Sherlock Holmes
It was Sherlock Holmes, I believe, who said, Eliminate the impossible, and whatever remains, however improbable, is the truth. As I survey the field of open source medical software, I see the impossible with one improbable exception: VistA. I hypothesize that unless the open source community embraces VistA (embraces meaning starts throwing coding resources at it big time) that there will never be open source medical solutions. Not at the rate things are going now. At our hospital it was Cerner versus VistA. Cerner won. Had there been a vibrant, interested, critically massed open source community surrounding VistA, VistA would have won. Please recall that VistA is installed in every VA hospital and is beloved by users. Please recall also that today the VA is acknowledged to be at the forefront of patient safety initiatives, for example, barcode scanning of medications at the point of care. Should the open source community really ignore this open source initiative in medicine because it isn't C++ or Java? Should the open source community pretend that VistA is just another front end/back end/other end that can be connected with everything else with .Net or CORBA? You make the call. Patients are dying while you decide (ref IOM, etc.). (This posting is loosely in response to Dan's posting)
Re: Sherlock Holmes
At 09:47 AM 1/4/2003 -0500, John Gage wrote: It was Sherlock Holmes, I believe, who said, Eliminate the impossible, and whatever remains, however improbable, is the truth. As I survey the field of open source medical software, I see the impossible with one improbable exception: VistA. I hypothesize that unless the open source community embraces VistA (embraces meaning starts throwing coding resources at it big time) that there will never be open source medical solutions. Not at the rate things are going now. At our hospital it was Cerner versus VistA. Cerner won. Had there been a vibrant, interested, critically massed open source community surrounding VistA, VistA would have won. Please recall that VistA is installed in every VA hospital and is beloved by users. Please recall also that today the VA is acknowledged to be at the forefront of patient safety initiatives, for example, barcode scanning of medications at the point of care. Should the open source community really ignore this open source initiative in medicine because it isn't C++ or Java? Should the open source community pretend that VistA is just another front end/back end/other end that can be connected with everything else with .Net or CORBA? Why should this be ignored? VistA can already be connect with CORBA: http://www.esitechnology.com/library/downloads/esiobjects/EOdescription.asp At one time a CERNER engineer said they were implementing all of the OMG CORBA interfaces, but I've not seen evidence of this in their commercial offerings. We should be able to have full interoperability between CERNER and VistA so that one could build a federated medical record system with both. One should not have to use only one system in all hospitals. We all will be losers if this is the result. Integrating heterogeneous systems is needed if we are to really succeed in healthcare. I think the open source community needs to take the lead in this area. Dave You make the call. Patients are dying while you decide (ref IOM, etc.). (This posting is loosely in response to Dan's posting)
Re: Sherlock Holmes
While there is merit in the things you say, VistA players were by far the largest segment of the crowd at OSHCA 2002 and KS Baskar who was instrumental in open sourcing GT.M won the Linux Medical News Achievement Award. As I understand it, a problem right now is that a fully open source stack for VistA isn't completely available yet. Perhaps some of the Hardhats would care to comment? -- IV On Sat, 04 Jan 2003 09:47:16 -0500 John Gage [EMAIL PROTECTED] wrote: I hypothesize that unless the open source community embraces VistA (embraces meaning starts throwing coding resources at it big time) that there will never be open source medical solutions. Not at the rate things are going now. At our hospital it was Cerner versus VistA. Cerner won. Had there been a vibrant, interested, critically massed open source community surrounding VistA, VistA would have won. Please recall that VistA is installed in every VA hospital and is beloved by users. Please recall also that today the VA is acknowledged to be at the forefront of patient safety initiatives, for example, barcode scanning of medications at the point of care.
