I have been following this thread loosely for some
time, and feel the obligation to make a few comments
about VistA. I am an Enterprise Architecture for the
Veterans Health Administration (VHA), focused on the
Application Development space. Though I cannot speak
authoritatively for VHA, there are a few points that
should be considered.
The Positives:
-VistA has enjoyed widespread use and user acceptance
within the organization. It is well used and embraced
by the clinical community, and many (if not all) VA
Medical Centers require practitioners to use the
system for progress notes, orders, and full support of
clincial practice.
-The application is open source.
-I am aware of several organizations outside of VHA
(and in fact internationally) that are using the VistA
kernel with significant success.
The GUI is considered by many to be pushing
state-of-the-art.
Conversely, there are some issues and current
activities:
-VistA is based on an aging application
infrastructure. Efforts are underway within VHA to
determine the next generation architecture and migrate
towards it. The "plumbing" behind the GUI has
significant maintenance issues, and VHA is facing
continuing challenges in this area.
-To my knowledge, any reengineering effort relating to
VistA will have minimal GUI impacts. We have an
interface well liked and accepted, so the "end user"
impact of the reengineering would be largely
unnoticable.
-Lack of commercial alternatives within the M space
puts VHA at risk, which is one of (but not the only)
drivers towards a reengineering activity.
-Next generation VistA is looking to employ newer
technologies and methodologies (e.g., object-oriented
approaches).
-VistA is optimized for use within a point of care or
tightly coupled integration of points of care, but
does not support the robust services needed for
sharing information across our VHA medical centers.
Though some capabilities (such as view of portions of
a medical record) are available within VistA, shared
semantics, mediation, etc. would be additions in the
re-engineering. Plans are to build-out a full Health
Data Repository (e.g., a Clinical Data Repository) as
part of the back-end to the system.
There has been a lot of good work done in VistA, and
it has served VHA very well. I just wanted folks on
this list to understand its current maturity and
evolution plans. I hope these ramblings have been
useful.
- Ken Rubin
EDS
VHA Enterprise Architect
--- "Smith, Arthur B." <[EMAIL PROTECTED]> wrote:
> VISTA/CPRS is most definitely NOT in the hands of
> InterSystems. VISTA was
> developed by our tax dollars and is our property.
> It can be obtained
> through the Freedom of Information Act (FOIA). Last
> time I checked, a CD
> with the latest FOIA release will cost you about
> $25.
>
> InterSystems has largely cornered the commercial M
> (MUMPS) market -- and
> VISTA/CPRS is deeply intertwined with M. Cache --
> InterSystem's flagship
> product -- is M with many extensions. However, GTM
> is now available as an
> open source MUMPS, and the port of VISTA to GTM is
> nearly complete, I
> believe. This port is being headed by Rick
> Marshall, who has long been a
> very major player in both the VA and M communities.
>
> With an open source information system (VISTA)
> running on an open source
> database/programming platform (GTM) running on an
> open source operating
> system (Linux), there is little InterSystems or any
> other company can do to
> tie up the software end of the business.
>
> -art smith
>
> > -----Original Message-----
> > From: John S. Gage
> [mailto:[EMAIL PROTECTED]]
> > Sent: Tuesday, September 18, 2001 9:21 AM
> > To: [EMAIL PROTECTED]
> > Subject: Re: VA medical record systems
> >
> >
> > However, Wayne, you are not addressing VISTA/CPRS,
> I don't
> > believe. They
> > are already completely in the hands of
> Intersystems.
> >
> > At 08:35 AM 9/18/01, you wrote:
> > >George James wrote:
> > >>1 The M interpreter is expensive if you
> purchase from
> > one of the
> > >>proprietary vendors. The presentation from
> Bhaskar at
> > oscha made the
> > >>point however that GT.M is now Open Source and
> free for
> > implementation
> > >>on Linux.
> > > >
> > >It may soon be that open source M will be the
> mainstream of
> > M. I say
> > >this
> > >because we have just finished a major upgrade on
> a system
> > that had run out
> > >of cpu cycles and diskI/O. The upgrade was two
> part: hardware and
> > >software. In the case of software, our vendor,
> who
> > supports M is now
> > >upgrading to Cache, InterSystems follow-on to M.
> I predict
> > that most
> > >commercial software will eventually find it's way
> to either
> > open source M
> > >or Cache.
> >
>
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