Take us beyond VistA? We are nowhere near VistA, except at the VA!VistA may be quite good or even the best solution in many ways - but it is by no means perfect. R+D will still to need to continue. I see GnuMed, OIO, OpenEMed, etc as R+D efforts to take us beyond VistA.
Yes, there are things to do with VistA such as make an M interpreter that is open source and open source a GUI, but extremely talented people are trying to do that and are succeeding.
Any other open source initiative at the hospital level (and by the way they see outpatients at the VA, tons of them, and probably a reduced set of VistA would fit on a laptop) THROWS AWAY VISTA, unless you have the interoperability vision in which all hospitals can have different systems all of which are interoperable. That, I believe, is the HL-7 vision, in which case, as Sammy "The Bull" Gravano would say, "What's the problem?". All we have to do is wait for all systems to be interconnected with all other systems and we are home free.
