporation who detailed the success of the key M Language technology that
> drives not only VistA(r), but also a substantial portion of the world's
> successful healthcare IT systems. Subcommittee Chairman John Ensign (R-NV)
> asked multiple questions about VistA(r) in the Q&A period. Ensign asked
> Ragon to tell him the history of VistA(r) and then requested more details
> on the savings made by using VistA(r) at the VA. A full webcast of the
> hearing is available at the Committee's web site and it's well worth
> watching.
>
> A discussion of what the Senate has done in regards to EHR's would not be
> complete without mention of the efforts of several Senators who have
> quietly labored to make it happen. We are thinking in particular of Senator
> Daniel K. Inouye (D-HI). Senator Inouye, a senior member of the Senate, is
> a highly-decorated World War II combat veteran who earned the nation's
> highest award for military valor, the Medal of Honor. Over the past decade
> Dr. Inouye has secured funding for the Pacific Telehealth and Technology
> Hui in Hawaii (www.pacifichui.org) for research into telemedicine and
> advanced medical technologies.
>
> Under the direction of Dr. Stanley M. Saiki, the Hui has funded several
> projects that have been of critical importance to the adaptation of
> VistA(r) to the private sector. This includes the porting of the VA's
> VistA(r) code base to run on the Linux operating system as well as an ASP
> version of VistA(r). The Hui also financed some of the key early
> implementations of VistA(r) outside of the VA, including the implementation
> of VistA(r) in American
> Samoa and in several clinics in Hawaii.
>
> VistA(r) at LinuxWorld's Open Source in Healthcare Day
>
> The rapid emergence of VistA(r) as an open source application/platform has
> finally caught the attention of the open source community at large. The
> Open Source Development Labs (OSDL) sponsored a full day session at the
> LinuxWorld Conference in San Francisco this week dedicated to the topic of
> open source in healthcare. The keynote speaker was Ken Kizer, former
> undersecretary of the VHA and CEO of Medsphere. Kizer was one of the key
> leaders that transformed the VA's hospital system into the best hospital
> system in the country (as documented by every standard measure of quality).
> Kizer gave an excellent presentation on the state of healthcare in America
> and how VistA(r) and open source can play a role in fixing many of the
> systemic problems, including the high death toll due to medical errors (as
> outlined by Kizer, medical errors are the third leading cause of death in
> the United States today).
>
> Several other well-known members of the VistA(r) community also spoke at
> the conference, including K.S. Bhaskar, Vice President for Engineering at
> Fidelity National Information Services & COO of WorldVistA, Joseph Dal
> Molin, WorldVistA's Interim President and VP of Business Development, and
> Frank Pecaitis, Medsphere's VP of Sales and Marketing. Scott and Steve
> Shreeve, founders of Medsphere, were in the audience as well as Mike
> Ginsburg from DSS, and Chris Richardson from WorldVistA. Two of the
> original developers of VistA(r), and card-carrying members of the
> Underground Railroad, George Timson and Wally Fort were also in the
> audience. They received a strong ovation from the audience when they were
> introduced.
>
> VistA(r) News will have more details on the session presentations in the
> next issue of the newsletter. Several of the presentations, including Dr.
> Kizer's, can be seen at the event wiki--<
> http://www.osdl.org/wiki/dcl_health_care_day/index.php/Main_Page>.
>
> Microsoft Enters the EHR Market
>
> The open source community is not the only one that sees the value of
> VistA(r). Microsoft also sees the potential for fully integrated EHR and
> has purchased a product, Azyxxi, so that it can compete head on with
> VistA(r) and other EHR's. Azyxxi is what is called a "health intelligence"
> application that can integrate data from hundreds of sources and make it
> available to doctors electronically. It was developed by doctors at the
> emergency department of Medstar Health's Washington Hospital Center in
> Washington, D.C. Although it only has a small subset of the functionality
> of VistA(r) today, Azyxxi does hold promise as it grows and develops over
> the next decade in particular when compared to commercial EHR products that
> lack VistA(r)'s integration and capabilities.
