Hello hardhats:
As you know, we at the St. Petersburg Times recently published stories about the Carnegie Mellon assessment of HealtheVet. We may well do at least 3 followup stories soon.
1) If VistA needs so much fixing, why are people outside the VA embracing it? (Finland, West Virginia public health care,the HHS VistAOfficeEHR initiative, etc.) Kaiser Permanente's new $1.6-million Epic system, I believe, is written in Cache despite years of criticism of M-language.
2) Why Oracle over Cache for the national database? Some internal VA documents seem to indicate equal functionality for Cache. Would Cache be a more natural fit with existing programs? Were proper competitive procedures followed before the decision to use Oracle?
3) Is VistA really all the broken? Congress seems to want big specific overhauls, with specific budgets and deadlines, preferrably COTS (Clinger-Cohen), and preferrably nothing that smacks of the VistA "legacy'' system. VA headquarters seems to give Congress what they want, but some of these big projects have a very spotty history, at best, when it actually comes to meshing with existing VistA structure. Carnegie Mellon and other evaluators seem to focus on management, but are the flaws more fundamental than that? Historically, VistA's power seems to have stemmed more from incremental, bottom up development. Could VistA's flaws be mended in that same fashion if the VA had a free hand to do so? One possible test might be the DoD-VA records transfer, one of HealtheVet's main justifications at the moment and a big priority with Congress. People have suggested that VistA and CHCS were once twins and are still first cousins and could e asily and cheaply be made to talk to each other if the VA had access to DoD codes and could write in an M environement.
These stories are by no means etched in stone. We are still researching them. But at first glance, they seem like very important issues to explore.
I would like your opinion on the future of Vista and VA computing. What are the current flaws in VistA? What is the best way to fix them? What are the strengths and weaknesses of the HealtheVet initiative? What would you do if you were King or Queen of the VA and had all the budgetary authority you needed? I think Congress and the VA family are all seeking answers to these questions and this is a good time to be airing them.
Please e-mail me from a home computer or call me from a private phone, not from VA computers or phones. I am looking for mentoring and enlightenment. I will not use your name in print or conversation without your permission based on what you tell me. Some of your names are already on documents (like the old Forum e-mails) and I might quote from those, but that is independent from any personal opinions you might wish to share. Please be reasonably brief (Mr. Marshall, I have read your previous rants on the Forum...fascinating as they are verbose). And if you know of any documents that illustrate your points, we would sure like copies.
In exchange, I will send the Carnegie Mellon report to anyone who wants it. Or I will send it to you even if you don't want to share your thoughts.
Regards,
Steve Nohlgren
