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VistA, OpenVista, WorldVistA in the News

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"To quit or retain MUMPS, all or in part, that is the question" is lead on FCM.com's article discussing the industry's take on the VA's recent Modernization input, then subsequent Open Source RFI.

The topic is generating strong opinions among industry members.

 

Stakeholders include executives with a financial investment in existing open source VistA applications retaining MUMPS. For example, Medsphere Systems Corp.’s OpenVista is currently used in a modified form by the Indian Health Service and a number of public and private hospitals. MUMPS also is used in several other commercial electronic health record systems and in the banking industry.

 

“For modernization of VistA, we are recommending MUMPS for heavy-duty transaction processing,” said Rick Jung, chief operating officer of Medsphere. “MUMPS’ power to rapidly process transactions is unparalleled.”

 

MUMPS ought to remain the core of VistA, while other computer languages could be used for developing applications for related processes such as pushing data out to physicians, Jung said.

 

The point is not to replace MUMPS, but rather to build upon the stable and high performance platform that is VistA. New applications and technologies can and should be built using M and other languages -- the technology to extend the platform exists and is already being used in this manner.

 

 

 

The chair of the IAC Modernization committee initially backed away from the idea of replacing M, but went on to state he believes it should be considered for a few reasons:

He said the working group members anticipated controversy if they addressed the MUMPS question, and sought to avoid it.

 

“Why should we pick that fight? Let the experts decide,” Meagher said in a recent interview with FCW.

 

However, Meagher added that in his personal opinion, MUMPS should not be retained as part of a VistA modernization because it is outdated and because he claimed few MUMPS programmers are being trained. “Is MUMPS the right entity? I think the obvious answer is ‘no,’”

 

You can read the entire article at FCW.com.

99 Views 0 Comments 0 References Permalink Tags: medsphere_press, ed_meagher, iac, rick_jung, vista, va, open_source
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DVIDS (defense industry news) picked up a story suggesting several Iraqi ministries have agreed to work collaboratively on a WorldVistA-based EHR in Iraq:

Representatives from the Iraqi Ministries of Defense and Health and the Kurdistan Ministry of Health signed a memorandum of agreement earlier this month that will facilitate the implementation of an integrated, comprehensive health information system.

 

The program, WorldVistA, is based on the U.S. Department of Veterans Affairs health care management system and is expected to be in place in October.

 

 

The US military medical advisor in Iraq also supports the collaboration:

“WorldVistA will greatly enhance the Iraqis’ capability to communicate with each other, which in turn will provide quality health care to the people of Iraq,” said U.S. Army Col. Andrew Kosmowski, the senior medical advisor to the MoD Surgeon General’s Office.

 

Read the entire article at DVIDS.com.

209 Views 0 Comments 0 References Permalink Tags: worldvista, vista_press, iraq, kurdistan
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Nextgov.com published an article on the recent open source RFI from the VA:

The Veterans Affairs Department asked industry, government agencies and academic researchers last week for insights on using open source software as a key component of a modernized electronic heath record system, a move that could have serious implications for the Obama administration's initiative for adoption of digital medical files nationwide.

 

The focus of the RFI is for public comment on a series of questions around the implications of open source and VistA:

VistA software can be obtained under the Freedom of Information Act, and developers such as Medsphere Systems Corp. in San Diego have used the code to configure open source electronic health records systems. VA wants to take advantage of third-party developers such as Medsphere to improve and develop a modern VistA system. The project could lead to "broader proliferation of common electronic health record software and solutions," VA officials said.

While collaboration in the open source community brings with it "tremendous options," officials added, it also requires sensitivity to intellectual property rights and the development of a governance system to ensure stability.

VA asked for comments and insights on how to use open source software in its modernization efforts, including the role it should play in an "open source ecosystem and the role that non-VA developers should play in that ecosystem." The department also wants input on how other federal agencies could participate or benefit from an open source approach to develop a modernized electronic health record.

 

The article makes mention of the IAC "modernization committee" report, which published a series of recommendations, including the use of open source within the VA and more directly as a part of VistA.  Of note, the VA put the comment period on a fast track, requesting responses by August 25th.

 

You can read the entire article at nextgov.com.

139 Views 0 Comments 0 References Permalink Tags: open_source, vista_press, medsphere_press, iac, roger_baker, ed_meagher, joseph_dal_molin
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Healthcare IT News is reporting that the VA is now posting security breach data online.  Baker continues to deliver on his pledge of transparency.