> VA VistA Innovations Site (www.innovations.va.gov )
> VistA Monograph Home (www.va.gov/vista_monograph )
>
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> EDITORIAL POLICY STATEMENT
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
> While the underlying basis for publishing this newsletter is the
> publisher's belief in the potential of VistA(r) to vastly improve the
> quality of healthcare in the US and its potential to make affordable
> healthcare IT technology available to the developing world, the editorial
> policy is to be independent and, to this end, the newsletter will not
> promote vendor products or services. As an expression of its independence,
> the newsletter may, from time to time, include information that may reflect
> negatively on VistA(r). The newsletter may include information about future
> events that the editor feels are relevant to the communities for which the
> newsletter is intended but such information in no way endorses such events.
>
> Opinions expressed in the newsletter and the identity of the person or
> organization expressing such opinions will either be clear from the context
> or will be explicitly stated.
>
> Note: VistA(r) is a registered trademark of the Department of Veterans
> Affairs. It stands for "Veterans Health Information Systems and Technology
> Architecture."
>
> Roger A. Maduro is the publisher and editor-in-chief of VistA(r) News. He
> is a leading expert in the application of open source software and concepts
> to improve information technology systems. In the past 5 years he has
> focused on solutions in healthcare, in particular the migration of VistA(r)
> from an application specific to the Department of Veterans Affairs to one
> that can run everywhere from the private sector clinics and hospitals to
> national health systems. He is one of the founders of the VistA Software
> Alliance (VSA) and currently a board member. He is also a member of the
> WorldVistA organization.
>
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> SUBSCRIPTION AND CONTACT INFORMATION
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
> If you wish to subscribe to this newsletter, please send an email to
> subs...@lxis.com. If you wish to cancel a subscription, please send an
> email to unsub...@lxis.com.
>
> email: rama...@lxis.com
> phone: (571) 217-6921
>
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
> VistA(r) News| P.O. Box 6201 | Leesburg | VA | 20178
>
>
>
I have a few issues with some of the statements made in the commentary about AHLTA. AHLTA and VistA serve very different purposes, and different patient populations. What works for one will not always work for the other. Here are just a few comments on some of the articles. I work with AHLTA daily, and so admittedly I have a bias (but not any more so than that of the writer(s) below). Feel free to take my comments for what they are worth.
1. AHLTA and VistA are not equivalent products. AHLTA and CPRS is a better comparison. It isn’t a perfect one, but better than comparing AHLTA and VistA. There is a lot of functionality in VistA that is not accessible in the CPRS. AHLTA has a similar dependency on CHCS. However, AHLTA does have some functionality outside of CHCS (as opposed to CPRS, which is just a GUI on top of VistA).
2. The DoD didn’t decide to use Cache based on it’s performance compared to Oracle. It is simply easier to port the database between differing implementations of the same language.
3. The DoD is not spending several billion dollars developing AHLTA. They are spending several billion dollars implementing and maintaining AHLTA. Development is only one part of implementation. The implementation budget also includes all of the hardware required to change the dumb terminals in every clinic over to a PC, as well as all of the servers, routers, and other hardware upgrades needed. The ‘several billion’ covers the entire life cycle of the product. This is strictly semantics, but an important point none-the-less. We are spending millions (not billions) on the software side.
4. Once a note is completed in AHLTA, it is available worldwide. Our soldiers who are PCSing don’t have to worry about the records catching up to them electronically eventually. The average DoD beneficiary is much more mobile than the average VA beneficiary. There are some valid points why we are building something different.
5. Speaking of Katrina, the information from Keesler AFB was available to those patients when they were sent to other DoD facilities. This was due to AHLTA. It was not their entire record, but it was all of their meds, labs, x-ray reports, and some notes as well.
6. AHLTA is being used to generate over 80k encounters a day right now. The 2011 date is for when the funding for CHCS dries up (and so must be replaced by other products meeting that functionality).
