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The Story of VistA

“The Centerpiece of VA's Success is VistA.”
by

Rehab Rayan

on 14 July 2013

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Transcript of The Story of VistA

Overview
Throughout the Veterans Health in all health care settings
Background and History
CPRS
VistA Imaging
BCMA
My HealtheVet
Components
Applications
Modules
Projects
WorldVistA EHR:
The VistA Office Project(VOE)
Implementation
Adapt VistA (universally affordable, high quality EHR)
CCHIT EHR certification standards(functionality, security, interoperability).
Sustainability.
Key to Successful Project
Contact Requirements.
Schedule.
Budget.
VOE vs.VistA
Sequential Implementation
PIMS.
Lab,pharmacy,Rad.
Full CPRS with CPOE
Strengths
Weaknesses
Evidenced and Standards Based.
Popular, edited by doctors, encourage IT.
PHR.
Competition “vendor lock-in”.
Administrative data (organizational evaluation & efficiency),
Medical data (medical care) :Use of remote electronic & web based technologies to improve care.
Limited clinical information for research.
Large data sets (data loss).
Long-term preservation, storage of records.
System maintenance and Technical Support.
Difficult to use in small offices.
User training and Usability.
US Case Study Holy Cross - New York
1 million acute care visits yearly, 2 major hospitals, over 500 inpatient beds , 38,210 annual discharges, 9 clinics.
2006, proposal for implementation.
EHR viewed essential.
Successful implementation (information retrieval, clinical documentation via the health network).
Planed Budget ($5 million/Y for 3 Y- within 6 M)
Quality
measures
Out-patient quality measure:
Cancer Screening
VA and Private Sector, 2004 - 2007
VistA in Statistics
“World class”
award-winning
Harvard University Innovations in American Government Award.
“Top 100” CIO Award.
(TEPR), 1st Place (My HealtheVet).
Government Technology Leadership award (BMAS)
.
VistA Internationally
Jordan
2007 ... National Adoption
46 hospitals and 1000 clinics.
Pilot Sites(King Hussein Cancer Center,Prince Hamzah Hospital (MoH),Amman Comprehensive Clinic.
98% self-dependance in 18 months.
2011

Successful go-live of full implementation
.
1990
HMIS project at NCI-CU.Customization in house(conversion to Arabic).
Upgrading (CPRS).
Planning for VistA imaging.
http://www.hardhats.org/adopters/cairo_details.htm
http://worldvista.sourceforge.net/vista/
Implementation failures due to poor vendor support and training.
( adoption rate of IT).
Lessons Learned
Free is lower
vs.
Paid is Better?!
Vacuum in world vistA.
Filled in Medsphere.
Future Solutions
Quality improvement ecosystem(Evidence based peer review of Knowledge & SW,
Cooperative ecosystem
).
Feedback loop
with “
business intelligence
” .
Innovative network
approaches (
Open Source Collaboration
).
Conclusion
References
WorldVistA(2007). WorldVistA EHR Overview and Status. [ONLINE] Available at:
http://worldvista.org/conference_presentations/16th-vista-community-meeting-jan-10-13-midland-texas/midland_wv_meeting_status_dalmolin.pdf/at_download/file
(accessed 21 May 13).
Vista Software Alliance(2007). Implementation of an EHR: Focus on VistA. [ONLINE] Available at:
http://www.vistasoftware.org/

(accessed 22 May 13).
Dept. of Veterans Affairs. VA EMR: VistA. [ONLINE] Available at :
http://www.va.gov/
(accessed 22 May 13).
SAIGONTECH(2007). Vietnam Dung Ho-Coop Presentation Final Report. [ONLINE] Available at:
http://www.saigontech.edu.vn/index.php/en
(accessed 22 May 13).
WorldVistA(2007). The VistA Office Project and WorldVistA EHR: Better Health Care Through Open, Collaborative, Evidence Based, Software Evolution. [ONLINE] Available at:
http://www.worldvista.org
(accessed 22 May 13).
Department of Veterans Affairs (VA)(2011). Electronic Health Record: Providing Information for Clinical Care and Data for VA Health Research. [ONLINE] Available at:
http://www.va.gov/
(accessed 22 May 13).
Department of Veterans Affairs (VA)(2012). Electronic Health Record. [ONLINE] Available at:
http://www.va.gov/
(accessed 22 May 13).
WorldVistA(2012). Implementing VistA Internationally: Myth-Busting Lessons From Jordan. [ONLINE] Available at:
http://worldvista.org/
(accessed 22 May 13).Medsphere(2010). 
Introduction to Free / Open Source VistA EHR. [ONLINE] Available at:
https://medsphere.org
(accessed e.g. 31 August 11).
Community Health Network of West Virginia. The revolution of open source software in healthcare technology. [ONLINE] Available at:
http://www.chnwv.org
(accessed 22 May 13).
Noll, J. A Study of the Vista Electronic Medical Record Software. In: C. Boldyreff et al (eds.) What Constitutes Open Source? USA: IFIP International Federation for Information Processing; 2009. P (310-319).
FTP-IHS. VistA Imaging: An Update on IHS Activity and Directions. [ONLINE] Available at: ftp://ftp.ihs.gov/(accessed 22 May 13).
vxVistA-OS EHR. Uses Atlassian Open Source Web Tools to Deploy vxVistA-OS EHR. [ONLINE] Available at:
http://www.vxVistA.org
(accessed 22 May 13).
Veterans’ Health Administration. The VA’s Open-Source Electronic Medical Record System:An opportunity for the NHS? . [ONLINE] Available at:
http://www.va.gov
(accessed 22 May 13).
Herbsleb,J;Birn,M.C;Towne,B.W. The VistA Ecosystem: Status and Future Directions. 1st ed. United States: Pittsburgh. Institute for Software Research-School of Computer Science-Carnegie Mellon University; 2010.
Institute of Medicine (IOM). United States and International. Case Studies of VistA Implementation. United States:; 2006. p (223-284).
http://www.vuvox.com/collage/detail/06ae2fa586
http://www.ehealth.va.gov/EHEALTH/CPRS_Demo.asp
VistA.
DHCP.
Comprehensive EHR.
Application Suit.
"Better Healthcare at Lower Cost Through Collaborative, Evidence Based, Software Evolution"
GPL/FOIA.
eg. Apache, Linux Kernel, Mozilla Firefox.
No single Code base.
Why?!
“Legacy Software Industry Model is a Poor Fit for the Health Sector”
“Health systems are “ecosystems” NOT “industries”… Complex Adaptive Systems...Chaotic !
Increase Quality of care, Safety, Outcome, Profitability, Revenue.
Decrease Medical Errors, Costs.
Challenges
Home-Telehealth
Modules
Database
OS
DBMS
Flavors
http://worldvista.org/Software_Download/worldvista-ehr-demos
•Successful implementation in Public/Private sectors , the whole hospital/out patient clinics.
•High care quality, patient satisfaction and low medication errors.
•All under free license.

SoftWare
Full transcript