Two longtime programmers at the VistA Community Meeting Monday at George Mason University in Fairfax, Va., offered a history of the U.S. Veterans Affairs Department's VistA electronic health-record system and a way forward for VA and military brass planning an estimated $28 billion retooling of VistA and a counterpart EHR within the Military Health System.
The meeting is being held by WorldVistA, a not-for-profit organization that promotes the use of an open-source version of the VA's health IT system in the U.S. and abroad.
Programmer Tom Munnecke, who started working at the VA in 1978, noted that the VistA precursor, the Decentralized Hospital Computer Program, was developed in spite of opposition from a centralized IT bureaucracy at the VA in Washington. He likened the development of VistA to the development of the Internet, which relied on three basic open-source components—URLs, http and html. DHCP, in comparison, was based on acceptance of a common database and programming environment.
"We used the term decentralization back then," Munnecke said. "I think that was another key part of (VistA's) success factor, another part of the 'secret sauce.' In a bureaucracy, everyone wants things centralized below them and decentralized above them. I'm very concerned that we've moved to a centralized, one-size-fits-all, monolith."
Frederick D.S. “Rick” Marshall began a 19-year career working at the VA in 1984. He co-founded World VistA in 2002 and now heads VistA Expertise Network, an IT consultancy. He said efforts to advance VistA should likewise focus on three elements: aesthetics, architecture and functionality. Each will require the expertise of people with unique skills, although members of all three groups must communicate freely with each other.
"We need a place for visionaries," Marshall said. "We crave a dramatic vision. It's one of the things we haven't had for a long time in the VA. This is what we need. We don't ask the doctor to tell us what the future will be."