There is clearly a need for our veteran’s health information to be available across the spectrum of care. Adopting the same EHR is only one way of achieving that goal. Building software that can exchange data back and forth in a secure, reliable, standards based manner is another solution. A benefit to that solution is that we can share data with *any* system that also shares those standards. That is what we are trying to build in AHLTA. There are problems right now sharing data back and forth with the VA, but these are technical problems that aren’t insurmountable. Once we have systems that talk together when needed to share data about common patients, we will have what congress wants (and our veterans deserve).
I am in no way trying to say VistA is not a wonderful product. There are some things that I wish AHLTA did more like CPRS. However, I also see several advantages to the AHLTA interface over CPRS. Both products could learn from some of the civilian products out there.
Here’s the bottom line (at least according to insignificant me): We don’t all need to use the same product. The data on our patients is what really matters, and we need to be able to share data between all the different EHRs out there (when needed).
Dr. James Abbott
Maj, USAF, MC
(This is not meant in any way to be an official statement of DoD or Air Force policy. Just my two cents.)
-----Original Message-----
Subject: [Hardhats] VistA(r)
News-Aug. 18, 2006-Senate Calls for DoD to Adopt VistA(r)/VistA(r) at
LinuxWorld.
========================================================================
VistA® News
Editor, Roger A. Maduro, LxIS
August 18, 2006. Vol. 1, No. 2
=========================================================================
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
COMMENTARY
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We report on several major developments in this issue of VistA® News. These
range from a public call by the Senate for the Department of Defense (DoD) to
adopt the U.S. Department of Veterans Affairs VistA® EHR software to a
major breakthrough in recognition for VistA® in the open source community's
LinuxWorld conference in San Francisco.
Congress Calls for DoD to Adpot VistA®
On July 21st, the Senate Committee on Appropriations released a proposed
funding bill asking DoD to adopt VA's VistA® electronic health record
software as their EHR platform. This follows a similar proposal in the House
funding bill. While the final bill has to be worked out in conference later
this year, the intent of Congress is clear. This would be a very positive step
towards creating a fully-integrated health care system for active-duty American
servicemen as well as veterans.
The need for a fully integrated EHR has become an urgent matter given the large
number of wounded servicemen coming from Iraq into the VA medical system.
Transferring their medical records from the Military Health System (MHS) to the
VA Medical system has proven to be a challenge. Although major strides have
been made by joint efforts of DoD and the VA, there is still a lot of work to
be done. Having one EHR system solves the data transfer and registration
issues. In this issue we cite some rather colorful statements from Secretary of
Defense, Donald Rumsfeld, in this regard.
Integrating both systems makes even more sense when one looks behind the
scenes. There is an excellent background testimony by Dr. Michael Kussman, the
Principal Deputy Under Secretary of Health of the VA on the nature and history
of both VistA® and DoD's EHR infrastructure and data sharing efforts. DoD's
Composite Health Care System (CHCS) is actually a derivative of VistA®.
Both systems have a great deal of internal similarities and run on the same
advanced M Language-based multi-dimensional database system. In fact, as
reported below, DoD just signed a contract with InterSystems to use Cache,
their M-Language product, based on its demonstrable superior performance in
comparison to Oracle's legacy database technology. Thus migrating DoD to use
VistA® requires far less effort than one would suspect. Combining the
efforts of both development teams will produce better code, faster, and at
substantial savings.
As one can see in this issue's news clippings, bureaucrats at DoD are opposed
to adopting VistA® as their EHR platform. Instead, they would like to spend
several billion dollars in taxpayer's money in developing a new EHR, the Armed
Forces Health Longitudinal Technology Application (AHLTA). The claim is that at
some distant date in the future AHLTA will develop and grow to have the same
functionality that VistA® already has today (the projected delivery date
for AHLTA is 2011). The clincher, according to DoD bureaucrats, is that AHLTA
would be supposedly "better adapted" than VistA® to DoD's
mission.
One interesting observation here is that the private sector has already voted
with their feet on this particular issue. Ignoring DoD's CHCS and AHLTA, a
large number private sector hospitals, State hospitals and clinics, and even
entire countries, are now actively implementing VistA®. A number of
companies have emerged to carry out these private-sector
implementations. Companies such as DSS, Medsphere, Perot Systems, and
several others, have spent collectively over $100 million in total over the
past three years adapting VistA® to the requirements of the private sector.
