Frequently Asked Questions

Q: Where can I find answers to Frequently Asked Questions?

A: Right here, as soon as others put data on this page!

Thanks to Michael Atchison for his help on this.

'System Description' and 'Technical Requirements' questions

Here are some of the 'System Description' and 'Technical Requirements' type of questions you thought you could also help me with. If you don't know the answers to these questions or are not sure about answering them, could you let me know who I might be able to speak to with regard to some of these questions relating specifically to the Vista software I would appreciate it.

Is the Vista system built or is it comprised from "commercial off-the-shelf software" or both?

[Schlehuber, Cameron] All but a few components of VistA are in the public domain. The Dental package is now for the most part a COTS package. Also, the CPT codes and prescription instructions (in English and Spanish) are copyrighted and not included in the VistA FOIA.

Is any or all of your system software COTS (Commercial off-the-shelf software? e.g. middleware?

[Schlehuber, Cameron] See response below.

List the server platform(s) utilized by your system?

[Schlehuber, Cameron] The VistA MUMPS code (which is in the public domain) requires an environment as specified in the ANSI MUMPS X11 standard. There are several vendors that can provide that environment on a wide variety of OS platforms. Most notable among them are Intersystem's Cache and Fidelity's GT.M, which both run on a variety of OS platforms from Linux, Unix, VMS, Windows, Sun Solaris, etc. The various GUIs currently run only on Windows 2K or "higher" (e.g. XP). But most of the applications in VistA only require a Telnet session.

What are the minimum (and recommended, if known) hardware requirements for the software?

[Schlehuber, Cameron] That naturally depends on the size of the care provider and patient population. The Salt Lake VAMC is at about the median size of VA Medical Center facilities. They run the server on 4 ES40 computers (each has a single Alpha 64-bit cpu from HP) and I believe about 100 Gigabytes of disk (about half full with about 25 years of accumulated data). That does not include Imaging requirement, which use Jukeboxes for storage.

a) Servers?

[Schlehuber, Cameron] For a clinic with up to 7 "users", the following would be more than adequate:

Server Hardware/Platform Requirements

  Minimum processor speed is 1.4 gigahertz
  Minimum memory requirement is 512 megabytes
  Minimum hard drive space is 60 gigabytes
  Compact Disk (CD) drive
  Network capability (if more than one computer is used)

b) Desktops/Laptops?

[Schlehuber, Cameron]

Workstation Hardware requirements

  Minimum processor speed is 1 gigahertz
  Minimum memory is 256 megabytes
  Minimum hard drive space is 10 gigabytes
  Network Capability

Workstation Operating System Requirements

  Microsoft Windows 2000 or higher

Describe the minimum (and recommended, if known) optimum operating system of the software.

[Schlehuber, Cameron] See above response on server platforms.

Is there additional software required for use of the Vista system for:

a) Users?

[Schlehuber, Cameron] No.

b) System Administrators?

[Schlehuber, Cameron] No.

In what language(s) is your system software developed? What version? Different language up front?

[Schlehuber, Cameron] VistA on the server side is written in ANSI Standard MUMPS (ANSI 1995 standard). The few applications that use a GUI interface have the client side written in Delphi versions 5 and 6.

Is the system software

a) GUI and table driven?

[Schlehuber, Cameron] Yes.

b) Client/Server based?

[Schlehuber, Cameron] Yes.

c) Include the use of up-to-date industry standard codes, e.g. ICD-9, CPT4, DSM-4, NDC, others?

[Schlehuber, Cameron] Yes. In addition to the list below, VistA is gradually being fitted with SNOMED CT.

  ICD-10-CM   International Classification of Diseases, Diagnosis
  ICD-10 Proc International Classification of Diseases, Procedures
  ACR         Index for Radiological Diagnosis
  AI/RHEUM    Disease/Findings Knowledge Base
  COSTAR      Computer Stored Ambulatory Records Term File
  HCPCS       Current Procedural Codes
  CPT-4       Current Procedural Terminology
  CRISP       Computer Retrieval of Info. on Scientific Projects
  COSTART     Coding Symbols Thesaurus for Adverse Reaction Terms
  DODFAC      DoD DMIS ID's
  DORLAND     Dorland's Medical Dictionary
  DSM-IIIR    Diagnostic & Statistical Manual of Mental Disorders
  DSM-IV      Diagnostic & Statistical Manual of Mental Disorders
  DXPLAIN     Diagnostic Prompting System
  HHCC        Home Health Care Component, Diagnosis/Interventions
  ICD-9-CM    International Classification of Diseases, Diagnosis
  ICD-9       ProcInternational Classification of Diseases, Procedures
  CONGRESS    Subject Headings
  LOINC       Logical Observation Identifier Names and Codes
  MCMASTER    Glossary of Epidemiology Terms
  MeSH        Medical Subject Headings
  MTF         DoD Military Treating Facilities
  META        Unified Medical Language System Metathesaurus
  NANDA       Classification of Nursing Diagnosis
  NIC         Nursing Intervention Classifications
  NOC         Nursing Outcomes Classifications
  OMAHA       Omaha Nursing Diagnosis and Interventions
  PROBLEM     Problem List Code Set
  RVC         Reason for Visit Classification for Amb Care
  TITLE 38    Service Connected Disabilities
  SNOMED 2    Systematized Nomenclature of Medicine
  UMDNS       Universal Medical Device Nomenclature System
  UNDEF       Undefined Code/Coding System (Code = "None")
  UWA92       Glossary of Neuronames

Does VistA include mental health and substance abuse/addiction services?