VA must notify Congress monthly about both routine and major data  breaches, a requirement imposed in the aftermath of several security  breakdowns during the past year.

 

The public can now see those reports for itself, as the VA began to post them on the VA's Web site on Aug. 11.

 

"We gain a lot with transparency," Baker said. "When you see what  normally happens and how they are handled, it lends a bit of confidence  to what we're going to do when more serious ones occur," he said.

 

Amusingly, the document still bears the warning that the data should only be released under the direction of the CIO and states "No portion of this report should be furnished to the media, either in written or verbal form." (unless they read it on the web, I guess?)

 

Why would the open source VistA community care?  In some cases, potential adopters of open source VistA have legitimate concerns around VistA codebase security. Being able to review monthly reports showing mundane equipment or employee security breaches, but no VistA-based security risks, should provide a new level of comfort that VistA (properly protected within an enterprise) is indeed secure and ready for their facility.

 

Read the entire article on Healthcare IT.com

101 Views 0 Comments 0 References Permalink Tags: security, va, transparency, roger_baker
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In Federal Computer Week, VA CIO Roger Baker announced progress on the VLER program, referencing the adoption of the DOD's patient identifier to help track service personnel between the two systems:

To move along the VLER project, a month and a half ago, the VA began using DOD's Electronic Data Interchange Personal Identifier (EDIPI) for all its health and benefits records for veterans, Baker said.

“We will have a single, individual identifier for beneficiaries,” Baker said. “This is fundamental for the VLER.”

The EDIPI is a personal identifier code used internally by the DOD. The department assigns a nine-digit unique identifier to each new service member. The DOD identity cards display a 10-digit identity code, which consists of the EDIPI and an additional digit.

Previously, after service members retired from the military, the VA assigned additional number codes to identify them as they received benefits.

 

 

More interestingly, Baker specifically referenced the efforts around establishing a VistA modernization strategy by year's end:

Meanwhile, the VA expects to make a decision by year’s end about modernizing its Veterans Health Information Systems and Technology Architecture (VistA) record system and will issue several requests for information from industry before that decision, Baker said in a conference call with reporters.

 

Baker goes on to reference the IAC report, suggesting that the report was "good advice" and being incorporated into their strategy.  He suggested the transparency of that report was important to "stimulate the discussion" about VistA's future.

 

Read the entire article at FCW.com.

136 Views 0 Comments 0 References Permalink Tags: dod, vler, vista_press, va, roger_baker
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While not VistA specific, HealthCareIT News is running a story about a grant between the KMI, the VA, the DoD, Emory University and a few others to study Tramatic Brain Injury treatments through the use of video game technology -- a phase one study showed possibilities:

Kinetic Muscles, Inc. (KMI), a provider of neurorehabilitation technology for stroke and cerebral palsy patients, has received a two-year Phase II Small Business Innovation Research (SBIR) grant to study a new treatment for military veterans returning from war with traumatic brain injury (TBI). The announcement follows the promising results of Phase I of study, which combined neuropsychological therapy and digital gaming technology. This led the Department of Defense to fund Phase II, which will validate effectiveness of the therapy system through clinical testing in VA hospitals.

 

Therapeutic interventions that incorporate both state-of-the-art gaming technology and cutting-edge cognitive and motor rehabilitation strategies have the potential to be cost-effective and engaging – particularly for a generation of soldiers who have grown up playing video games.

 

"Treatment of TBI builds upon KMI’s neurotherapy technology platform," said Ed Koeneman, chief operating officer at KMI and principal investigator for the study. "Patients with stroke and TBI experience similar cognitive and movement deficits. KMI technology addresses rehabilitation for both groups through repetitive training of specific tasks."

 

The CDC reports "1.7 million Americans are affected by TBI each year, and there are 5.3  million people with permanent TBI-related disabilities in the United  States".  Having had a family member touched by such an injury, it is good to hear of promising studies.

 

The full article is available online.

326 Views 0 Comments 0 References Permalink Tags: tbi, va, dod, research
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In a recent article VA's "Aviva" system was mentioned as their next generation platform for health systems.  Federal Computer Weekly has posted an article with a few more technical details that are making the specifics of this project more clear.

The Aviva working prototype was delivered on Jan. 4 with access to VA and Defense Department data, new search functionalities not found in VistA and a “scalable and reusable foundation,” Peter Levin, chief technology officer for the VA, said in a presentation March 8 to a workgroup of the Health and Human Services Department’s Health IT Standards Committee.