They have also added additional capabilities and modules, and have assembled
their implementation, support and training teams. These companies would not be
doing this if it was not a sound business decision and if they did not think
that VistA® was the EHR technology of the future.
I have a few issues with some of the statements made in the commentary about AHLTA. AHLTA and VistA serve very different purposes, and different patient populations. What works for one will not always work for the other. Here are just a few comments on some of the articles. I work with AHLTA daily, and so admittedly I have a bias (but not any more so than that of the writer(s) below). Feel free to take my comments for what they are worth.
I agree with Greg, these packages should not be competeing, but merge into interoperable applications.
I invite the AHLTA user to take a look at what has been done to extend the GUI
for the military by Emory Fry and his compatriots at Balboa. That same
development tract could be easily adapted to rapidly give VistA different
GUIs for the military side if VistA were used there. CPRS need not be your
GUI or could be one of them. Emory joined Terry Wiechmann to give a talk at
the last WorldVistA meeting. Unfortunately, Terry's portion was not
captured, but Emory's was and it has the audio and PPT here:
http://downloads.opensourcevista.net/EsiObjects
Please don't take this to mean that I think VistA is perfect and the solution
for all problems or that it doesn't have problems. I certainly don't, but the
budgets of the VA and the DOD would be better spent if they were working
toward one solution, not two, and it has seemed to me from the beginning that
VistA should have been used to do it.
I also don't think that working toward one central medical record is the
solution. Everyone needs to be able to operate in a stand alone mode from
the level of a small clinic or or handheld a patient's side in a home or a
battle right on up the ladder and then to be able to merge the data as needed
and as the capability exists and but not to rely on that single central
record to provide everything. I think solutions that can do both are needed
for speed and continuity of care at the local level as well as for
enterprise wide management. I believe both the VA and the DOD are working/
or will be working, at this in their own ways. The VA is working hard to
standardize its terminology to bring up the central record that hopefully
will not be expected to be the only record. I think the DOD will soon
figure out that it will need more than one central database to provide the
continuity and speed it needs.
Gregory Woodhouse
gregory....@sbcglobal.net
--
Nancy Anthracite
I do have one very large praise for VistA. The programmers are responsive
to the users. Having a fast turn-around on new functionality (in response
to user requests) helps to make VistA what it is. AHLTA, over the last 18
months, has not advanced much while a major change in architecture took
place. Now that we have broken through that barrier, it will advance
quickly. There are many upcoming features that will make it much more
acceptable to the end users. Having it not advance much recently has
certainly hurt its creditability.
As far as what AHLTA does that CHCS doesn't do, it provides a single
world-wide database. As opposed to the last article I saw posted (Health
Data Bottleneck on Military.com) the notes from Landstuhl Regional Medical
Center in Germany *are* viewable at any other MTF. That is not the case
with CHCS, but it is with AHLTA. Also, the ability to complete notes (with
coding included) isn't a part of CHCS, but it is an integral part of AHLTA.
Line item billing can't be done in ADM (part of CHCS), but is a piece of
cake in AHLTA. This is essential for billing purposes.
One thing that AHLTA will soon do (hopefully next three months, but I'm not
holding my breath) is allow me to see all meds a patient is taking, whether
they get them at a DoD facility, the VA, the Mail Order pharmacy or a
downtown local pharmacy. I don't think VistA gives it's users that level of
detail, and I don't know if VistA shows PDTS data (civilian network med data
for DoD patients). As a primary care doc, seeing the list of meds my
patients are taking (as opposed to their guessing when they don't bring
their pills) will help me take much better care of them. I know you can
enter all of a patient's meds into VistA, but it would be much better to
receive that information electronically. That is an example of data sharing
that will have huge benefits to our patients today.
The DoD decision to do AHLTA as opposed to VistA was made way above my pay
grade. It will be very expensive now to change systems. As more data is
shared between the two systems, critics will have less to complain about.
