CHC Corner - Revision history

DavidWhitten at 00:05, 7 July 2012

2012-07-07T00:05:26Z

195.128.179.143 at 21:05, 13 January 2006

2006-01-13T21:05:21Z

82.207.62.156 at 04:06, 5 January 2006

2006-01-05T04:06:12Z

← Older revision		Revision as of 04:06, 5 January 2006
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	[[5) Are any Community Health Centers currently utilizing VistA?]]		[[5) Are any Community Health Centers currently utilizing VistA?]]
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JohnLeoZ at 03:02, 26 October 2005

2005-10-26T03:02:52Z

← Older revision		Revision as of 03:02, 26 October 2005
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	VistA to community health centers' special needs.		VistA to community health centers' special needs.

	=From: Hardhats Listserve:=		==From Hardhats Listserve:==

	Here are some recurrent questions us nontechies have about VistA:		Here are some recurrent questions us nontechies have about VistA:
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	[[4) What other concerns should we have regarding adopting VistA?]]		[[4) What other concerns should we have regarding adopting VistA?]]

	5. Are any Community Health Centers utilizing VistA ~~currently~~?		[[5) Are any Community Health Centers currently utilizing VistA?]]

64.69.103.221: /* From: Hardhats Listserve: */

2005-10-26T00:46:42Z

From: Hardhats Listserve:

← Older revision		Revision as of 00:46, 26 October 2005
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	[[4) What other concerns should we have regarding adopting VistA?]]		[[4) What other concerns should we have regarding adopting VistA?]]

			5. Are any Community Health Centers utilizing VistA currently?

JohnLeoZ at 04:45, 21 September 2005

2005-09-21T04:45:49Z

← Older revision		Revision as of 04:45, 21 September 2005
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	VistA to community health centers' special needs.		VistA to community health centers' special needs.

	~~'''~~From: Hardhats Listserve:~~'''~~		=From: Hardhats Listserve:=

	Here are some recurrent questions us nontechies have about VistA:		Here are some recurrent questions us nontechies have about VistA:

68.14.218.205 at 00:36, 21 September 2005

2005-09-21T00:36:11Z

← Older revision		Revision as of 00:36, 21 September 2005
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	[[3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?]]		[[3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?]]

			[[4) What other concerns should we have regarding adopting VistA?]]
	~~'''~~4) What other concerns should we have regarding adopting VistA?~~'''~~

	~~Expect a long learning curve. Get help.~~

	~~I think a factor here is how much you want to put into the system.~~
	~~It is not turn key at this point, although there are installers~~
	~~who can do the work for you. It is not going to have all the~~
	~~bells and whistles that commercial EMR's want you to pay for.~~
	~~It is not currently integrated with a billing system or a system~~
	~~for appointments.~~

	~~[[Matthew King~~]] ~~adds:~~
	~~On the other hand, a lot of the bell and whistles that seem to~~
	~~exist in many commercial products are actually rudimentary or even~~
	~~vaporware. VistA isn't as pretty, but is very functional, with~~
	~~easily modified clinical and preventive care reminders,support for~~
	~~disease management, advanced drug interaction checks and lexion~~
	~~support. The CPRS module supports drag and drop template building.~~
	~~This makes custom templates a snap, something you pay dearly for~~
	~~in many commerical products. The experts say 1/3 of medical errors~~
	~~can be reduced by intelligent software design. Since the VA~~
	~~product exists for patients, not profits, it is designed for~~
	~~clinical functionality and patient safety, so that is where it~~
	~~shines. Most commercial products have recently added EHRs as an~~
	~~afterthought in an emerging market. The bells and whistles look~~
	~~slick, but don't necessarily add to patient safety.~~

	~~[[Rick Marshall]] replies:~~
	~~Above all, it is a serious commitment. It is free as in freedom, not~~
	~~free beer. It will save lives, not time. You cannot do this alone; you~~
	~~may think you can, but sooner or later you will run aground without~~
	~~help. To succeed with VistA you need the community in ways you cannot~~
	~~imagine, but the good news is they will welcome and help you, and it~~
	~~will not be long before you can return the favor. The big hurdle with~~
	~~VistA is that anyone used to making medical informatics decisions has~~
	~~learned how to prepare for defeat, to choose vendors on the basis of how~~
	~~deep their pockets are (so you can sue them when the project collapses~~
	~~in failure) instead of on the basis of their expertise and customer~~
	~~service, to choose based on marketing flair and reputation. VistA is~~
	~~the real deal, and for that very reason may be difficult to recognize as~~
	~~such by customers who have learned only how to choose among flashy~~
	~~failures. VistA requires the "customer" to become a partner, a~~
	~~collaborator, words that have all but lost their meaning in the modern~~
	~~marketplace; when you become fully engaged with the VistA lifecycle, you~~
	~~will come to understand that if VistA is broken it is your fault as much~~
	~~as ours, that it is your responsibility to hold the developers and the~~
	~~software to a high enough standard to meet your needs. Unlike with most~~
	~~commercial software products, you will rewarded instead of punished for~~
	~~engaging in the critique, review, and even development of VistA.~~

