Re: [openhealth] Senator Endorses VistA for EHR Standard
Greg Woodhouse [EMAIL PROTECTED] wrote: One problem in people not learning from VistA is that it is so difficult to install and run! The other point is that the various modules have different licences. It is not fully open sourced in that sense (or am I wrong?). Some of the largest modules are for insurance purposes and they may be useless for some others. especially outside the USA. Let us develop good documentation and make VistA easier to setup, and separate the open source free parts clearly from the others. I know that there is an OpenVistA project but, the documentation is insufficient on the above facts. Nandalal --- Joseph Dal Molin [EMAIL PROTECTED] wrote: Nandalal, you have in one sentence described how VistA was first developed and evolved for the better part of its history, all be it the number of collaborators was much larger. [GW] I think that's a fair statement. So the real issue IMHO is not designing and building the perfect system is but how to leverage the vast experience and knowledge that is imbeded in VistA's DNA. [GW] What form does that DNA take? There seems to be some disagreement on this point. Some have argued that the knowledge that has been gained through the development of VistA (and I think it's immense) is to be found only in the code itself. Othewrs argue that artifacts such as data dictionaries, manuals, user interfaces, etc. are realizations of knowledge at a slightly higher level of abstraction. VistA was not developed through something like the Rational Unified Process, starting with functional requirements, UML models, etc., but grew in a more organic bottom up fashion. But that doesn't mean the knowledge isn't there. It seems unfortunate to me that no one is asking What can we learn from VistA? For that matter, what is its essence? What sets it apart from other systems to which people often prefer it? I know those questions seem abstract, and rather philosophical, but at some point, I think we need to ask ourselves what type of problem it is that we're attempting to solve, and what is it that constitutes a good solution. Why? === Gregory Woodhouse [EMAIL PROTECTED] All truth passes through three stages: First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident. --Arthur Schopenhauer SPONSORED LINKS Software distribution Salon software Medical software Software association Software jewelry Software deployment - YAHOO! GROUPS LINKS Visit your group openhealth on the web. To unsubscribe from this group, send an email to: [EMAIL PROTECTED] Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service. - - Bring words and photos together (easily) with PhotoMail - it's free and works with Yahoo! Mail. [Non-text portions of this message have been removed] Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
Re: [openhealth] Senator Endorses VistA for EHR Standard
Phillipe, I would like to know your approach to things, more clearly. The list I made is more in fun than an initiative for OSHCA!! My interest infact is in the use of IT for the area of Research, audit and CME for clinicians. The BIG jobof making those for administrators, managers, ministers, governments is far too complex. I think it has been clearly shown that the ability to communicate between different type of acpplications and to have an international standard on this may solve one major issue. Interoperability will stop here, most likely. How far will SNOMED go, in the worldwide context to standardize nomenclature? Let us wait and see. nandalal Philippe AMELINE [EMAIL PROTECTED] wrote: Joseph Dal Molin a écrit : I feel a partnership between a couple of IT savyy clinicians and expert programmers with a wholesome way of looking at things, can create the infrastructure of the future HISs. Nandalal, you have in one sentence described how VistA was first developed and evolved for the better part of its history, all be it the number of collaborators was much larger. So the real issue IMHO is not designing and building the perfect system is but how to leverage the vast experience and knowledge that is imbeded in VistA's DNA. Frankly speaking how many lives could be saved and improved by simply implementing VistA as far and wide as possible and at the same time engaging that community to improve the software? Is chasing perfection by starting from a clean slate worth the human opportunity cost? Joseph Joseph, By simply implementing VistA as far and wide as possible, do you mean that you want to provide the patients with Vista ? Because even if VistA is a very good system, it can't replace all existing systems (so you will have many discrepancies in the network) and beside, it is not possible to address the continuity of care issue through HISs (in the same way motion pictures and still images are different). Nandalal's point 5 : 5. Scale to a hospital/region/country/world! is, from my point of view, a very dangerous feeling. It gives me the same feeling as if you would say : our aquarium architecture is made of a carbon filter and an air pump, and we want to scale it on a lake, a river, an ocean. A HIS is an into the box solution, don't even try to scale it in order to manage the open world. This sort of things makes me nervous because in France I am fighting everyday against HIS vendors selling their solution as county wide scalable. Sometimes just because they can manage all Dicom modalities. I hope I can convince the people in charge of current national health record that a perfect HIS is a dangerous object in the landscape if it restricts its scope from in-patient to out-patient and doesn't have as a primary duty to contribute to a global patient health journey. As you know, a single period of time, a single location, a single problem is the usual architecture of... the classical tragedy. Philippe SPONSORED LINKS Software distribution Salon software Medical software Software association Software jewelry Software deployment - YAHOO! GROUPS LINKS Visit your group openhealth on the web. To unsubscribe from this group, send an email to: [EMAIL PROTECTED] Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service. - __ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com [Non-text portions of this message have been removed] Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
