Creating new vistas for VistA

I want to wrap up coverage of last week's VistA Community meeting, held in Fairfax, Va., and hosted by the not-for-profit organization WorldVistA.

First, there was a warning from U.S. Veterans Affairs Department information technology pioneer Tom Munnecke, who talked about the difference between toasters and cats.

Because WorldVistA has its own open-source version of the VA's VistA electronic health-record system, there was a lot of excitement at the meeting about the VA embracing its own open-source development model for VistA. But there was some apprehension expressed, too—most pointedly from Munnecke.

If you dismantle a toaster, reverse-engineer it and put the pieces back together with improvements, you still have a working toaster, Munnecke said. On the other hand, "You can't take a cat and vivisect it and still have a live cat anymore."

Healthcare software is more cat than toaster, Munnecke said. Proper development requires an "evolutionary spiral between the software and the community" in which it is used. "Focusing only on the software and not the community is fallacious."

Second, a huge potential benefit to the VA from its proposed open-source development project is that it might help the department incorporate into its own VistA iteration the increasing number of improvements worked up by an expanding global community of developers outside the VA.

Denise LeFevre is the CIO at 153-bed Oroville (Calif.) Hospital, which is up for about $1.6 million in federal EHR incentive payments. LeFevre said Oroville should finish some needed upgrades to its open-source version of VistA by June 30, rack up the requisite 90 days of meaningful use and get paid yet this year.

But, to meet federal meaningful-use criteria, VistA needs an outpatient e-Rx module to send prescriptions to local pharmacies, a tool to send and receive messages in the CCR/CCD formats and configuration to produce the requisite quality reports, according to programmer and WorldVistA member George Lilly. Lilly developed the e-Rx and CCR/CCD modules that Oroville will use, and fellow WorldVistA member Dr. Matt King worked on its quality reporting revisions.

Finally, there was a status report from Joseph Dal Molin, who has served as a consultant to the government of Jordan, where a pilot project to install WorldVista's open-source software in Amman is well under way.

VistA is live in all outpatient offices and several inpatient wards at the 500-bed Prince Hamza Hospital and is ready to go live at the Amman Comprehensive Clinic, Dal Molin said. Of equal significance, a team of about 50 programmers, retrained in MUMPS, VistA's database and programming language, has helped Jordan reach IT self-sufficiency in just 18 months, he said.

Dal Molin said programmer Sam Habiel has helped the Jordanians convert the roll-and-scroll interface in their VistA system's patient scheduling module to a more modern version that uses a graphical interface developed initially by the Indian Health Service. Citing this work as an example, Dal Molin said that as the VA moves forward with its open-source development plan, it should be prepared to accept improvements to VistA from a growing community of global users and developers.

Follow Joseph Conn on Twitter: @MHJConn.