 

In other words, the VA has built a presentation layer, which in the near term is the clinical data viewer for medical record data shared between the VA and DoD (via the NHIN), but longer term, they believe will form the platform for newer applications.

 

Aviva is designed to be modular and to allow for health data exchange through HHS’ Nationwide Health Information Network. Aviva is modular, efficient, scalable and Web-based, and it has modern programming language, Levin said.

Health data exchange with VistA has been impeded by an inadequate user interface, need for extensive user training, highly specialized and outdated programming language, and lack of common standards, he added.

 

Again -- the immediate design and development focus has been on health data exchange on the NHIN, but with modularity and extensibility kept in mind -- the goal is that Aviva can be used as a platform for future development.

 

Too soon to say much more as no real details on the technology and architecture have been revealed. Knowing a bit about the NHIN architecture and other projects within the Military Health Systems, we can assume it's a SOA-based system that allows the presentation layer to aggregate data from various sources, likely utilizing middle-tier services to process, normalize and extend upon the retrieved data.

 

You can read the entire article on Federal Computer Week.


487 Views 0 Comments 0 References Permalink Tags: va, dod, vista_press, aviva, peter_levin, nhin, soa
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VA and VistA get a brief note as leaders in the idea that an integrated system (including diagnostic images) is key to improving care:

This capability was first proved with the VistA electronic medical record system that manages text, DICOM, and non-DICOM images for all hospitals and outpatient clinics of the Veterans Health Administration. It is becoming commercially available as well. A number of vendors at the HIMSS meeting were demonstrating EMR products and electronic dashboards that merged text and images.

 

Just another example of VA VistA's emphasis on integration being ahead of its time.

 

You can read the entire article online.

300 Views 0 Comments 0 References Permalink Tags: radiology, vista_press, va, imaging
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In this Government Health IT article, the VA's CTO Peter Levin reveals plans for the 'next generation' VistA:

The Veterans Affairs Department is at work on the next-generation of VistA, its 20-plus year-old electronic medical record system, which is often praised by users but considered a headache to planners working to bring VA health systems fully into the Internet age.

 

Unfortunately this is not a new concept within the VA.  This has been attempted at varying levels before.  Additionally it seems strangely premature. We know the new VA leadership is moving fast to turn around aging infrastructure and other halted projects. But, we also know they have engaged an industry advisor group requesting recommendations on modernizing VistA from outside experts.  That report is not yet available, so a 'decision' of this magnitude doesn't seem to make much sense.

 

The real answer will be in their budget -- did anything like 'Aviva' get funding?

 

There is some good news here though.  It appears that everyone in government health delivery organizations is heading in the same direction -- right now they are on different roads, but at least there is agreement on the destination.

 

“All we really care about is data interoperability or data interoperability first,” Levin said. “We can exchange business rules later. If we can have some kind of convergence of the user layer, that’s great. But right now I am focused on data.”

 

Ultimately, VA wants to segment the kaleidoscope of data, business rules and lines of MUMPS code into a presentation layer “that protects the user from changes that take place behind the curtain.”

 

In making it interoperable, Levin said, VA would “segregate the presentation layer of VistA and attach it to the nationwide health information network.”

 

The key takeaways are around architecture decisions:

 

  • Separating the currently entangled data, business and presentation tiers is step one to modernization
  • Convergence of functionality from Indian Health Services' RPMS and Veteran Affairs VistA

 

You can read the entire article online.

738 Views 0 Comments Permalink Tags: peter_levin, va, vista_press, convergence, ihs, aviva
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Government HealthIT posted a news blurb about the VA's (continued) efforts to return to their collaborative roots.  No doubt, if appropriately managed and acknowledged, this will be a moral boost as well:

The Veterans Affairs Department has launched a competition among its employees to see who can come up with the best ideas for how to use health IT to improve the agency’s healthcare practices and treatments.

 

Under the terms of the contest, employees may enter health IT ideas in a variety of categories, such as engaging veterans in their care, helping medical providers, increasing transparency and improving workflow.

 

“Many components of our VistA electronic health records system originated in innovations from our health care workforce” said Dr. Gerald Cross, acting VA under secretary for health. VA's health IT system has always been a collaboration among its healthcare users and IT staff, he added.

 

Read the entire article at Government HealthIT.

