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VistA, OpenVista, WorldVistA in the News

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with VistA has been impeded by an inadequate user interface, need for extensive user training, highly specialized and outdated programming language, and lack of common standards, he added.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


40 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.

41 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.

100 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.

183 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.

1,280 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.

316 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.

408 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.

309 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.

331 Views 0 Comments 0 References Permalink Tags: scott_gould, roger_baker, va
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Anyone associated with the implementation of an electronic health record (EHR) knows it is not an easy task. Now the American Medical News is validating that perspective with the publication today (11/23) of an article on the educational efforts associated with the American Recovery and Reinvestment Act (ARRA) and EHR implementation in general. The primary sources for the article are Dr. Edmund Billings and Lior Blik, the CEO at Medsphere partner NITHealth.

"What's very clear from the [American Recovery and Reinvestment Act] incentives and the drive towards getting 100% EMR adoption ... is you have to have people on site and in the field that know how to use and deploy and make EMRs work," said Edmund Billings, MD, chief medical officer and executive vice president of products for Medsphere. "When you have 15% of practices and under 5% of hospitals that are fully adopted, you don't have a lot of people who know how to do this."

The article mentions both Medsphere and NITHealth regarding effort to increase EHR understanding, but doesn't necessarily connect the two companies as partners in the New York/New Jersey area. Even so, NITHealth's specific plans for the area are a focus.

In January 2010, the Borough of Manhattan Community College plans to begin offering classes that NITHealth helped to design. Three separate curriculums will be offered, one of which is geared toward clinical professionals.

Both Medsphere and NITHealth are positioned as drivers in the effort to broaden the understanding of EMRs both in existing healthcare facilities and among people considering healthcare as a career.

 

Visit the American Medical News Web site to read the full article.

276 Views 0 Comments 0 References Permalink Tags: blik, billings, nithealth, american_medical_news
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A recent article in the San Diego Union-Tribune (UT) focuses on the boost to area businesses coming from the components in the American Recovery and Reinvestment Act (ARRA) that focus on promoting EHR adoption by healthcare facilities. The author does a good job of citing relevant sources regarding the benefits of health IT, but also puts the benefits in context with regard to the speed of tangible results.

Once the networks are up and running, it should make hospitals, clinics and private practitioners’ offices run more efficiently — and cheaply. A 2005 report by the think tank Rand Corp. estimated that a properly designed network could save the health care system as much as $77 billion per year by providing doctors with the necessary tools to make decisions.

 

Those kinds of savings are far in the future and will come only after health care providers, which now rely on paper for their record-keeping, are interlinked and work out the inevitable kinks and bugs of connecting competing software systems, as well as addressing the challenge of keeping personal records secure.

The only critic of the federal governments stimulus efforts quoted in the article questioned whether many physicians really need the financial assistance.

Tevi Troy, who was a deputy secretary of health and human services in the Bush administration, said that even though he believes that electronic health records are “inherently good” and that government should take steps to encourage their growth, he questions why the program will require so much taxpayer money.

“Should taxpayers purchase a good that some doctors and hospitals have already had the ability to purchase with their own money?” Troy asked in a paper published by the conservative Heritage Foundation this year.

Medsphere figures prominently in the UT article, with quotes from Mike Doyle that are actually the product of comments he made on Tuesday, 11/17, as part of a panel on entrepreneurial opportunities at the MIT Enterprise Forum in La Jolla. In offering up his optimistic forecast for health IT, Mike was unfortunately identified as the president of some company called 'Medtech.' His sunny comments did not, however, lose their impact.

Mike Doyle, Medtech’s president, predicts that the health technology field will continue to grow even after the stimulus goes away.

 

“A whole new market is going to revolve around this space, whether it’s manufacturers who build devices that can plug into the (electronic health records) systems or software companies that can build more applications for the systems,” Doyle said.

Use the link at the top of this blog post to read the entire article.

275 Views 0 Comments 0 References Permalink Tags: doyle, arra, union-tribune
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A recent article in Health Management Technology on EHR implementation at Memorial Hospital of Sweetwater County initally pretty much touches on all the benefits we tout ourselves: increased efficiency, improved regulatory compliance, and tremendous cost savings.

 

But Linda Simmons, VP of operations and chief nursing officer at Memorial Hospital, also identifies results related to implementation process that stand out and might prove useful to other hospitals.

Memorial Hospital made the decision to go live in one day instead of rolling out the technology in partial components. The OpenVista EHR was implemented across the facility, with BCMA adopted the following day. "Given the size of the facility, having one department digital with another still relying on paper was thought to create more problems and confusion," Simmons explains.

