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Joe,
your note title example can be explained in this way. For years Vista was
used in a standalone manner. Each site, was essentially an island, that
could create it's own note titles, lab test names, etc.
Then, software like RDV's and Vistaweb came along, and exposed
(everyday) the fact that people used different terms at different sites, for
essentially the same data.
This
is not a software problem, it's a data problem. It's an artifact of making what
was essentially a standalone system, into a networked
system.
It's
cure, is standardization work. Unfortunately that work can be tedious and not as
glorious as other work, which is why it has been a slow starter. But sooner or
later that work will get done, and Vista will be around for
awhile.
Actually, the
standardization work is being done VistA M-side.
-----Original
Message-----
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of David Sommers
Sent: Thursday, June 09, 2005 7:49
PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
And I doubt the
underlying technology in the current VistA is restricting the ability to make
this happen now. It just happens to occur where the VA is doing "new
work" (unless it's being back-ported to VistA).
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Gordon Moreshead
Sent: Thursday, June 09, 2005 8:50
PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
Oh!? That is a
data/terminology standardization issue and not particularly relevant to
"replacing Vista". This can be an issue in any system implemented in
multiple sites.
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Gillon, Joseph
Sent: Thursday, June 09, 2005 6:24
PM
To:
'hardhats-members@lists.sourceforge.net'
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
Yep. One of the
many, very valid reasons the VA is replacing VistA, and one not mentioned, I
believe, in the St. Pete Times article.
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Cameron
Schlehuber
Sent: Thursday,
June 09, 2005 5:53 PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
Regarding the
nonstandard note titles and the difficulties that poses ... there have
actually been some significant peer-reviewed journal articles by some VA folks
on that very issue. In fact, standardization of note titles is one of
the things currently in the queue to be accomplished in VistA (I'm not sure
but I believe it's also part of the CPRS-R work coming out very soon). A
fair amount of automated matching to standard titles will be performed (no
doubt with some manual intervention and checking). Once in place, new
note titles would be quickly built up from a compound set of expressions from
the Enterprise Reference Terminology which would cover virtually all of the
useful note titles (excepting the odd and uninformative ones such as "Dr
Soandso's notes"). That means that both old and new titles can be sorted
and searched in computationally meaningful ways for quick and easy
use.
-----Original
Message-----
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Gillon, Joseph
Sent: Thursday, June 09, 2005 1:06
PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
That's an interesting
problem you pose. Did you ever see Euclid? It had a
problem-centric UI that apparently providers loved. I guess you would
click on, say, diabetes, and it would tell you what you should know about
diabetes for patients of a certain age, gender, ethnicity, whatever. It
would offer recommendations for meds and also check prescriptions for possible
problems. It was written by a doc who's now in Reno. He just sent
me the latest which is now web-based and uses MDO, the middleware techonology
that VW uses.
A sort of related but
not quite the same feature is something VW will use soon, and that's
Up-to-Date and medical dictionary searches. User highlights text, right
clicks, picks the search engine and gets info.
I'm saying all this
just to indicate there are efforts to get some AI into our EMRs. In
fact, the CPRS-R folks are going to use a lot of the old Euclid
functionality. Oh, it has a thing called Assist that helps write
notes. Sorry I don't know exactly how...
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Sowinski, Richard
J.
Sent: Thursday, June 09,
2005 3:51 PM
To:
'hardhats-members@lists.sourceforge.net'
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
It's good to see you
on Hardhats. What took you so long ?
Sorry about "hunt and
peck" analogy it's just the most apt description of what I see users doing
when they use these products.
It's just my bias, I
think remote data viewers fill an interim niche. But I have had busy
docs tell me that they don't have the time to sift through this data on most
patients, unless they are really, really curious about something. I think the
same thing can be said for Docs sifting through reams of CPRS data from their
own site! Just no time to do that: they see their patient, write their
note, write their prescription and any other orders, and get on to the
next patient.
This is no reflection
on your VistaWeb product. I think it's a great tool, faster than RDV's, and an
accomplishment on your part. It certainly helps alot when Docs really
want to see that data.
I also think it is
good that there is such great interest outside of VA in some of the
things VA has developed over the past few years, including
VistaWeb.
Joe, you are on the
right track, I think your VistaWeb product could be separated pretty simply
from some of the "complexities" underneath.
We can talk off-line
if you want. I don't want to burn anymore Hardhats bandwidth on this topic,
especially considering who is listening.
I have all the
respect in the world for the St Peterburg Times and their affiliation with the
Poynter Institute, one of the most respected journalism schools in the
country, but I wish we could "talk tech" here without worrying about being
monitored or quoted.
After all,
that's really what this forum is for.
-----Original
Message-----
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]On Behalf Of Gillon, Joseph
Sent: Thursday, June 09, 2005 1:06
PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
First, I should
mention that if you are a VA employee be careful what you say to this
guy. He's a biased, sensationalist reporter looking to make copy and
not, IMHO, particulary interested in veracity. More interested in
uncovering another CoreFLS than anything else.
On to Rich.
