I agree, largely because the snares, pitfalls, traps, and surprises that
Brian Bray describes in his rationale for Open Source apply with a
vengeance to VistA. I have a fear, however, that I would like to share
with the group. Call me psychotically paranoid, but here goes.
The V.A. is pouring money into VistA. Pouring money. I believe that it
is installed in every V.A. hospital in the U.S. (100,000's of
patients). Installed on PC's running against Compaq (DEC) servers.
Installed with a GUI (CPRS) written in Delphi, I believe.
Now look at HIPPA. HIPPA is a bill whose purpose was to make it so
workers did not lose their health coverage when they changed jobs. But
(BUT!) it contains a provision about computerized medical records. What
it says is if Congress cannot pass legislation governing computerized
medical records, then the Administrative branch will make the rules.
Congress didn't and the Administration is.
One could easily imagine similar legislation, or even NO legislation but
just a liberal interpretation of HIPPA by the Administrative branch,
that went something like this. "We have too many medical errors costing
too many lives in medicine. Medical errors kill more people than
automobiles (>40,000 per year). We don't even know what's going on in
medicine [so where do the numbers come from?], because there are no
records. Soooooooo, we will require electronic records as of July 1,
2001. Lacking a credible alternative, the electronic records will be
VistA."
I don't think this is entirely a fantasy. Certainly, the people at
Intersystems and Compaq probably don't regard it as a fantasy. Not to
mention Micro$oft (the clients run NT). Cerner and SMS, etc. would go
nuts, but they might not carry the day.
This is why a browser-based system is so strategic. Browser-based
systems can be installed overnight without hardware costs (in
institutions with PC clients, i.e. all institutions). What is going to
come out of the other end of all this is going to be browser-based. How
far will anyone get saying you have to install mainframes or even
dedicated servers in every hospital, if there's a remote server
alternative? If you want fancier GUI's than the browser can handle,
then make it something a lot like an applet, but even that will be too
much overhead at the institution side. Just browsers.
John Gage
"Daniel L. Johnson, MD" wrote:
> 2 cents: Without disparaging VistA or any other previously developed system,
> my judgment is that it is time to start fresh, with the newest programming
> tools and higher-level languages, building on the lessons learned from
> previous efforts. (This is related to the theorem that well-developed
> systems become crufty and it's most efficient to translate the lessons,
> algorithms, standards, and paradigms acquired in development into a
> clean-slate effort.)
>
> DJmd
