Okay, I'm not a doctor, I'm a software developer who has spent most of his career working with VistA. Some problems are inherently hard, and we should expect them to requires us to expend a fair amount of intellectual effort, no matter how cleverly our tools are designed. In fact, there is a whole branch of computer science known variously as Kolmogorov complexity or algorithmic complexity theory that tries to formalize the notion of the "hardness" of a problem, and explain why certain problems cannot easily be solved in any language or with any tools. This is subtly different from complexity theory, which is concerned with the complexity of specific algorithms. Kolmogorov complexity looks at the problem itself, attempting to quantify how hard it is.
That being said, my biggest reservation about VistA is NOT that supporting it (or understanding it!) is difficult -- perhaps that would be true of any HIS system with comparable capabilities -- but I wonder how much of the learning curve you speak of intrinsic and how much of it is accidental. Every day, I see hours of effort going into supporting or enhancing VistA applications, when it is obvious that much of the effort could have been avoided if only the applications had been coded differently to start with. No one is omniscient, no one can anticipate every future need, and I absolutely, absolutely do not mean this as a criticism of the original developers of what became VistA, but there are serious problems that do need to be addressed. I'm afraid we're a little too eager at times write off real problems, saying it's just a matter of the learning curve.
When I was in graduate school, one thing I quickly learned is that if you really want to understand mathematics, the best way to do it is often to go back to the "classics" (meaning the work of nineteenth and early twentieth century mathematicians like Gauss, Riemann, Klein, Lie, Cauchy, and others). Modern theories are often beautiful and exceptionally powerful, but to really understand them, we need to look at how the underlying ideas play out in concrete situations and why the more abstract theories were developed in the first place. I do not wish to offend, but I think of VistA as belonging to the classical era in computing general, and medical information systems in particular. I look at it as a rich source of insight and a tool that is very powerful and very useful. But it has its weak points, too. Instead of ignoring them (or worse, denying that they are there) why do we not ask how we can do better? I think we can -- if we are willing, that is.
I recognize that many or most of the people on this list are health care providers, and not software developers. I have a great deal of sympathy for those of you that just want something that will work for your practice, clinic or hospital. Not everyone is going to be primarily interested in what goes into building a HIS system, but we also have an incredible mix of talent on this list, and I cannot help but be impressed by the energy that goes into building (I was going to say configuring, but that may be a distinction without a difference) healthcare systems. Frankly, I don't know how many of you find the energy to do what you do.
==== Gregory Woodhouse [EMAIL PROTECTED] On May 16, 2005, at 3:09 PM, Kevin Toppenberg wrote:
Well, this is kind of like asking the choir if they like to sing.
But I have some personal experience with this. I am a physician who has installed this myself in a multiple specialty group. When I presenting the software to our group, the primary concerns were whether there was commercially available support (there is).
To date, not many offices (that I know of) have implemented VistA. I think this is because there is a learning curve. We are all hoping that VistA office will address some of these issues when released by CMS later this year.
But concerns about lack of support from the VA has not been an issue on my radar, or one that I have heard much about (regarding acceptibility of VistA)
Kevin Toppenberg, MD
------------------------------------------------------- This SF.Net email is sponsored by Oracle Space Sweepstakes Want to be the first software developer in space? Enter now for the Oracle Space Sweepstakes! http://ads.osdn.com/?ad_id=7412&alloc_id=16344&op=click _______________________________________________ Hardhats-members mailing list [email protected] https://lists.sourceforge.net/lists/listinfo/hardhats-members
