RE: [Hardhats-members] == VistaWeb Missing Apps ==

Thu, 09 Jun 2005 17:28:20 -0700

Yep.  One of the many, very valid reasons the VA is replacing VistA, and one not mentioned, I believe, in the St. Pete Times article.

 

From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Cameron Schlehuber
Sent: Thursday, June 09, 2005 5:53 PM
To: hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==

 

Regarding the nonstandard note titles and the difficulties that poses ... there have actually been some significant peer-reviewed journal articles by some VA folks on that very issue.  In fact, standardization of note titles is one of the things currently in the queue to be accomplished in VistA (I'm not sure but I believe it's also part of the CPRS-R work coming out very soon).  A fair amount of automated matching to standard titles will be performed (no doubt with some manual intervention and checking).  Once in place, new note titles would be quickly built up from a compound set of expressions from the Enterprise Reference Terminology which would cover virtually all of the useful note titles (excepting the odd and uninformative ones such as "Dr Soandso's notes").  That means that both old and new titles can be sorted and searched in computationally meaningful ways for quick and easy use.

 

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Gillon, Joseph
Sent: Thursday, June 09, 2005 1:06 PM
To: hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==

 

That's an interesting problem you pose.  Did you ever see Euclid?  It had a problem-centric UI that apparently providers loved.  I guess you would click on, say, diabetes, and it would tell you what you should know about diabetes for patients of a certain age, gender, ethnicity, whatever.  It would offer recommendations for meds and also check prescriptions for possible problems.  It was written by a doc who's now in Reno.  He just sent me the latest which is now web-based and uses MDO, the middleware techonology that VW uses. 

 

A sort of related but not quite the same feature is something VW will use soon, and that's Up-to-Date and medical dictionary searches.  User highlights text, right clicks, picks the search engine and gets info.

 

I'm saying all this just to indicate there are efforts to get some AI into our EMRs.  In fact, the CPRS-R folks are going to use a lot of the old Euclid functionality.  Oh, it has a thing called Assist that helps write notes.  Sorry I don't know exactly how...

 

From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Sowinski, Richard J.
Sent: Thursday, June 09, 2005 3:51 PM
To: 'hardhats-members@lists.sourceforge.net'
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==

 

Joe,

 

It's good to see you on Hardhats. What took you so long ?

 

Sorry about "hunt and peck" analogy it's just the most apt description of what I see users doing when they use these products.

 

It's just my bias, I think remote data viewers fill an interim niche. But I have had busy docs tell me that they don't have the time to sift through this data on most patients, unless they are really, really curious about something. I think the same thing can be said for Docs sifting through reams of CPRS data from their own site! Just no time to do that: they see their patient, write their note, write their prescription and any other orders, and get on to the next patient.

 

This is no reflection on your VistaWeb product. I think it's a great tool, faster than RDV's, and an accomplishment on your part. It certainly helps alot when Docs really want to see that data.

 

I also think it is good that there is such great interest outside of VA in some of the things VA has developed over the past few years, including VistaWeb.

 

It's all good.

 

Joe, you are on the right track, I think your VistaWeb product could be separated pretty simply from some of the "complexities" underneath.

 

We can talk off-line if you want. I don't want to burn anymore Hardhats bandwidth on this topic, especially considering who is listening.

 

I have all the respect in the world for the St Peterburg Times and their affiliation with the Poynter Institute, one of the most respected journalism schools in the country, but I wish we could "talk tech" here without worrying about being monitored or quoted.

 

After all, that's really what this forum is for.

 

- Rich

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Gillon, Joseph
Sent: Thursday, June 09, 2005 1:06 PM
To: hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==

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

       
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        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)


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