Hi,
The VistA presentation at oshca was nice ; there is certainly a lot of work
behind that app.
>From what I saw, VistA is currently a "classical" application, and seems to
lack 2 important points for the near future (and Ken Rubin's message also
quote it) :
- semantic, to evolve from data or documents management to knowledge
management
- continuity of care, to evolve from a "hospital is everything" opinion to a
"hospital is a part of a whole system" point of view.
Unfortunately, these two points are the key of "modern systems".
Happily, the other systems don't do it either, and it is a domain where open
source can be much more than commercials, because in open source we can
merge knowledge and projects (or parts of projects).
If I could make a proposal for oshca 2002, it would certainely be to focus
on projects merging (now that oshca 2001 allowed projects leaders to know
each other).
To come back to VistA, it is certainely a good thing to have an open source
project that can compete with system sold for 1 M Euro for a medium size
hospital. It's up to us to work on what's missing, and make a killer app of
it.
Regards,
Philippe AMELINE
Odyssee project
www.nautilus-info.com
----- Original Message -----
From: "Ken Rubin" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, September 19, 2001 2:19 PM
Subject: RE: VA medical record systems
> I have been following this thread loosely for some
> time, and feel the obligation to make a few comments
> about VistA. I am an Enterprise Architecture for the
> Veterans Health Administration (VHA), focused on the
> Application Development space. Though I cannot speak
> authoritatively for VHA, there are a few points that
> should be considered.
>
> The Positives:
> -VistA has enjoyed widespread use and user acceptance
> within the organization. It is well used and embraced
> by the clinical community, and many (if not all) VA
> Medical Centers require practitioners to use the
> system for progress notes, orders, and full support of
> clincial practice.
>
> -The application is open source.
>
> -I am aware of several organizations outside of VHA
> (and in fact internationally) that are using the VistA
> kernel with significant success.
>
> The GUI is considered by many to be pushing
> state-of-the-art.
>
>
> Conversely, there are some issues and current
> activities:
>
> -VistA is based on an aging application
> infrastructure. Efforts are underway within VHA to
> determine the next generation architecture and migrate
> towards it. The "plumbing" behind the GUI has
> significant maintenance issues, and VHA is facing
> continuing challenges in this area.
>
> -To my knowledge, any reengineering effort relating to
> VistA will have minimal GUI impacts. We have an
> interface well liked and accepted, so the "end user"
> impact of the reengineering would be largely
> unnoticable.
>
> -Lack of commercial alternatives within the M space
> puts VHA at risk, which is one of (but not the only)
> drivers towards a reengineering activity.
>
> -Next generation VistA is looking to employ newer
> technologies and methodologies (e.g., object-oriented
> approaches).
>
> -VistA is optimized for use within a point of care or
> tightly coupled integration of points of care, but
> does not support the robust services needed for
> sharing information across our VHA medical centers.
> Though some capabilities (such as view of portions of
> a medical record) are available within VistA, shared
> semantics, mediation, etc. would be additions in the
> re-engineering. Plans are to build-out a full Health
> Data Repository (e.g., a Clinical Data Repository) as
> part of the back-end to the system.
>
>
> There has been a lot of good work done in VistA, and
> it has served VHA very well. I just wanted folks on
> this list to understand its current maturity and
> evolution plans. I hope these ramblings have been
> useful.
>
> - Ken Rubin
> EDS
> VHA Enterprise Architect
>
>
>
> --- "Smith, Arthur B." <[EMAIL PROTECTED]> wrote:
> > VISTA/CPRS is most definitely NOT in the hands of
> > InterSystems. VISTA was
> > developed by our tax dollars and is our property.
> > It can be obtained
> > through the Freedom of Information Act (FOIA). Last
> > time I checked, a CD
> > with the latest FOIA release will cost you about
> > $25.
> >
> > InterSystems has largely cornered the commercial M
> > (MUMPS) market -- and
> > VISTA/CPRS is deeply intertwined with M. Cache --
> > InterSystem's flagship
> > product -- is M with many extensions. However, GTM
> > is now available as an
> > open source MUMPS, and the port of VISTA to GTM is
> > nearly complete, I
> > believe. This port is being headed by Rick
> > Marshall, who has long been a
> > very major player in both the VA and M communities.
> >
> > With an open source information system (VISTA)
> > running on an open source
> > database/programming platform (GTM) running on an
> > open source operating
> > system (Linux), there is little InterSystems or any
> > other company can do to
> > tie up the software end of the business.
> >
> > -art smith
> >
> > > -----Original Message-----
> > > From: John S. Gage
> > [mailto:[EMAIL PROTECTED]]
> > > Sent: Tuesday, September 18, 2001 9:21 AM
> > > To: [EMAIL PROTECTED]
> > > Subject: Re: VA medical record systems
> > >
> > >
> > > However, Wayne, you are not addressing VISTA/CPRS,
> > I don't
> > > believe. They
> > > are already completely in the hands of
> > Intersystems.
> > >
> > > At 08:35 AM 9/18/01, you wrote:
> > > >George James wrote:
> > > >>1 The M interpreter is expensive if you
> > purchase from
> > > one of the
> > > >>proprietary vendors. The presentation from
> > Bhaskar at
> > > oscha made the
> > > >>point however that GT.M is now Open Source and
> > free for
> > > implementation
> > > >>on Linux.
> > > > >
> > > >It may soon be that open source M will be the
> > mainstream of
> > > M. I say
> > > >this
> > > >because we have just finished a major upgrade on
> > a system
> > > that had run out
> > > >of cpu cycles and diskI/O. The upgrade was two
> > part: hardware and
> > > >software. In the case of software, our vendor,
> > who
> > > supports M is now
> > > >upgrading to Cache, InterSystems follow-on to M.
> > I predict
> > > that most
> > > >commercial software will eventually find it's way
> > to either
> > > open source M
> > > >or Cache.
> > >
> >
>
>
> __________________________________________________
> Terrorist Attacks on U.S. - How can you help?
> Donate cash, emergency relief information
> http://dailynews.yahoo.com/fc/US/Emergency_Information/
