On Fri, 9 Aug 2002, Smith, Todd wrote: ... > I think that the use of "future-proof" is probably too high a standard > to ask of VistA.
Hi Todd, I disagree. If the so-called "future-proof" concept is of any value, it ought to be applicable to systems such as VistA. The value of open source approach is that we should be able to incorporate improvements developed elsewhere into VistA. > The advanced informational systems concepts embodied by GEHR and OIO are > clearly "clean-paper" designs compared to some base-line engineering > that has been maturing since the '70s. I do feel that VistA also contains highly functional features that other system still cannot match. The challenge is to find ways to synthesize new systems that improve upon existing systems. > IMHO, VistA is not "future-proof", but it is a stable, well-designed > architecture that has held up reasonably well over the years. If VistA is useful in its current state, can we improve it by adding "future-proof" features? What if we introduce GEHR archetypes or OIO forms into VistA? > I don't believe without a "clean-paper" design, ANY system can be > "future-proof". Existing schema may remain "static" - however, I believe it is reasonable to extend existing schema through a "future-proof" module. Thereafter, the static schema can be incrementally replaced with "future-proof" schema - as necessary. Do you see what I mean? > What VistA offers is a complete hospital system that is stable and has > been refined into a highly usable system. True. However, as Thomas Beale nicely pointed out in his "future-proof" paper, customization / modification are huge challenges. So, as long as you use VistA at a VA Medical Center and your users are 100% satisfied with what the system offers (or can be simply shooed away), VistA is a perfect system. (Of course, VistA is not the only system that employ a static schema). > No other open-source medical software that I know of at this time is > capable of running a hospital. The OIO system has recently been introduced into a hospital (Nandalal's site in Sri Lanka). The data schema is nowhere near as comprehensive as VistA - yet. However, the data schema is so easy to extend and modify (="future-proof") that the size of the data schema is almost a non-issue. Rather, the system evolves as staff at the hospital decide what information they like to maintain electronically (and how). > If there was something else, then we might be able to a feature > comparison but until then this is the only game in town. I think it would be helpful to consider how best to improve VistA and learn from VistA. I doubt any given system has a monopoly on all the good ideas :-). We really should take full-advantage of the open-source methodology to study each system, to clarify the design choices and intellectual contributions. This means challenging each developer to discuss their work in public :-). > I hope that over time OIO and GEHR and others might be able to run a > hospital and then the "best" system would be the one that meets our > needs the closest. My vision is somewhat different. I believe the most useful system would be highly flexible so that end users can easily mold it to fit their specific needs. There will be many pre-assembled packages that include domain-specific data schema (e.g. urology clinic forms) and associated business logic (workflow/treatment algorithms). These packages will serve as the starting point for further customization. Where we are with the OIO project is that we have the basic building blocks for the data schema (=OIO forms). The OIO Library serves as a repository for the "pre-assembled packages". We also have tools that use these building blocks (e.g. data mining reports). The next big thing is plug-and-play workflow/algorithm. The idea is to propose, test, and pass on what we have learned. Hopefully, if we are successful, the "future-proof" features will not be unique to the OIO system for too long :-). Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org (Hosting OIO Library #1 and OSHCA Mirror #1)