Yes.

What is there for Screening and Intake/Enrollment?

There is support for completing a group of initial administrative functions necessary to provide behavioral health services to an individual, e.g. capture data related to initial screening, incoming referral(s), registration/admission, financial eligibility, program eligibility, releases and notices, service authorizations, maintain historical data.

There is a full range of screening tools available along with narrative summaries etc. In substance abuse there is a computerized Addiction Severity Index. Using the Clinical Reminders package one can screen in Primary Care all patients for substance abuse and depression.

What is there for Clinical Evaluation and Assessment?

There are modules for initial and ongoing clinical evaluations and assessments to determine an individual's service and support needs, e.g. capture data related to scheduling, mental health and addiction evaluations and assessments, individual medical data, level of care, clinical diagnoses, program enrollments.

VistA supports the full multi-axial DSM-IV diagnosis and it is part of mental health package. Scheduling is a separate function but all visits are tied to providers, procedure and diagnosis for documentation and third part billing. GAF scores are central to disability assessments. Clinical Reminders and Mental Health packages together provide reminders for follow up care.

What complete behavioral health assessment instruments and scoring is included in the FOIA version of VistA?

[Schlehuber, Cameron] The following MH Assessment Instruments are in the FOIA VistA:

• AIMS - Assessment Instrument for Mental Health System ?
• ALCO
• ANGR
• APPB
• ASI
• ATQ
• AUDC
• AUDCR
• AUDIT
• BUSS
• CAGE
• CESD
• CESD5
• CLERK
• CRIS
• CRS
• DEMO
• EATP
• ERS
• HLOC
• HX2
• HX3
• ICL
• IEQ
• JENK
• LEGL
• MARP
• MEDH
• MHLA
• MHLB
• MHLC
• MISS
• MROS
• NEUR2
• PAIN
• PCLC
• PCLM
• PHYD
• PROB
• PSOC
• RLOC
• SAI
• SDES
• SEXF
• SEXH
• SEXS
• SHARI
• SHUD
• SLEP
• SMAST
• SOCW
• SOHX
• SOMP
• SPTSD
• SURV
• SWS
• TENS
• TRMT
• VALD

What is there for Counseling and Care Management?

There is support for developing, implementing and tracking behavioral health plan(s) for service(s) and support(s) for each individual, e.g. capture data related to counselors, treatment plans, support services, referrals out, transfers/ closures.

Treatment plans in MH is a feature still under active development by VA. Currently treatment plans are taken care of by using Progress Notes and the use of templates authored locally at each hospital. Such templates still need to be standardized and the output is simple text.

What is there for Treatment and Recovery/Aftercare Support Services?

All episodes of care are available for tracking an individual's behavioral health (mental health and addiction) treatment services, and recovery/aftercare support and maintenance services once active treatment has been completed, and treatment/recovery/aftercare support plans, discharge readiness and follow-up.

What is there for Medication Management?

The Pharmacy package supports tracking medications administered in the treatment of mental health and addiction disorders.

What is available for Education, Prevention and Outreach Services?

Patient education, prevention and outreach each have components in the Mental Health package for treatment of individuals as well as groups.

Please describe the search engine and search capabilities of your system.

[Schlehuber, Cameron] The ad hoc search capabilities are best detailed in the document for the Advanced VA FileMan user found at http://vista.med.va.gov/fileman/docs/u2/index.shtml Note that many applications have specialized search and report capabilities as well.

Please describe the developers of the software, e.g. agency technical personnel, contract personnel.

[Schlehuber, Cameron] Federal employees and contract employees.

Does your agency personnel populate/maintain the tables in the system software?

[Schlehuber, Cameron] Tables that are standard across the VHA enterprise are maintained centrally and updates are distributed regularly (some essentially in real time). Tables specific to local facilities are maintained by personnel local to the facility.

Did your agency (the VA) require any external assistance(contractor) to implement the software?

[Schlehuber, Cameron] No.

What type of training was required for the VA's system software implementation (user training, system administrator/technical training)?

[Schlehuber, Cameron] Extensive training is required for system administration. Training for users varies depending on the application and the user's duties. Depending on their familiarity with computers, care providers may require no more than an hour of training, though most will pick up what they need by exploring the applications and learning from their peers.

Has the VA developed training materials specific to your system, e.g. computer based training (CBT) materials and manuals.

[Schlehuber, Cameron] There are extensive training materials. See http://www.vehu.med.va.gov/

Who maintains your software, e.g. agency personnel, contract personnel?

[Schlehuber, Cameron] VHA personnel are responsible for developing and maintaining all VistA software.

Does the VA have User Help Desk Support?

[Schlehuber, Cameron] Only for Veterans Health Administration facilities. It does not extend to the private sector. See http://www.worldvista.org/ for guidance on getting contract support for VistA.

How many users does the VA support?

[Schlehuber, Cameron] VHA has over 200,000 employees, all use VistA.

Does the VA provide Technical Help Desk Support?

[Schlehuber, Cameron] Only for Veterans Health Administration facilities. It does not extend to the private sector. See http://www.worldvista.org/ for guidance on getting contract support for VistA.

How many system administrators (full time equivalents) does it take to support the fully implemented system software?

[Schlehuber, Cameron] That naturally depends on the size of the organization using VistA and the number of applications implemented and used. A small clinic using only part of VistA would be able to easily get by with a part-time position.