422 Views 0 Comments 0 References Permalink Tags: va, competition, collaboration, gerald_cross
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From a snippet on HISTalk this morning:

David Whiles, IT director at Midland Memorial Hospital (TX), is recognized by the hospital district’s board of directors for its implementation of OpenVista. He expresses surprise: “It’s a hospital project, not an IT project.” Seems like they should give him a CIO title.

 

 

I could not agree more -- the CIO title would be well deserved.  The short article in a local newpaper details the work David has done to create a unified health record within Midland Memorial Hospital, using Medsphere OpenVista.

Although Director of Hospital Information Systems David Whiles has received national and worldwide recognition for his work to give Midland Memorial Hospital a fully electronic medical records system, Wednesday marked the first time he received formal kudos from the Midland County Hospital District Board of Directors.

Visitors from across the nation and world have visited Midland to see how the system -- based on the one used by the Veterans Administration -- was implemented.

Whiles has received coverage from the Wall Street Journal and trade magazines as well.

Whiles said he was shocked at the recognition and gave credit to the team that works with him. "It's a hospital project, not an IT (information technology) project," he said.

 

 

Well said and congratulations to David and the entire team at Midland Memorial Hospital.

 

The entire article is available online.

2,369 Views 0 Comments 0 References Permalink Tags: mmh, david_whiles, openvista
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Announced this morning, remote hosting of VistA-based solutions is now available:

Astronaut, LLC  Announces Astronaut VistA Shuttle™ Beta program. Astronaut VistA Shuttle™ allows health care facilities, educators, developers, and physicians to start and manage affordable, encrypted, cloud based instances of Astronaut VistA Electronic Health Record (EHR) in minutes. This Beta is the first offering of a cloud-based Veterans Affairs VistA EHR with many enhancements. Astronaut, LLC offers both WorldVistA™ and OpenVista™ based editions.

 

 

Ignacio Valdes, President and CEO of Astronaut, explained the motivation behind the offering and the name:

The inspiration for the name "Astronaut VistA" is twofold. Astronaut, LLC is headquartered in Houston, Texas, near NASA mission control. Second, Astronauts make extremely complex technology and science applied in a high-pressure environment into something that looks easy and fun. Astronaut intends to make VistA into something that any clinician can easily enjoy while positioning its users and products to achieve ARRA certification and "meaningful use". CEO and President Ignacio Valdes, MD, MS, states: "Astronaut, LLC was formed to benefit society through innovative and affordable Electronic Medical Record software based on standard, proven products. The future is here. Astronaut provides software that greatly improves the functionality and user experience for VistA in the private sector."

 

You can learn more about Astronaut and the Shuttle offering on their website.

577 Views 0 Comments 0 References Permalink Tags: astronaut, shuttle, ignacio_valdes, openvista
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The head of the VistA Policy group formed earlier this year under the auspices of the IAC, is quoted in a Federal Computer Weekly article stating facts about VistA:

“VistA is the best health information system in the world, bar none,” Ed Meagher, who chairs the Industry Advisory Council (IAC) VistA Project, told Federal Computer Week. “At the same time, VistA is very old, very hard to maintain, hard to manage and manipulate, and incredibly expensive to maintain.”

 

While factual, the context of the quote is important. VistA powers arguably the largest health system in this country, possibly the world.  That's close to 1300 facilities across the US (states AND territories!) all linked together and able to aggregate the patient data of a vet seen in California and Virginia in real-time.  Maintaining that sort of system is hard and expensive, no matter whether it is homegrown, bought off the shelf or adapted from another source.

 

Further, it is important to recognize that maintaining infrastructure has costs. Even worse, if you ignore or defer the maintenance of infrastructure you incur technical debt. A system that is pushed from one leadership team to the next, argued about in congress and generally left stagnant for a period of years without any investment will surely incur more and more of this technical debt.  Thankfully the new leadership at the VA seems to have recognized this and is attacking the problem from a number of angles, including IAC's committee.

VistA already is being used by some private hospitals; varieties of the VistA software code are available in open-source form at no charge. The IAC VistA Policy group is evaluating how it could be made more widely available in an open-source model, as well as other issues, Meagher said.

The goal is to leverage, as much as possible, the taxpayers’ $8 billion investment in developing VistA over the last 20 years, Meagher said.

“The key is that industry will be making a recommendation to the government, and that does not happen a lot. It is a very powerful thing,” Meagher said. “We have been given a real opportunity.”

 

This effort to maintain, automate the operations, and modernize the platform has very much been an ongoing project for the larger VistA Ecosystem -- the individuals, public and private organizations that participate in these efforts have made good progress on this front.

