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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?]] |
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| − | | + | [[4) What other concerns should we have regarding adopting VistA?]] |
| − | '''4) What other concerns should we have regarding adopting VistA?'''
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| − | Expect a long learning curve. Get help.
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| − |
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| − | I think a factor here is how much you want to put into the system.
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| − | It is not turn key at this point, although there are installers
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| − | who can do the work for you. It is not going to have all the
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| − | bells and whistles that commercial EMR's want you to pay for.
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| − | It is not currently integrated with a billing system or a system
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| − | for appointments.
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| − |
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| − | [[Matthew King]] adds:
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| − | On the other hand, a lot of the bell and whistles that seem to
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| − | exist in many commercial products are actually rudimentary or even
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| − | vaporware. VistA isn't as pretty, but is very functional, with
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| − | easily modified clinical and preventive care reminders,support for
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| − | disease management, advanced drug interaction checks and lexion
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| − | support. The CPRS module supports drag and drop template building.
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| − | This makes custom templates a snap, something you pay dearly for
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| − | in many commerical products. The experts say 1/3 of medical errors
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| − | can be reduced by intelligent software design. Since the VA
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| − | product exists for patients, not profits, it is designed for
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| − | clinical functionality and patient safety, so that is where it
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| − | shines. Most commercial products have recently added EHRs as an
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| − | afterthought in an emerging market. The bells and whistles look
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| − | slick, but don't necessarily add to patient safety.
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| − | [[Rick Marshall]] replies:
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| − | Above all, it is a serious commitment. It is free as in freedom, not
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| − | free beer. It will save lives, not time. You cannot do this alone; you
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| − | may think you can, but sooner or later you will run aground without
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| − | help. To succeed with VistA you need the community in ways you cannot
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| − | imagine, but the good news is they will welcome and help you, and it
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| − | will not be long before you can return the favor. The big hurdle with
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| − | VistA is that anyone used to making medical informatics decisions has
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| − | learned how to prepare for defeat, to choose vendors on the basis of how
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| − | deep their pockets are (so you can sue them when the project collapses
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| − | in failure) instead of on the basis of their expertise and customer
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| − | service, to choose based on marketing flair and reputation. VistA is
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| − | the real deal, and for that very reason may be difficult to recognize as
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| − | such by customers who have learned only how to choose among flashy
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| − | failures. VistA requires the "customer" to become a partner, a
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| − | collaborator, words that have all but lost their meaning in the modern
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| − | marketplace; when you become fully engaged with the VistA lifecycle, you
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| − | will come to understand that if VistA is broken it is your fault as much
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| − | as ours, that it is your responsibility to hold the developers and the
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| − | software to a high enough standard to meet your needs. Unlike with most
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| − | commercial software products, you will rewarded instead of punished for
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| − | engaging in the critique, review, and even development of VistA.
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| − | | |
| − | There is an endless amount to learn about it, and it is under continuous
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| − | development, continuously patched, continuously changing, as it must
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| − | be. The static details of VistA are less important than the living
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| − | process by which its users drive development through their continuous
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| − | stream of suggestions and complaints. You will not and cannot
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| − | appreciate how true that is until after you have been involved with
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| − | VistA for years. The secret to its success is no secret, not specific
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| − | features, nor the technology used. It is the dynamic, hyperactive
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| − | software lifecycle that engages the creativity of tens of thousands of
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| − | users to mold the software over and over so that the longer you wait the
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| − | better it gets, as opposed to most software which is static by design,
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| − | updated at best occasionally, and obsolesces with time.
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| − | | |
| − | That inversion of the norm, emphasizing change instead of stasis, is a
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| − | repudiation of the core beliefs of the software industry and much of
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| − | academia, and as such you must expect to hear an endless stream of
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| − | irrelevant complaints lodged against VistA, usually by those who have
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| − | not used it. From those who do use VistA, you will generally find an
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| − | endless stream of relevant complaints together with strong loyalty.
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| − | Like any experienced VistA professional, I can and will criticize VistA
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| − | up one side and down the other for hours on end. We like it in part
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| − | because we know its faults, and so we try to prioritize the work most
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| − | important to us; when the lifecycle is healthy, if something is broken
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| − | it's because we think it's more important for the developers to work on
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| − | something else first. Those who fully engage in the VistA lifecycle
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| − | know VistA's flaws far more intimately than its critics, but they know
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| − | its strengths, too, and they can point to features in the software that
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| − | they personally first brought to the attention of the VistA development
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| − | community. In a way most software will never be, VistA really does
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| − | belong to its users, and they know it.
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| − | | |
| − | So when I echo other writers in saying VistA is free as in freedom, I
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| − | mean as in the responsibility that comes with true freedom, the
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| − | expectation to interact with it as an adult, taking responsibility for
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| − | what we need from it, and helping to chart our own future. To be blunt,
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| − | many people do not want that, prefer the simplicity of having limited
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| − | choices imposed upon them by someone more powerful, to recreate the
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| − | false security of childhood. Others do not mind the responsibility, but
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| − | cannot spare the time to learn a fully featured medical informatics
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| − | system, not even just the few parts of the few packages they would use
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| − | in their medical roles. In general, we find the truth about VistA
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| − | properly screens our potential clients; the right people respond well to
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| − | the challenge and possibilities of VistA, and enrich the community and
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| − | its software when they engage with us.
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| − | | |
| − | PPS: If I sound opinionated in the above, it is because experience has
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| − | made me so. For the first half of my career with VistA, I thought it
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| − | was probably nothing special, that every hospital system must have
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| − | something comparable. My disgust with the state of the art and
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| − | appreciation for VistA has accumulated over the years through a series
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| − | of disillusioning exposures to how most medical software works--or
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| − | doesn't. I do not know if there is even one feature in VistA that it
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| − | does better than any other system, but no other system seems to be able
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| − | to combine them all into such an integrated architecture driven by such
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| − | a potentially responsive software lifecycle. The experience of patients
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| − | in New Orleans in the wake of Hurricane Katrina would seem to be the
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| − | latest dramatic illustration. I have gradually arrived at the
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| − | surprising conclusion that my friends and I are working on something
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| − | unusually cool. Who knew?
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