Re: [openhealth] Senator Endorses VistA for EHR Standard
Hi Nandalal, There was nothing personal in my message. I just wanted to point out that time is probably come for out of the box thinking. You are probably aware that current standards in the medical domain are all dedicated to report making. It means that nothing exists to give a proper vision of the patient's health project before this action. Of course, you could imagine extracting this information from the amount of previously received reports, but it would take a huge amount of time and, as you said in a previous mail, it would necessitate that each and every health professional work on a unique EMR. And to be able to read hundreds of documents each time he sees a chronic patient. This is an in the box vision : the HIS can grow and become a regional or national system in order to address the continuity of care issue. Now let's suppose you provide the patient with a personal health project manager that lists health problems in a diachronic way (along time) + pointers toward (main) existing documents + health goals (follow up colonoscopy every 3 years, maintain BMI below 35...) according to health problems. This way, you provide the customer with a tool for customers (with his health as an asset to manage continuously over time), and service providers keep their service provider's tool (with a specific issue to address during a given period of time). Philippe Nandalal Gunaratne a écrit : Phillipe, I would like to know your approach to things, more clearly. The list I made is more in fun than an initiative for OSHCA!! My interest infact is in the use of IT for the area of Research, audit and CME for clinicians. The BIG jobof making those for administrators, managers, ministers, governments is far too complex. I think it has been clearly shown that the ability to communicate between different type of acpplications and to have an international standard on this may solve one major issue. Interoperability will stop here, most likely. How far will SNOMED go, in the worldwide context to standardize nomenclature? Let us wait and see. nandalal Philippe AMELINE [EMAIL PROTECTED] wrote: Joseph Dal Molin a écrit : I feel a partnership between a couple of IT savyy clinicians and expert programmers with a wholesome way of looking at things, can create the infrastructure of the future HISs. Nandalal, you have in one sentence described how VistA was first developed and evolved for the better part of its history, all be it the number of collaborators was much larger. So the real issue IMHO is not designing and building the perfect system is but how to leverage the vast experience and knowledge that is imbeded in VistA's DNA. Frankly speaking how many lives could be saved and improved by simply implementing VistA as far and wide as possible and at the same time engaging that community to improve the software? Is chasing perfection by starting from a clean slate worth the human opportunity cost? Joseph Joseph, By simply implementing VistA as far and wide as possible, do you mean that you want to provide the patients with Vista ? Because even if VistA is a very good system, it can't replace all existing systems (so you will have many discrepancies in the network) and beside, it is not possible to address the continuity of care issue through HISs (in the same way motion pictures and still images are different). Nandalal's point 5 : 5. Scale to a hospital/region/country/world! is, from my point of view, a very dangerous feeling. It gives me the same feeling as if you would say : our aquarium architecture is made of a carbon filter and an air pump, and we want to scale it on a lake, a river, an ocean. A HIS is an into the box solution, don't even try to scale it in order to manage the open world. This sort of things makes me nervous because in France I am fighting everyday against HIS vendors selling their solution as county wide scalable. Sometimes just because they can manage all Dicom modalities. I hope I can convince the people in charge of current national health record that a perfect HIS is a dangerous object in the landscape if it restricts its scope from in-patient to out-patient and doesn't have as a primary duty to contribute to a global patient health journey. As you know, a single period of time, a single location, a single problem is the usual architecture of... the classical tragedy. Philippe SPONSORED LINKS Software distribution Salon software Medical software Software association Software jewelry Software deployment
Re: [openhealth] Senator Endorses VistA for EHR Standard