Re: Sherlock Holmes
Dave makes a very important point...VistA needs to be able to, and can, integrate with other systems...and while a fully integrated system as Ignacio points out is much easier to work with the reality is that in most cases migration requires several steps. Secondly VistA doesn't have all the bases covered...e.g. obstetrics and pediatrics are not in VistA but are in its derivatives in the Indian Health Service and in the DoD system. It also does not have financials that would be up to what is necessary in most hospitals. Joseph On Sat, 2003-01-04 at 10:15, David Forslund wrote: At 09:47 AM 1/4/2003 -0500, John Gage wrote: It was Sherlock Holmes, I believe, who said, Eliminate the impossible, and whatever remains, however improbable, is the truth. As I survey the field of open source medical software, I see the impossible with one improbable exception: VistA. I hypothesize that unless the open source community embraces VistA (embraces meaning starts throwing coding resources at it big time) that there will never be open source medical solutions. Not at the rate things are going now. At our hospital it was Cerner versus VistA. Cerner won. Had there been a vibrant, interested, critically massed open source community surrounding VistA, VistA would have won. Please recall that VistA is installed in every VA hospital and is beloved by users. Please recall also that today the VA is acknowledged to be at the forefront of patient safety initiatives, for example, barcode scanning of medications at the point of care. Should the open source community really ignore this open source initiative in medicine because it isn't C++ or Java? Should the open source community pretend that VistA is just another front end/back end/other end that can be connected with everything else with .Net or CORBA? Why should this be ignored? VistA can already be connect with CORBA: http://www.esitechnology.com/library/downloads/esiobjects/EOdescription.asp At one time a CERNER engineer said they were implementing all of the OMG CORBA interfaces, but I've not seen evidence of this in their commercial offerings. We should be able to have full interoperability between CERNER and VistA so that one could build a federated medical record system with both. One should not have to use only one system in all hospitals. We all will be losers if this is the result. Integrating heterogeneous systems is needed if we are to really succeed in healthcare. I think the open source community needs to take the lead in this area. Dave You make the call. Patients are dying while you decide (ref IOM, etc.). (This posting is loosely in response to Dan's posting) -- Joseph Dal Molin [EMAIL PROTECTED] e-cology corporation
Re: Sherlock Holmes
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. Take us beyond VistA? We are nowhere near VistA, except at the VA! 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.
Re: Sherlock Holmes
Is this the good news or the bad news? VistA needs a few elements to make it complete. That is a recommendation for VistA not an objection. There's no other open source project out there that can make that claim...that can even remotely make that claim. Dave makes a very important point...VistA needs to be able to, and can, integrate with other systems...and while a fully integrated system as Ignacio points out is much easier to work with the reality is that in most cases migration requires several steps. Secondly VistA doesn't have all the bases covered...e.g. obstetrics and pediatrics are not in VistA but are in its derivatives in the Indian Health Service and in the DoD system. It also does not have financials that would be up to what is necessary in most hospitals. Joseph
Re: Sherlock Holmes
At our hospital it was Cerner versus VistA. Cerner won. Just curious. Was Physician Satisfaction with Two Order Entry Systems, a research paper published in the Journal of the American Medical Informatics Association Volume 8 Number 5 Sep/Oct 2001 ever being used for publicity purposes. The research assesses physician satisfaction with the user interface of CPRS of VistA with a commercially available product (the product was not named) available at the Mount Sinai Hospital, NY. I don't know what the other system is. Anyone knows which system is it? I was pleasantly surprised to read that physicians were generally dissatisfied with the commercial product and were more satisfied with the CPRS. Just wondering if that research paper should be used more extensively to promote VistA? One of our paperless hospitals here is using the cerner system and they had endless integration problems that had to be solved with huge expenditure. With that experience with cerner, I have my doubts our Govt will experiment with cerner again but what are the alternatives? And they have money to spend :) When a new hospital is built they can't wait for volunteers to tinker with a system to customize for the local setting. So we're back to the business model that any group needs to put together quickly to beat competition during