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VistA is powerful, but is it adaptable?
The lead in a Federal Computer Week story pretty well sums up the conundrum: "Is VistA a diva in disguise?" The open-source EMR at the heart of the Department of Veterans Affairs' health IT strategy "is the best health information system in the world, bar none," says Ed Meagher, a former VA deputy assistant secretary of information and technology, but, he adds, it's also an old system that's difficult to manage and very high-maintenance.
Meagher, now a private consultant, has been hired by VA CIO Roger Baker to lead a workgroup that will make recommendations on how to modernize VistA and make it more adaptable to the private sector. "VistA is very old technology. That does not mean it does not work or is not useful. It is not a perfect answer, but I think there are potential uses for it," explains Dr. David Kibbe, a health IT consultant to the American Academy of Family Physicians. "This is a very good trend that is occurring."
Of course, a number of companies already have taken the source code for VistA and commercialized it as a lower-cost alternative to the many proprietary, enterprise EMRs on the market. "Affordability is a huge issue," says Michael Doyle, president and CEO of one such company, Medsphere Systems. "We can do everything the other systems do at a fraction of the cost," he tells FCW.
Medsphere has converted the VistA source code, developed more than two decades ago in a programming language called MUMPS, to work with a more modern SQL database. Some programmers tend to like MUMPS because of its long history, but there isn't a lot of MUMPS training available these days, nor is there much in the way of a MUMPS development community.
For more on VistA at the crossroads:
- check out this Federal Computer Week story
Related Articles:
VistA once again held up as an example of an EMR success
Is VistA a viable replacement for paper records?
Story claims proprietary EMRs could 'screw up' health reform
Comments
We are one of the universities (Robert Morris University, Moon Township, PA, near the Pittsburgh International Airport) providing education that is up-to-date in MUMPS and MUMPS-related technologies, especially InterSystems Caché and Fidelity National GT.M. We also teach the VA's FileMan database technology used in VistA and actively support and host WorldVistA conferences.
Another university involved educationally with VistA technology is Shepherd University in West Virginia.
Valerie Powell
One of the important advantages of VistA is its comprehensive approach to care. It is more suitable for support of preventive care, comprehensive care, chronic illness care, and interdisciplinary care team strategies, such as those preferred by the Patient Centered Medical Home (PCMH) and Dr. Wagner's Chronic Care Model (CCM) than most commercial products. For example, there is thorough integration of medical and dental data, not found as a routine feature of most commercial products, in spite of ample clinical research in the dental/periodontal fields relevant for improvement of diabetes care and cardiovascular disease care (including care for patients with heart disease and stroke). Commercial EMR vendors will be glad to add features, which means a delay in implementation and added costs. Also in pediatric care, where the immediate past president and the current president of the American Academic of Pediatrics (AAP) have made statements favoring integration of medical and dental patient records, most commercial EMR vendors have made no commitment to offer medical-dental EMR integration as standard, without extra cost. At present a children's hospital using a commercial EMR may find it necessary to "paste" data from an electronic dental record into the same patient's EMR.
Supporting interdisciplinary communication among providers is important for quality of care and for patient safety.
Valerie Powell
This article is rather funny if you look at it a little closer. VistA and MUMPS are being compared with "More Modern SQL". SQL is a 2 dimensional database technology and MUMPS is a multi-dimensional database and VistA is the framework that takes excellent advantage of this technology. To the inquisitive, please google "NoSQL". What is old is new again. MUMPS was so far ahead of itself due to some very intelligent insight into the needs of the data requirements of the Medical community, that has been applied in the financial community as their secret weapon in massive data storage and recovery.
From the post:
"Medsphere has converted the VistA source code, developed more than two decades ago in a programming language called MUMPS, to work with a more modern SQL database."
I wanted to take a moment to clarify this statement -- I suspect that the details of the technology were lost in translation.
We have released into open source a new platform technology (although not a new concept) we call FM Projection. This is a tool that takes the mature, reliable database management tool used throughout VistA and its variants, and *project* the schema and data into a relational model.
This is not a replication or replacement of data or technology -- it is an extension that exposes the data to new and different tools. The important point is that this technology augments the VistA-based systems, it does not "convert" data.
For details on the FM Projection technology, please visit our new project space here:
https://medsphere.org/community/project/fm-projection
Additionally, we presented our platform technology, including FM Projection, yesterday at the VistA Community Meeting. A recording of this presentation is available here:
https://medsphere.org/blogs/events/2010/01/15/extending-the-platform
Many thanks and we look forward to the feedback on this tool.
- Ben Mehling
Medsphere Systems Corporation
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