I agree it's not a healthy situation...the amount of money has little to do with the software...VistA is consistently rated by doctors and nurses as better than Epic, Cerner etc. The cost has more to do with procurement and software development practices in the US federal system and EU, Canada, Australia etc. for that matter... plus the size and complexity of the VA itself. There are many examples of how improvement can be made faster and at a reasonable cost... Tony Shannon and Rob Tweed contributed good examples recently.
Having said that .... this is way off topic for this list... happy to discuss offline or suggest going to HardHats. Joseph On 15-04-20 12:44 PM, Bert Verhees wrote: > 200 Million dollar for a software upgrade? > Let's say, 2000 high quality programmer years? > > It does not occur to me as a healthy situation. Is the system so much > behind? What is the vision, can't just be implementing some new > technologies. It must be a whole new vision, and a new product coming > out of that which has nothing much more then backwards compatibility > to remind of the old system. > > I think with 400 high quality programmers in 5 years they should be > able to wipe out all the closed source vendors, especially if the > product will be developed on non profit base. It looks like a war > against the healthcare software industries. > > > > Op maandag 20 april 2015 heeft Joseph Dal Molin <dalmolin at e-cology.ca > <mailto:dalmolin at e-cology.ca>> het volgende geschreven: > > Danny, > > I echo most of Tony's comments... to me openEHR is focused on > getting the DNA right so that interoperability comes naturally... > while VistA is a public domain and open source EHR solution that > could benefit from some degree of genetic re-engineering. So could > every other EHR and health care solution for that matter. To > Tony's point on refactoring etc. the VA is investing close to $200 > M upgrading VistA levarging technology like java script, node.js etc. > > WorldVistA is a charitable, non-profit, incorporated in 2002, > which established the open source community for VistA, ported > VistA to a full open source stack, and is the steward of > WorldVistA EHR which is the dominant version of VistA used outside > the US (e.g. Jordan's national health system, Mexico IMSS and 12+ > hospitals in India) The Hardhats forum is the place to explore > VistA if anyone interested in learning more about VistA: > > http://groups.google.com/group/Hardhats > > The takeaway in this thread for me is what and how can communities > learn from each other without requiring complete religious > conversion? I know we are all extremely busy, but it's remarkable > how little cross-pollination is taking place the open source world. > > Cheers, > > Joseph > > Joseph Dal Molin > President, E-cology Corp. > Chairman, WorldVistA > Tel: +1.416.232.1206 > Skype: dalmolin > > On 15-04-20 07:22 AM, Tony Shannon wrote: >> Danny >> >> Not sure what you're background is in informatics, but sense you >> could fairly easily get confused here. >> There may be something helpful in these articles. >> frectal.com/2013/09/18/transatlantic_thoughts_onvista_nhs/ >> <http://frectal.com/2013/09/18/transatlantic_thoughts_onvista_nhs/> >> frectal.com/2014/06/30/21stc-healthcare-open-platform/ >> <http://frectal.com/2014/06/30/21stc-healthcare-open-platform/> >> >> Essentially; >> #VistA is a successful EHR from the VA, which needs refactoring >> to bring it into the 21st Century. Its architecture is complex + >> and it could do with improvements along the lines of openEHR imho. >> #openEHR offers the technical specifications & architecture that >> many of us feel is well suited to 21st Century healthcare >> platform, esp the two level modelling elements (aka archetypes >> and templates) to build scalable healthcare applications. openEHR >> can be implemented in several flavours with languages from .net >> to java and databases from SQL to NoSQL in active use. >> That first article was to suggest these 2 camps could learn from >> each other.. >> ie VistA could learn from openEHR and openEHR could learn from >> the NoSQL properties of M. >> >> Much of the standards efforts in healthcare to date has been >> about standardising the messages between system eg HL7 , FHIR >> etc, which doesn't get to the heart of the 21st C challenge. >> openEHR goes deeper than that to standardise the architecture of >> healthcare applications via a platform approach, (which by the >> way can help with message standardisation as a by-product). >> >> Further background reading here; >> http://frectal.com/book/ >> >> regards >> Tony >> >> >> Re: greetings and 2 questions >> openEHR-implementers >> [openehr-implementers-bounces at lists.openehr.org >> <javascript:_e(%7B%7D,'cvml','openehr-implementers-bounces at >> lists.openehr.org');>] >> on behalf of Diego Bosc? [yampeku at gmail.com >> <javascript:_e(%7B%7D,'cvml','yampeku at gmail.com');>] >> Outlook Web Access has blocked access to attachments. Blocked >> attachments: ATT00001.txt. >> To help protect your privacy, some content in this message has >> been blocked. If you are sure that this message is from a trusted >> sender and you want to re-enable the blocked features, click here. >> Sent:20 April 2015 12:05 >> To: >> For openEHR implementation discussions >> [openehr-implementers at lists.openehr.org >> <javascript:_e(%7B%7D,'cvml','openehr-implementers at >> lists.openehr.org');>]; >> For openEHR clinical discussions >> [openehr-clinical at lists.openehr.org >> <javascript:_e(%7B%7D,'cvml','openehr-clinical at lists.openehr.org');>] >> Sorry for the confusion, I assumed you had a background in FHIR :) >> I think what archetypes are is well explained here: >> >> https://openehr.atlassian.net/wiki/display/healthmod/Introduction+to+Archetypes+and+Archetype+classes >> I encourage you to visit the wiki. Archetypes are aimed to >> clinicians so you will have no problems with that. I'll also send >> this mail to the clinical discussions list, from which you will >> get responses suited for you. >> The use of standards in healthcare is not the as widespread as it >> is in other domains, and not all factors are 'solvable' (i.e. >> political factors) >> >> 2015-04-20 12:48 GMT+02:00 Danny Nguyen <dannyn08 at gmail.com >> <javascript:_e(%7B%7D,'cvml','dannyn08 at gmail.com');>>: >> Hi Diego, >> >> Thank you for the response. >> >> 1. WorldVista is the group but yes it seems to be a software >> too. There is also a software called openVista. The origination >> of Vista came from the Veterans affairs in the US. It was written >> in MUMPS programming language with is also the database. From my >> understanding, GT.M is the mumps database but mumps is also the >> language. The database is indexed so I think that is noSQL. How >> is openEHR different? Which implementations have been successful >> and do they talk to each other? >> >> 2. Wow, this is confusing to me. Can you please elaborate? Please >> explain like I am a two year old. I am a clinician by training >> and new to programming. Archetypes? I found this: >> >> http://www.cise.ufl.edu/research/ParallelPatterns/CITarchetypes/archetypes.html. >> Also can you explain how interoperability is still a problem if >> there is a standard like HL7/ISO13606? ISO13606 mentions >> something about identifiable information. >> >> Best, >> >> danny >> >> >> On Mon, Apr 20, 2015 at 3:02 AM, Diego Bosc? <yampeku at gmail.com >> <javascript:_e(%7B%7D,'cvml','yampeku at gmail.com');>> wrote: >> Hello Danny, >> >> 1) I didn't know about the existence of WordVistA, but by the >> looks of it seems to be a software, is it right? openEHR is a set >> of open specifications to build future-proof health information >> systems. There are some reference implementations in different >> programing languages and technologies. >> >> 2) I don't think anyone would say that a single standard solves >> interoperability problem. I assume that FHIR would be perfect if >> your requirements align with the original purpose of each >> Resource. However, I think there is still work to do with the >> profiling of FHIR resources. I believe that just to know if the >> profile of the server and the client are "compatible" is still an >> open problem, and without that you end with one-to-one agreements >> which I find difficult to call interoperability. I think this >> part is better solved with the dual model approach. To make an >> analogy, the archetype approach is similar to FHIR profiling, but >> everything would come as profiles of FHIR Composition Resource. >> Instead of a 80-20 philosophy, archetypes follow a maximal >> approach, which can be specialized or templated for your use >> case. This assures that specialized archetypes follow both the >> original archetype and the reference model. You can see examples >> of archetypes in http://www.openehr.org/ckm >> >> PS: ISO13606 is an archetype based ISO standard for the semantic >> interoperability of EHR data, and has been a standard for some >> years now. FHIR is still a DSTU. I think that your second >> question could be rewritten with any other healthcare standard ;) >> >> Regards >> >> >> 2015-04-20 3:10 GMT+02:00 Danny Nguyen <dannyn08 at gmail.com >> <javascript:_e(%7B%7D,'cvml','dannyn08 at gmail.com');>>: >> Hi, >> >> The following questions may be US centric but my general intent >> is the general healthcare topic of interoperability: >> >> 1. What is the difference between WorldVistA and OpenEHR? I know >> VistA is written in Mumps which claims a superior organization of >> vast numbers of dependencies. >> >> 2. If HL7 (FHIR being developed: http://www.hl7.org/FHIR) is the >> standard in data protocol between all healthcare software >> vendors, doesn't that mean that any system that can use that >> protocol solve the interoperability problem? >> >> I'd really appreciate hearing the facts and then separating those >> from the different point of views. >> >> Best, >> >> -- >> danny >> >> >> >> _______________________________________________ >> openEHR-implementers mailing list >> openEHR-implementers at lists.openehr.org >> <javascript:_e(%7B%7D,'cvml','openEHR-implementers at >> lists.openehr.org');> >> >> http://lists.openehr.org/mailman/listinfo/openehr-implementers_lists.openehr.org >> >> >> _______________________________________________ >> openEHR-implementers mailing list >> openEHR-implementers at lists.openehr.org >> <javascript:_e(%7B%7D,'cvml','openEHR-implementers at >> lists.openehr.org');> >> >> http://lists.openehr.org/mailman/listinfo/openehr-implementers_lists.openehr.org >> >> >> >> -- >> danny nguyen >> linkedIn >> >> >> _______________________________________________ >> openEHR-implementers mailing list >> openEHR-implementers at lists.openehr.org >> <javascript:_e(%7B%7D,'cvml','openEHR-implementers at >> lists.openehr.org');> >> >> http://lists.openehr.org/mailman/listinfo/openehr-implementers_lists.openehr.org >> >> >> >> _______________________________________________ >> openEHR-clinical mailing list >> openEHR-clinical at lists.openehr.org >> <javascript:_e(%7B%7D,'cvml','openEHR-clinical at lists.openehr.org');> >> >> http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org > > > > -- > /This e-mail message is intended exclusively for the addressee(s). > Please inform us immediately if you are not the addressee./ > > > > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical at lists.openehr.org > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
