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