this current surge in uptake in computerized systems in hospitals and clinics. Had there been a vibrant, interested, critically massed open source community surrounding VistA, VistA would have won. I still think we need to present this in a business manner with a trusted entity spear-heading it. And there is also the usual procurement processes that one has to contend with - specifications for different sized hospitals, bank guarantees, contracts, performance indicators, timelines etc. Please recall that VistA is installed in every VA hospital and is beloved by users. Please recall also that today the VA is acknowledged to be at the forefront of patient safety initiatives, for example, barcode scanning of medications at the point of care. Are there product brochures available for marketing VistA? The OSS community is familiar with these but are the decision makers (usually committees) aware of these? As mentioned by Joseph, there are bits at the DoD and the Indian Health Services. Are these being integrated into the version of VistA that are being promoted to the hospitals outside VA and who is doing the integration? I see the major problem being lack of funds. Medsphere is progressing rapidly because they do have a business plan and they also do have funding. Am I right Scott? Molly -- Dr Molly Cheah Primary Care Doctors' Organisation Malaysia (PCDOM) eMail: [EMAIL PROTECTED] Web-site: http://pcdom.org.my DAGS Project: http://pcdom.org.my/dags/ DAGS Pilot: http://pilot.pcdom.org.my
Re: The VistA Thing
I got the VISTA fileman and other modules running on an old K62-300 computer at my office under GNULinux and GT.M . Everything you need is at http://hardhats.sourceforge.net/pub/gtm and http://hardhats.sourceforge.net/pub/steel/2.01 in steel/2.01 check out the file setup.txt by Steve Shreeve. It is actually an installation script. You may need to modify things for your environment but if you have done some system admin. on Linux and are familiar with shell scripts you can follow his comments in the file. That being said, I can't find anywhere to get the CPRS GUI and connect it to the above database. The database does seem to have the RPC-Broker module that is apparantly used to connect it to the CPRS GUI.Even though I was able to get the database running, most of the instructions I've found seem to assume that you're fluent in M so we need some instructions that assume zero knowlege of M but a basic familiarity with Linux, the shell etc. Bruce Slater, MD wrote: My understanding was that VistA has a separate outpatient module. One way to promote the full VistA implementation would be promote this to private practice guys who have looked at commercial packages and winced at the total acquisition cost. It would seem that someone who wanted to promote VistA could bundle the OP module and the M platform in a easy to install Windows or Linux-based CD for demo purposes. If we are not at that point where this is feasible, then we should delay discussion until it is actually demonstrable to large numbers of people. An open-source product that is demonstrable on the Windows platform would be a (pardon the military expression) force multiplier. You would have thousands of proto-geek MDs installing this and talking about it at hospital staff meetings, the doctor's lunchroom and medical society meetings. We need a groundswell of interest in SOMETHING to induce decision makers to consider open-source as a concept. There must be people on this list who have the technical skills to do this ...
Re: The VistA Thing
This posting on Linux Med News is also helpful to give an overview of the VISTA installation process: http://www.linuxmednews.com/linuxmednews/1018974735/index_html But the setup.txt script fits better with the packages on hardhats.sourceforge.net I did not run setup.txt as a script, just typed in the commands one at a time. I had to change a number of things that were different in my shell environment. Unfortunately, I didn't write them all down. Bruce Slater, MD wrote: My understanding was that VistA has a separate outpatient module. One way to promote the full VistA implementation would be promote this to private practice guys who have looked at commercial packages and winced at the total acquisition cost. It would seem that someone who wanted to promote VistA could bundle the OP module and the M platform in a easy to install Windows or Linux-based CD for demo purposes. If we are not at that point where this is feasible, then we should delay discussion until it is actually demonstrable to large numbers of people. An open-source product that is demonstrable on the Windows platform would be a (pardon the military expression) force multiplier. You would have thousands of proto-geek MDs installing this and talking about it at hospital staff meetings, the doctor's lunchroom and medical society meetings. We need a groundswell of interest in SOMETHING to induce decision makers to consider open-source as a concept. There must be people on this list who have the technical skills to do this ...