 

There are now multiple major proof points as to just how well a non-VA facility can adopt a VistA-based system and to just how much ROI they can expect from that investment.

 

The entire article is available online at Federal Computer Weekly.

807 Views 0 Comments 0 References Permalink Tags: ed_meagher, iac, vista_press, technical_debt, roi
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In an extremely provocative blog post last week that mentions Medsphere's recent contract with Kern Medical Center, SmartPlanet's Dana Blankenhorn (formerly of ZDNet) makes the case that with time running down on prepping for meaningful use and qualifying for federal ARRA funds, open source may have an advantage over proprietary systems.

The Bush Administration starved VistA of development funds, preferring a system of contracts and contractors who used HIMSS-approved gear. At the peak of the fight the VA even lost control of its own lab software system to Cerner, a commercial rival.

 

... the Obama Administration reversed the trend. Top officials proclaimed themselves fans of VistA, and its open source approach.

 

Suddenly, it seems, VistA has the advantage.

The core of Blankenhorn's argument is not that VistA and derivative solutions have superior functional attributes and compete effectively in every 'bake-off and beauty contest.' Well, he doesn't make this argument directly. Rather, he says that open source projects are not subject to some of the same contracting provisions as proprietary and can be implemented within the time remaining before federal stimulus funds become available.

Kern, a county hospital, has needed an EHR for some time. But getting a commercial system meant writing a Request for Proposal (RFP) for a consultant who would write an RFP for a system, and a complex process of analysis to make sure what they ordered would be what they needed. Plus millions of dollars for the software.

 

Enter Medsphere, a commercial supporter of VistA software. Their OpenVista is open source. Kern could download it, call it free, and then sign a professional services contract with Medsphere for support.

 

Suddenly, a two-year contracting process could be squeezed into six months. And with the first deadlines for getting stimulus money coming in 2011, Hensler found he could suddenly get in line for some of that money, thanks to open source.

Of course, Blankenhorn's unspoken argment is that open source solutions, in this case OpenVista, are capable of getting a medium-sized acute care and teaching facility like Kern Medical Center prepped for the federal govenment's meaningful use assessments. Why even consider the solution otherwise? Then there are the other benefits mentioned in the blog: adaptability, affordability, real partnership with the services provider, etc.

 

Blankenhorn's statement--Advantage: Open Source--may be the strongest to date on the viability of open source solutions as we rush headlong into the federal government's program to bring healthcare into the modern technological era.

 

You can read Dana Blankenhorn's entire blog post here.

513 Views 0 Comments 0 References Permalink Tags: blankenhorn, hensler, kmc, kern_medical_center
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NextGov follows up on the report from earlier this year regarding 45 halted VA projects -- 17 have now been entirely disbanded. The article largely addresses the work the VA is doing to adopt stricter processes and guidelines around IT project oversight.

The Veterans Affairs Department has ended or cut funding for 15 information technology projects that it temporarily halted this summer, VA officials said on Tuesday night.


The department in July announced it had stopped 45 IT projects -- budgeted at about $200 million total -- that were either over cost or behind schedule to decide whether they should continue.

 

The projects were identified as part of an effort to prepare the agency for posting of project data to the government's project status/spending dashboard.

Problems with the initiatives surfaced while VA was preparing materials for a White House Web site that tracks IT project development and launching its own new project assessment system.

 

This approach "has been very, very instructive and a very powerful tool in restoring confidence in our ability to do IT," VA Deputy Secretary Scott Gould said in an interview with Nextgov.com. "We have a commitment to deliver on cost and on schedule." Gould, a former vice president for public sector strategy at IBM Global Business Services, VA Secretary Eric K. Shinseki, and Chief Information Officer Roger Baker said such IT oversight is critical to supporting the nation's veterans.

 

The report didn't include more than numbers of projects restarted or halted, so it isn't clear (yet) which projects will continue on and which are gone forever:

Of the 45 projects flagged, VA gave 17 a second chance to meet their next milestone and nearly all hit their target dates.

 

 

The appraisals are part of a new project assessment method aimed at holding IT investments accountable to the taxpayer. The Project Management Accountability System halts programs that fail to meet incremental milestones.

 

Thirteen of the projects frozen this summer have been restarted.

 

Read the entire article on NextGov.com.

566 Views 0 Comments 0 References Permalink Tags: scott_gould, roger_baker, va
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