And how did the 'Big Bang' approach work for Memorial Hospital?

"Having all departments on digital records was stressful to clinicians and staff," says Simmons, "but the feedback from medical staff following a month after going live was positive. It was much easier to integrate EHR technology and patient care in one day, preferable than several weeks or months of gradual adoption."

As Medsphere explains to new customers, there are "Five Ways to Go Live." Did Memorial Hospital demonstrate that one is superior to the others? Perhaps. After the initial chaos of this approach, things have calmed considerably and the hospital is now reaping the rewards.

"In time, even the ones who were most resistant to EHR became the biggest fans," asserts Simmons. "For example, older physicians, who initially resisted EHR technology, are now some of the most popular users of OpenVista at MHSC."

"... MHSC improved clinical care dramatically following the implementation of OpenVista," Simmons says. "The omission of medications, for example, the number-one reason for medication errors at Memorial Hospital, decreased to a minimal one to two per quarter following the implementation of the EHR system. Furthermore, late administration of medication, which occurred in the hundreds per quarter prior to EHR adoption, decreased to 33, as clinicians were prompted by alerts from digital patient records."

Read the entire article at healthmgttech.com.

279 Views 0 Comments Permalink Tags: health_management_technology, mhsc, linda_simmons
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FierceEMR reminds their readers that VistA is a good example of a national EHR:

Lest anyone forget, there's a huge organization right here in the good old U.S. of A. that has been quite successful with an enterprise-wide EMR implementation for several years: the Department of Veterans Affairs. That EMR, the Veterans Health Information Systems and Technology Architecture--better known as VistA--is the subject of a major feature in the Wall Street Journal, intended as a lesson for the thousands of other hospitals that are moving to digitize their medical records.

 

They also call attention to a recent announcement about a VistA implementation pilot in Amman Jordan:

VistA isn't for everyone, since the VA is a closed system that employs all of its physicians and nurses. It's also effectively a single-payer organization, with all the pros and cons associated with that model. Of course, some private firms have been successful commercializing VistA and scaling it down for use in a multi-payer environment. And, as a story in E-Health Europe about a VistA implementation in Amman, Jordan, demonstrates, other countries have taken advantage of the open-source software to bring EMRs to their own hospitals.

 

Read the entire article at FierceEMR.

280 Views 0 Comments 0 References Permalink Tags: vista_press, jordan
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This article in the Fort Worth Business Press, largely summarizes the details of medical records purposes, the ARRA stimulus package, and current adoption levels -- starting with a bit of history:

When Dr. Henry Plummer developed the concept of the “unit record” nearly 100 years ago, his idea was to place all of a patient’s records in a single file that traveled with the patient and could be stored in a central repository. His concept of medical care continuity quickly became the standard for medical record keeping worldwide.

 

I wonder what Dr. Plummer would make of today’s adoption of electronic medical records (EMR) by U.S. health care providers? After all, the concept is basically the same, just expanded to take advantage of today’s capacious electronic storage and retrieval methods.

 

 

VistA and VA get a brief node for universal access to patient records and interoperability:

Even the federal government thinks electronic record keeping is important. Veterans’ hospitals across the country share an electronic system called VistA, which shares records of veterans in its health system. Should a patient find him or herself in a VA hospital, even away from home, the hospital will have the same access to his or her records that the hometown hospital does.

 

Read the entire article at FWBussinessPress.com.

367 Views 2 Comments Permalink Tags: vista_press, stimulus, henry_plummer, adoption
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Federal Computer Weekly covers the story about the VA's efforts to reach out to the commercial industry via the IAC to understand what VistA's future could be:

With industry's involvement, questions are coming to the fore, including whether anyone would want to use VA's aging system — and the answer appears to be yes.

 

“There is definitely a demand, and it probably would be very competitive with commercial electronic health record systems,” said Lauren Jones, principal analyst at Input, a market research firm in Reston, Va.

 

 

By conforming to an open source model, such as OpenVista and NHIN Connect the VA could leverage quite a bit of momentum and spreak VistA farther and wider:

The modernization is likely to include updating VistA’s architecture and conforming with OpenVistA, an open-source version of VistA, said Larry Albert, president of the health care sector at Agilex Technologies, who has worked on VistA. Another goal might be making VistA easier to use while also maintaining its clinical richness, he said.

 

The broader health provider community would greatly benefit from access to an open-source VistA with the Connect open-source interface to the Federal Health Architecture, he said. That would combine an electronic health record with information exchange and system security, Albert said.

 

Read the entire article at FederalComputerWeekly.

219 Views 0 Comments Permalink Tags: roger_baker, vista_press, openvista, va, iac, nhin, open_source
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