Virtualizing CPRS Windows Desktop Apps

[Kimball Bighorse]

From the article posted previously:

https://www.linkedin.com/pulse/vas-vista-cloud-migration-poised-transform-healthcare-bill-james-iyope/

"Virtualize CPRS. CPRS stands for Computerized Patient Record System. It is a graphical front-end user interface to VistA which allows VA healthcare providers to enter, review, and continuously update all information related to any patient including medical history, diagnoses, medications, lab results, etc. CPRS runs in Microsoft Windows on a PC. Updates and patches to CPRS must be pushed out to thousands of PCs in VA. Managing these CPRS deployments is a difficult, expensive, time-consuming task. To simplify this process, VA should accelerate its virtualization of CPRS in Amazon AppStream and possibly Azure Virtual Desktop as well."

I would highly recommend targeting Electron instead. It's based on Web standards, would support multiple platforms, not just Windows, and has solved a lot of the update and deployment issues described. If you're using VSCode, you're already using it. Even Microsoft Teams uses it.

https://www.electronjs.org/

Does anyone have any experience with it here?

Kimball

[Kevin Toppenberg]

As a CPRS developer (in private practice, not with the VA), I would say that this is very possible.  But possible doesn't mean practical. 

It would just need a team of of highly trained software developers to comb through all the business logic that is encoded in the code and accurately translate it to the new platform.    I don't know about Electron in detail, but my understanding is that it has an environment similar to one finds when coding for a web browser.  If that is true, then the limitations of being single threaded, without a great way to program without callbacks / promises etc will introduce some headaches.   CPRS also makes use of windows messaging, such that one part of the code will issue a message, with an expectation that another part of the program will pick up the message later as the Windows loop processes messages.

Furthermore, does Electron have a graphical development environment?  I.e. can I view a form and drag a button to the place I want it?  Or do I have set this all up via text descriptions?  Also, will Electron be around in 20 years?  My perception of web technology is that most things are written in a disposable manner, i.e. not intended to be maintained for decades.   Cobol will probably outlast Electron, if I were to guess.

I guess my point is that most feel that after one spends all the time and effort to jump to a new development platform, one might as well introduce a new design at the same time.  And if one is doing that, then why not change the back end as well?  I think that is why the VA is wanting to leave VistA altogether and get to something entirely new, such as Cerner or Epic. 

Kevin

[Kimball]

Hi Kevin,

Super interesting, thanks for your feedback!

So, would you advocate for the Amazon AppStream or Azure Virtual Desktop approaches? Neither? Something else?

cheers,

Kimball

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"Everyone faces the decision to be either a creature or creator of circumstance."

--Eva Bighorse

[ivaldes]

Astronaut has been doing CPRS through the browser virtualization for at least 7 years. We tried many and finally went with guacamole. There are lots of intriguing but ultimately non-viable for us solutions that we rejected including those that involved recompiling CPRS with special libraries. 

-- Ignacio Valdes, MD, MS, ABPM, ABPN, CAM

-- Astronaut, LLC

-- https://astronautehr.com

[Kevin Toppenberg]

I think Ignacio's approach with Guacamole is quite interesting. We are a small office and don't need virtualization.  But if in many offices, then having something in the cloud seems the way to go.

Kevin