	~~There is an endless amount to learn about it, and it is under continuous~~
	~~development, continuously patched, continuously changing, as it must~~
	~~be. The static details of VistA are less important than the living~~
	~~process by which its users drive development through their continuous~~
	~~stream of suggestions and complaints. You will not and cannot~~
	~~appreciate how true that is until after you have been involved with~~
	~~VistA for years. The secret to its success is no secret, not specific~~
	~~features, nor the technology used. It is the dynamic, hyperactive~~
	~~software lifecycle that engages the creativity of tens of thousands of~~
	~~users to mold the software over and over so that the longer you wait the~~
	~~better it gets, as opposed to most software which is static by design,~~
	~~updated at best occasionally, and obsolesces with time.~~

	~~That inversion of the norm, emphasizing change instead of stasis, is a~~
	~~repudiation of the core beliefs of the software industry and much of~~
	~~academia, and as such you must expect to hear an endless stream of~~
	~~irrelevant complaints lodged against VistA, usually by those who have~~
	~~not used it. From those who do use VistA, you will generally find an~~
	~~endless stream of relevant complaints together with strong loyalty.~~
	~~Like any experienced VistA professional, I can and will criticize VistA~~
	~~up one side and down the other for hours on end. We like it in part~~
	~~because we know its faults, and so we try to prioritize the work most~~
	~~important to us; when the lifecycle is healthy, if something is broken~~
	~~it's because we think it's more important for the developers to work on~~
	~~something else first. Those who fully engage in the VistA lifecycle~~
	~~know VistA's flaws far more intimately than its critics, but they know~~
	~~its strengths, too, and they can point to features in the software that~~
	~~they personally first brought to the attention of the VistA development~~
	~~community. In a way most software will never be, VistA really does~~
	~~belong to its users, and they know it.~~

	~~So when I echo other writers in saying VistA is free as in freedom, I~~
	~~mean as in the responsibility that comes with true freedom, the~~
	~~expectation to interact with it as an adult, taking responsibility for~~
	~~what we need from it, and helping to chart our own future. To be blunt,~~
	~~many people do not want that, prefer the simplicity of having limited~~
	~~choices imposed upon them by someone more powerful, to recreate the~~
	~~false security of childhood. Others do not mind the responsibility, but~~
	~~cannot spare the time to learn a fully featured medical informatics~~
	~~system, not even just the few parts of the few packages they would use~~
	~~in their medical roles. In general, we find the truth about VistA~~
	~~properly screens our potential clients; the right people respond well to~~
	~~the challenge and possibilities of VistA, and enrich the community and~~
	~~its software when they engage with us.~~

	~~PPS: If I sound opinionated in the above, it is because experience has~~
	~~made me so. For the first half of my career with VistA, I thought it~~
	~~was probably nothing special, that every hospital system must have~~
	~~something comparable. My disgust with the state of the art and~~
	~~appreciation for VistA has accumulated over the years through a series~~
	~~of disillusioning exposures to how most medical software works--or~~
	~~doesn't. I do not know if there is even one feature in VistA that it~~
	~~does better than any other system, but no other system seems to be able~~
	~~to combine them all into such an integrated architecture driven by such~~
	~~a potentially responsive software lifecycle. The experience of patients~~
	~~in New Orleans in the wake of Hurricane Katrina would seem to be the~~
	~~latest dramatic illustration. I have gradually arrived at the~~
	~~surprising conclusion that my friends and I are working on something~~
	~~unusually cool. Who knew?~~

68.14.218.205 at 00:35, 21 September 2005

2005-09-21T00:35:15Z

@@ Line 21: / Line 21: @@
 [[2) What is the fundamental difference between a relational database and a hierarchical database and how does that effect the end-user? (Should we even care? If so why?)]]
-   '''3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?'''
+[[3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?]]
 '''4) What other concerns should we have regarding adopting VistA?'''

68.14.218.205 at 00:32, 21 September 2005

2005-09-21T00:32:34Z

@@ Line 19: / Line 19: @@
 [[1) Is Mumps a serious limitation to complete EHR functionality, code maintainence, HL7, or PMS interfacing?]]
-      There are several major commercial EHRs that use MUMPS.  In fact,
+[[2) What is the fundamental difference between a relational database and a hierarchical database and how does that effect the end-user? (Should we even care? If so why?)]]
-[Rick Marshall]] replies:
+   '''3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?'''
        Learning MUMPS is as simple as learning BASIC.  Learning about all

68.14.218.205 at 00:26, 21 September 2005

2005-09-21T00:26:52Z

← Older revision		Revision as of 00:26, 21 September 2005
Line 17:		Line 17:
	Here are some recurrent questions us nontechies have about VistA:		Here are some recurrent questions us nontechies have about VistA:

	~~'''~~1) Is Mumps a serious limitation to complete EHR functionality, code maintainence, HL7, or PMS interfacing?~~'''~~		[[1) Is Mumps a serious limitation to complete EHR functionality, code maintainence, HL7, or PMS interfacing?]]

	There are several major commercial EHRs that use MUMPS. In fact,		There are several major commercial EHRs that use MUMPS. In fact,