Heck, just seeing the difficulties we are having now with sharing data
between the two systems makes me wonder how hard it would be to place all of
the historic data from either system into the other. Our patients are
better treated with the electronic data we have than trying to start with a
clean slate. As much as users complain when they have to change their ways
of doing anything, they would complain more if we changed yet again without
giving them the historic data we have right now.
I am starting to ramble. I am notorious at work for my "War & Peace"
e-mails!
Have a great week all.
v/r
James Abbott, M.D.
v/r
James Abbott, M.D.
--
Nancy Anthracite
----- Original Message -----
From: "James Abbott" <ja...@i-shmoo.net>
To: <Hard...@googlegroups.com>
Sent: Sunday, August 27, 2006 6:31 PM
Subject: [Hardhats] Re: VistA(r) News-Aug. 18, 2006-Senate Calls for DoD to
Adopt VistA(r)/VistA(r) at LinuxWorld.
AHLTA, when first developed, stored everything in one big database as you
went along. The note that I was only half-finished with in AHLTA was stored
the same place all of the complete notes went. Every transaction was
between the local client and the big database. If you are trying to connect
to it from, say, Korea, each of those trips back and forth started to really
add up. Now, each of the incomplete notes are stored 'locally,' and only
once completed do they get sent to the big database. Locally is defined as
where the local CHCS server is located at.
That one change (notes staying local but available on all local machines
until they are completed) has taken the programmers 18 months to do
successfully. I may be over simplifying it, but I'm afraid not by much.
JRA
That was very eloquently stated. Thank you. We are discovering that
taking the data away from the point of care seems to be not such a good
idea. It seems as though there is an all or nothing quality of this whole
thing. The best care seems to be in both positions, centralized and
decentralized. They do not have to be mutually exclusive.
----- Original Message -----
From: "James Abbott" <ja...@i-shmoo.net>
To: <Hard...@googlegroups.com>
Sent: Monday, August 28, 2006 3:57 PM
Subject: [Hardhats] Re: VistA(r) News-Aug. 18, 2006-Senate Calls for DoD to
Adopt VistA(r)/VistA(r) at LinuxWorld.
I don't think it's a secret, but having worked with the VA - we've also
worked with the DOD. In that capacity, I've been honored to view both
architectures and they are different. From one stand-point, you have
the fundamental infrastructure. As James pointed out, the entire MTF
and CDR/LCS database replication process is "unique". In addition, the
underlying technology (Oracle/MSSQL vs M/Cache) - the long running DB
battle. And then you have UI and front end differences, CPRS (Delphi)
vs "AHLTA" (VB/.NET). So the areas to compare are difficult, even for
a Senator.
But you have to admit that the goals (no matter how many egos, budgets,
and committees are involved) is a great goal for us - the tax payers.
Instead of spending $X million, one lot here and another budget there -
combine the two. How many barcode medication projects should one
government have to implement? Is it a 3-year project or even a 5-year
project, maybe. But you have to start somewhere.
Once you start the process of combining, migrating, or scratching code
- then we'll be on our way to meeting the needs of every American.
(Go Army).
/David.
IMHO, VistA beats the CDR/LCS, but AHLTA beats out CPRS.
I even think it would be appropriate to use both Cache and Oracle. Each of
them has strong points and combining the two would provide tremendous
benefits.
I also disagree with the idea that the two methodologies of care are that
different. VistA focuses on preventative medicine and chronic care, but
AHLTA focuses on readiness, which is a very similar paradigm. The first
goal of both is to take proactive measures to keep the patient healthy.
Chris Farley
Independent Consultant
-----Original Message-----
From: Hard...@googlegroups.com [mailto:Hard...@googlegroups.com] On Behalf
Of David Sommers
Sent: Wednesday, August 30, 2006 1:20 PM
To: Hardhats
Subject: [Hardhats] Re: VistA(r) News-Aug. 18, 2006-Senate Calls for DoD to
Adopt VistA(r)/VistA(r) at LinuxWorld.