And hi BTW, been a while. Thinking just of implementing VW or RDV
outside the VA, you hit on one extremely important item, namely
standardization of data. I disagree with the "hunt and peck" label
you're sticking VW with since it shows all the data, collated, in
seconds. However, due to the non-standard note titles and stuff of
that ilk, when you sort the titles you don't necessarily get, say, all the
cariology notes, in one place. Were I starting a new multi-site VistA
system I would really, really, really give some time and effort to
implementing standard note/report titles, lab panel titles, team names,
etc. All this stuff is a totally squirrelly mess in the VA after years
of each site doing whatever it pleased.
And I think Rich
hits another nail on the head with the MPI thing. If you are going to
have distributed databases you definitely need something central to figure
out what sites to query. Well, maybe if you only had half a dozen
sites... Still. Rich, I know that VistA kicks out an HL7 message
on inpatient events (admit, discharge, transfer). Does it do anything
on outpatient visits? If it did you could just set up an HL7 listener
to catch these messages and put the relevant data into an SQL
database. Then, since VW can talk to SQL databases as well as VistA
databases, you could just replace the MPI RPC with a select
statement.
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of
[EMAIL PROTECTED]
Sent: Thursday, June 09, 2005 1:45
PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
----- Forwarded
by Steve Nohlgren/News/Sptimes on 06/09/2005 01:43 PM -----
|
|
[EMAIL PROTECTED]
Sent by:
[EMAIL PROTECTED]
06/09/2005 10:18
AM
Please respond to
hardhats-members |
To:
hardhats-members@lists.sourceforge.net
cc:
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps == |
Mr. Sowinski's
comments about the value of a central data repository or repositories speaks
to an issue we are wondering about at the St. Petersburg Times--whether or
not HealtheVet plans inject some unnecessary complexities while upgrading
VistA. As I understand it, the national HDR will be an Oracle database that
will merge clinical data real time and avoid this hunting and pecking for
remote info. It will also to allow for report writing and queries to
get a better handle on trends. Kaiser Permanente is splitting those two
functions in their Epic System. The clinical data is stored in a Cache
warehouse so everything pops up automatically no matter where the patient
goes for treatment, but that data also become input to an Oracle warehouse
for report writing and analysis. As I understand it, they figured that
keeping both functions in a relational database would require more CPU and
slow down the clinical side. Would such a divided s ystem make more sense
for the VA's centralized database. If anyone feels like responding to me
directly, you can use your home e-mail.
Thanks,
Steve Nohlgren
When I speak of the
"complexities" of the infrastructure I am speaking of
the MPI,
the
updating of data across sites, etc. Initializing all patients with
ICN's
etc.
Actually, I think that particular infrastructure could
be simplified, and
probably should be
simplified, if one wanted to
implement remote data viewing capability
outside of
VHA.
When
you think about it, you really only need a list of sites a patient
has
been
"registered at", and a good identifying scheme, to "assemble"
a patient's
record
from multiple sites.
But actually, the model
I prefer is a centralized repository or
repositories.
The problem
with apps like Remote Data Views and VistaWeb is, the physician
has
to
"hunt an peck" for data. Physicians are expected to do
20-minute
appointments,
write their computerized notes and orders, and
maintain 2000-patient panels.
Many Docs
simply do not have the time to
look through this remote data.
Other issues are, you cannot run
research-type queries across sites, to
identify cohorts
of patients
meeting certain research criteria. Data is not standardized.
Your lab
test name,
or lab test panel, may be different from mine.
With a
data repository: reminders, alerts, etc can be run against a
standardized
database,
and and data from many sites can be viewed via a common
interface. A Doctor
can even be
paged automatically, if a patient's
test data is outside normal ranges. Or
for any other
reason,
specified.
But apps like RDV's and VistaWeb certainly fill a niche,
for some Docs who
have smaller panels
or, who take the extra time, for
now.
- Rich
-----Original Message-----
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]
Behalf Of Jim
Self
Sent: Wednesday, June 08, 2005 5:55 PM
To:
hardhats-members@lists.sourceforge.net
Subject: RE: [Hardhats-members] ==
VistaWeb Missing Apps ==
Richard Sowinski wrote:
>The
reason I have asked people on this list if they have VistaWeb up
and
>running, is because I suspect
>they underestimate the
infrastructure required "under the hood", to make
it,
>or RDV
run.
>
>I also suspect, some have misconstrued what VistaWeb is.
I think some of
>them think it is a Web-based front-end
>to
Vista, instead of a remote view-only application, used to view
patient
>data at other sites.
I haven't tried to get VistaWeb
running because of a lack of free time for
playing with
things
dependent on M$ proprietary technology, but I have thought that
the
source files in
VistaWeb might be helpful in defining some aspects
of what a Web-based
front-end to VistA
should include.
>From
reviewing the VistaWeb documentation a while back, it seemed to me
that
it would be
quite easy using M2Web to improve upon the views of
VistA data provided by
VistaWeb if
someone could take a little time
just to specify what views are needed and
what data
fields should be
included. I had the same impression from a health-e-vet
demo earlier,
but
I haven't had the free time to pursue either very much so far. I have
a good
understanding
of the underlying technology (MUMPS, Fileman,
Web, etc.) but not of the
VistA EMR, so
someone with that knowledge
and/or the time to gather it could help greatly
to move such a
project
along.
---------------------------------------
Jim Self
Systems
Architect, Lead Developer
VMTH Computer Services, UC
Davis
(http://www.vmth.ucdavis.edu/us/jaself)
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