First, I should mention that if you are a
VA employee be careful what you say to this guy. He’s a biased,
sensationalist reporter looking to make copy and not, IMHO, particulary
interested in veracity. More interested in uncovering another CoreFLS
than anything else.
On to Rich. And hi BTW, been a
while. Thinking just of implementing VW or RDV outside the VA, you hit on
one extremely important item, namely standardization of data. I disagree
with the “hunt and peck” label you’re sticking VW with since
it shows all the data, collated, in seconds. However, due to the
non-standard note titles and stuff of that ilk, when you sort the titles you
don’t necessarily get, say, all the cariology notes, in one place.
Were I starting a new multi-site VistA system
I would really, really, really give some time and effort to implementing
standard note/report titles, lab panel titles, team names, etc. All this
stuff is a totally squirrelly mess in the VA after years of each site doing
whatever it pleased.
And I think Rich hits another nail on the
head with the MPI thing. If you are going to have distributed databases
you definitely need something central to figure out what sites to query.
Well, maybe if you only had half a dozen sites… Still. Rich,
I know that VistA kicks out an HL7 message on
inpatient events (admit, discharge, transfer). Does it do anything on
outpatient visits? If it did you could just set up an HL7 listener to
catch these messages and put the relevant data into an SQL database.
Then, since VW can talk to SQL databases as well as VistA
databases, you could just replace the MPI RPC with a select statement.
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED]
Sent: Thursday, June 09, 2005 1:45
PM
To: hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
----- Forwarded by Steve
Nohlgren/News/Sptimes on 06/09/2005 01:43 PM -----
|
|
[EMAIL PROTECTED]
Sent
by: [EMAIL PROTECTED]
06/09/2005 10:18 AM
Please
respond to hardhats-members
|
To: hardhats-members@lists.sourceforge.net
cc:
Subject: RE:
[Hardhats-members] == VistaWeb Missing Apps ==
|
Mr. Sowinski's comments about the value of a central
data repository or repositories speaks to an issue we are wondering about at
the St. Petersburg Times--whether or not HealtheVet plans inject some
unnecessary complexities while upgrading VistA.
As I understand it, the national HDR will be an Oracle database that will merge
clinical data real time and avoid this hunting and pecking for remote info. It
will also to allow for report writing and queries to get a better handle on
trends. Kaiser Permanente is splitting those two functions in their Epic
System. The clinical data is stored in a Cache warehouse so everything pops up
automatically no matter where the patient goes for treatment, but that data
also become input to an Oracle warehouse for report writing and analysis. As I
understand it, they figured that keeping both functions in a relational
database would require more CPU and slow down the clinical side. Would such a
divided s ystem make more sense for the VA's centralized database. If anyone
feels like responding to me directly, you can use your home e-mail.
Thanks,
Steve Nohlgren
When
I speak of the "complexities" of the infrastructure I am speaking of
the MPI,
the updating of data across sites, etc. Initializing all patients with ICN's
etc.
Actually, I think that particular infrastructure could be simplified, and
probably should be
simplified, if one wanted to implement remote data viewing capability
outside of
VHA.
When you think about it, you really only need a list of sites a patient has
been
"registered at", and a good identifying scheme, to
"assemble" a patient's
record
from multiple sites.
But actually, the model I prefer is a centralized repository or
repositories.
The problem with apps like Remote Data Views and VistaWeb is, the physician
has
to "hunt an peck" for data. Physicians are expected to do 20-minute
appointments,
write their computerized notes and orders, and maintain 2000-patient panels.
Many Docs
simply do not have the time to look through this remote data.
Other issues are, you cannot run research-type queries across sites, to
identify cohorts
of patients meeting certain research criteria. Data is not standardized.
Your lab test name,
or lab test panel, may be different from mine.
With a data repository: reminders, alerts, etc can be run against a
standardized database,
and and data from many sites can be viewed via a common interface. A Doctor
can even be
paged automatically, if a patient's test data is outside normal ranges. Or
for any other
reason, specified.
But apps like RDV's and VistaWeb certainly fill a niche, for some Docs who
have smaller panels
or, who take the extra time, for now.
- Rich
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] Behalf Of Jim
Self
Sent: Wednesday, June 08, 2005 5:55 PM
To: hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
Richard Sowinski wrote:
>The reason I have asked people on this list if they have VistaWeb up and
>running, is because I suspect
>they underestimate the infrastructure required "under the hood",
to make
it,
>or RDV run.
>
>I also suspect, some have misconstrued what VistaWeb is. I think some of
>them think it is a Web-based front-end
>to Vista, instead of a remote view-only
application, used to view patient
>data at other sites.
I haven't tried to get VistaWeb running because of a lack of free time for
playing with
things dependent on M$ proprietary technology, but I have thought that the
source files in
VistaWeb might be helpful in defining some aspects of what a Web-based
front-end to VistA
should include.
>From reviewing the VistaWeb documentation a while back, it seemed to me that
it would be
quite easy using M2Web to improve upon the views of VistA
data provided by
VistaWeb if
someone could take a little time just to specify what views are needed and
what data
fields should be included. I had the same impression from a health-e-vet
demo earlier, but
I haven't had the free time to pursue either very much so far. I have a good
understanding
of the underlying technology (MUMPS, Fileman, Web, etc.) but not of the
VistA EMR, so
someone with that knowledge and/or the time to gather it could help greatly
to move such a
project along.
---------------------------------------
Jim Self
Systems Architect, Lead Developer
VMTH Computer Services, UC Davis
(http://www.vmth.ucdavis.edu/us/jaself)
-------------------------------------------------------
This SF.Net email is sponsored by: NEC IT Guy Games. How far can you
shotput
a projector? How fast can you ride your desk chair down the office luge
track?
If you want to score the big prize, get to know the little guy.
Play to win an NEC 61" plasma display: http://www.necitguy.com/?r=20
_______________________________________________
Hardhats-members mailing list
Hardhats-members@lists.sourceforge.net
https://lists.sourceforge.net/lists/listinfo/hardhats-members
-------------------------------------------------------
This SF.Net email is sponsored by: NEC IT Guy Games. How far can you
shotput
a projector? How fast can you ride your desk chair down the office luge track?
If you want to score the big prize, get to know the little guy.
Play to win an NEC 61" plasma display: http://www.necitguy.com/?r=20
_______________________________________________
Hardhats-members mailing list
Hardhats-members@lists.sourceforge.net
https://lists.sourceforge.net/lists/listinfo/hardhats-members