--- Nandalal Gunaratne [EMAIL PROTECTED] wrote: Greg Woodhouse [EMAIL PROTECTED] wrote: [NG] One problem in people not learning from VistA is that it is so difficult to install and run! [GW] The trouble is that VistA was developed over a period of approximately 30 years during which it was incrementally deployed to the same intitutions. Though the process of deploying and installing VistA applications was vastly simplified with the introuction of KIDS (Kernel Integrated Distribution System), VistA simply is not installed from the ground up very often. The VA medical centers where it is now deployed have been running VistA for years, so they don't have to build everything from scratch, just install new patches or modules. What is going on on Hardhats (from my point of view, anyway) is that a group of people are trying to figure out how to bootstrap a new practice or institution on VistA, and it's proving to require some effort. The other point is that the various modules have different licences. It is not fully open sourced in that sense (or am I wrong?). [GW] There are VistA components that rely on proprietary technology to function, but that is really neither here nor there. If you write a C compiler for Windows, it can certainly be open source, even if it only runs on a commercial OS. With regard to platforms: VistA runs under InterSystems Cache' (a commercial M implementation) and GT.M (an open source M implementation). Historically, it has run under DSM, OpenM, MSM, and others). At present, Cache and GT.M seem to be the focus of most attention, but it (VistA) is not in principle limited to these platforms. In fact, one of the reasons VistA has historically stayed within the ANSI MUMPS standard (except for system libraries) is to maintain portability. [NG] Some of the largest modules are for insurance purposes and they may be useless for some others. especially outside the USA. [GW] Yes, that's true. I thought you were talking about the basic platform, not other systems with which it has interfaces. [NG] Let us develop good documentation and make VistA easier to setup, and separate the open source free parts clearly from the others. I know that there is an OpenVistA project but, the documentation is insufficient on the above facts. [GW] That sounds like a good idea to me. === Gregory Woodhouse [EMAIL PROTECTED] All truth passes through three stages: First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident. --Arthur Schopenhauer Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
Re: [openhealth] Senator Endorses VistA for EHR Standard
On Thu, 2006-01-26 at 14:37 -0600, Greg Woodhouse wrote: [KSB] ...snip... runs on a commercial OS. With regard to platforms: VistA runs under InterSystems Cache' (a commercial M implementation) and GT.M (an open source M implementation). Historically, it has run under DSM, OpenM, [KSB] Greg, that was a somewhat unfortunate choice of words, because your words imply that GT.M is not commercial. We are very much commercial! We have developers that need to be paid and lights that need to be kept on. Although both GT.M and Cache are commercial, an important difference is in the licensing. GT.M on x86 GNU/Linux, Alpha/AXP OpenVMS and Alpha/AXP Tru64 UNIX is offered as Free / open source software (FOSS) under the Gnu General Public License (GPL). The critical difference is in the business model. A business model based on the GPL means that while the software license is free, we must earn our revenue from the sale of services. A GPL based business model empowers the users, among other reasons, because it means that the vendor can never charge unreasonable support fees, cannot arbitrarily declare a product obsolete require customers to replace it with another (more expensive) product, etc. Conversely, a GPL based business model also puts some responsibility on the user because although the software is free, the users who use it to generate revenue should support the vendor (for example, in our case, by purchasing support) so that the software stays current into the future. One of the myths that is part of the FUD spread by vendors whose business models are not based on open source licenses is that software based on open source licenses is not commercial. Please do not inadvertently help spread this myth. Thank you for your consideration. Regards -- Bhaskar Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
Re: [openhealth] Senator Endorses VistA for EHR Standard
On Thu, 2006-01-26 at 16:02 -0600, Greg Woodhouse wrote: --- Bhaskar, KS [EMAIL PROTECTED] wrote: One of the myths that is part of the FUD spread by vendors whose business models are not based on open source licenses is that software based on open source licenses is not commercial. Please do not inadvertently help spread this myth. Thank you for your consideration. Regards -- Bhaskar How would you prefer that GT.M be described, if not open source? I can understand your concern here, especially since many open source projects are not commercially supported. I suppose a phrase like Commercial software with a GPL compatible license (or something like it) is possible, but it's awkward. Certainly, I want to refer to the product in the appropriate manner. Commercial and licensed under the GPL (or the broader category of FOSS software) are orthogonal attributes, and there are packages that fall into all four combinations of those attributes. So, in this case, to be completely precise, it was not Cache (commercial) vs. GT.M (open source), but Cache (commercial, non-FOSS) vs. GT.M (commercial, FOSS). So, removing the common attribute commercial, it would be correct to say Cache (non-FOSS) vs. GT.M (FOSS). Regards -- Bhaskar Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
[openhealth] FOIA VistA SemiVivA 20060113 available
FOIAVistA SemiVivA 20060113 is now available and can be downloaded from
Source Forge (http://sourceforge.net/projects/worldvista). A SemiVivA
package is an installation of VistA that is bundled with GT.M and ready
for use if you alreay have a PC running Linux.