Re: The VistA Thing
The VA FTP site is back in service, and the CPRS client should be in the directory: /vista/Software/Packages/Order Entry-Results Reporting - OR/Programs/ although I would review all the patches for newer client versions.. Alexander Caldwell wrote: I got the VISTA fileman and other modules running on an old K62-300 computer at my office under GNULinux and GT.M . Everything you need is at http://hardhats.sourceforge.net/pub/gtm and http://hardhats.sourceforge.net/pub/steel/2.01 in steel/2.01 check out the file setup.txt by Steve Shreeve. It is actually an installation script. You may need to modify things for your environment but if you have done some system admin. on Linux and are familiar with shell scripts you can follow his comments in the file. That being said, I can't find anywhere to get the CPRS GUI and connect it to the above database. The database does seem to have the RPC-Broker module that is apparantly used to connect it to the CPRS GUI.Even though I was able to get the database running, most of the instructions I've found seem to assume that you're fluent in M so we need some instructions that assume zero knowlege of M but a basic familiarity with Linux, the shell etc.
Re: Sherlock Holmes
On Sat, 2003-01-04 at 04:53, Karsten Hilbert wrote: It was Sherlock Holmes, I believe, who said, Eliminate the impossible, and whatever remains, however improbable, is the truth. Quite correct. I hypothesize that unless the open source community embraces VistA (embraces meaning starts throwing coding resources at it big time) that there will never be open source medical solutions. VistA does not fit my GP practice. It is as simple as that. Indeed. We need to remember that healthcare does not start at hospitals (although it often ends at hospitals). In developed countries, most of the big gains in health can and will continue to be made in primary care and in pre-primary care, meaning public health interventions and health promotion campaigns. That's not to say that there haven't been (and won't continue to be) significant advances in secondary care (eg the revolution in the treatment of myocardial infarction brought about by thrombolytic therapy and transluminal angioplasty, both of which had a significant impact on premature mortality and on reducing morbidity due to IHD). But health informatics has as much, perhaps more, to offer primary care as it does hospitals in terms of improving efficiency, effectiveness and safety. In the Two-Thirds World, for most people hospitals are a place of last resort (due to financial and geographic barriers to access, and due to quality-of-care issues), and primary care undertaken by non-physicians is the main game. Of course, systems which seamlessly integrate primary and secondary care are the best solution, and that's exactly what those clever Brazilians seem to be working on - and its open source (or will be). So, although VistA versus Cerner etc is of great interest to many of us, in the big scheme of things, it's just a distraction. We should be looking to the Two-Thirds World for open source in healthcare success stories, and for opportunities. Funding sources? Overseas aid and development agencies. We, in developed countries, need to convince our national public- and private-sector overseas aid and development agencies that funding open source healthcare software development is a good thing for them to do, because the benefits can be replicated again and again in different settings. AusAID (Australina govt overseas aid programme) funding the development of GnuMed for Laotian (and Cambodian, and Thai, and Vietnamese, and Filipino,and Indonesian) community health centres? How fabulous would that be? Tim C
Re: Sherlock Holmes take 2
On Sat, 2003-01-04 at 04:47, John Gage wrote: Should the open source community really ignore this open source initiative in medicine because it isn't C++ or Java? Should the open source community pretend that VistA is just another front end/back end/other end that can be connected with everything else with .Net or CORBA? The fact that VistA is implemented in Mumps is a bit of a problem, but not an insurmountable one (in that Mumps skills can be acquired, but gee, they're scarce on the ground here in Australia). More important issues are how well the VistA data model maps to other settings, and how hard it is to modify it. The use of VistA in indigenous health care services in the US suggests that either the data model is quite general (you wouldn't think so after looking at it...) or its not too hard to change. The acid test is whether VistA can escape the US. Experience here in Australia is that many US-derived commercial systems need extensive reworking to fit local requirements. So do European-derived systems, but these tend to be written from the outset with a large number of different healthcare systems in mind. Are there any non-US VistA sites, or any plans to establish some? Tim C
Re: Sherlock Holmes take 2
Not sure about your last question, but the fact that VistA developed in a business model without billing, MIGHT make it actually MORE applicable in socialized medicine environments, some of which apply in the two/thirds world. - Original Message - Are there any non-US VistA sites, or any plans to establish some? Tim C