Assuming that the distribution file is downloaded on your PC
as /Distrib/VistA/FOIAVistASemiVivA20060113.tgz, you can install it with
the following commands which must be executed as root:
cd /usr/local
tar zxvf /Distrib/VistA/FOIAVistASemiVivA20060113.tgz
This OpenVistA SemiVivA is slightly different from (i.e., hopefully
better than) its predecessors.
When OpenVistA SemiVivA 20060113 is installed on your PC in a
development environment, the intent is that the files distributed with
this release will not normally be modified (unless, for example, you
move to a new GT.M release and need to recompile and generate new object
files) - please read http://tinyurl.com/738jk for a discussion of the
model.
This OpenVistA SemiVivA comes pre-configured as a Release. You can
still use the vista script to demo VistA, but I expect that you are
more likely to use the install script to set up integration and
development environments and the run script thence to run an installed
environment.
This OpenVistA also comes able to handle a direct connection from a CPRS
GUI, as well as the latest CPRS GUI itself the program CPRSChart.exe
in /usr/local/FOIAVistA20060113/CPRS_Gui). To enable an installed
environment to handle a CPRS GUI connection request, you will need to do
the following:
1. Choose a port, e.g., 9297.
2. Identify the environment to handle the connection, and the userid for
the server process (e.g., /home/kbhaskar/myVistA and kbhaskar).
3. Add 2 lines to /etc/services, thus:
cprs-gui9297/tcp
cprs-gui9297/udp
The second line is not required, but it is traditional to reserve TCP
and UDP ports together.
4. Determine whether you are running inetd or xinetd as the Internet
superserver. If you are running inetd, you will need a line such as
the following in your inetd.conf:
cprs-gui stream tcp nowait kbhaskar /home/kbhaskar/myVistA/cprs_direct
If you are running xinetd, you will need something like:
service cprs-gui
{
disable = no
socket_type = stream
wait= no
user= kbhaskar
server = /home/kbhaskar/myVistA/cprs_direct
}
(I don't use xinetd, so the above is my guess as to what the entry
should be.)
5. Restart inetd/xinetd (on Debian GNU/Linux systems, this is a line
like /etc/init.d/inetd restart).
6. You may need to configure your firewall to allow connections on port
9297.
A CPRS GUI client should now be able to connect. If you have wine
installed on your Linux machine, you can try running the CPRS GUI on
Linux with (one line, look out for line breaks):
wine /usr/local/FOIAVistA20060113/CPRS_Gui/CPRSChart.exe s=localhost
p=9297 SPLASH=OFF CCOW=DISABLE
Good luck.
I promised to document the process of creating a SemiVivA package from a
FOIA release, and I have copious notes that I need to convert into
something readable. I will do that after I create FOIAVistA VivA
20060113.
Regards
-- Bhaskar
Yahoo! Groups Links
* To visit your group on the web, go to:
http://groups.yahoo.com/group/openhealth/
* To unsubscribe from this group, send an email to:
[EMAIL PROTECTED]
* Your use of Yahoo! Groups is subject to:
http://docs.yahoo.com/info/terms/
Re: [openhealth] Senator Endorses VistA for EHR Standard
Joseph Dal Molin wrote: I feel a partnership between a couple of IT savyy clinicians and expert programmers with a wholesome way of looking at things, can create the infrastructure of the future HISs. Nandalal, you have in one sentence described how VistA was first developed and evolved for the better part of its history, all be it the number of collaborators was much larger. So the real issue IMHO is not designing and building the perfect system is but how to leverage the vast experience and knowledge that is imbeded in VistA's DNA. Frankly speaking how many lives could be saved and improved by simply implementing VistA as far and wide as possible and at the same time engaging that community to improve the software? Is chasing perfection by starting from a clean slate worth the human opportunity cost? probably the only way to answer that is to find out what VistA _can't_ do. - thomas beale Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
