VISTA, Superhero!
In chapters three and four, Longman makes much of the VISTA, the VA’s electronic healthcare record (EHR) system. Interesting that it developed as a guerilla system that was banned and condemned by the IT elite in Washington. Setting fire to someone’s office and destroying a car are a bit extreme, but not beyond belief. Usually, such disputes occur between civil service and political appointees, and the consequences are limited to getting fired. (Anyone want to be a US attorney? Or work for the Park service?) If you think this doesn’t happen in the private world, read about (or see the movie) Karen Silkwood. Those who defy authority are not welcome.
In this case, however, the guerillas won, but only after someone from Central Command dared to actually look at what they had been fighting. In part, this was a war between the users and the nerds. VISTA was developed by users--one of its great strengths. It is also “open source” software, which some see as another advantage. (Think Linux.) Finally, it represents “distributed computing.” When I was a kid, all computing power was housed in a mainframe at “the computer center.” A few labs were fortunate enough to have terminals, but the programs ran at the CC. Steve Jobs and later IBM moved that power to desktops, and the IT people have been working ever since to return to the days of a mainframe (theirs) and dumb terminals (users).
Fortunately for the VA (and the rest of the healthcare world), someone recognized the value of what the users were doing. There was once an active program in the VA to distribute VISTA to others. One impediment was that it was written in MUMPS--an obsolete programming language. Database software has gotten better over time. Remember here, we’re talking about 1970.
Probably the most important advantage of VISTA is that it allowed the VA to move on and address quality of care and patient safety issues with the EHR behind them as infrastructure.
Will VISTA work for everyone? It’s available. HHS is pushing it. Remember, though, that the VA is a healthcare system. Inpatients, outpatients, office patients, nursing homes--the whole banana. They own their patients forever, making investments in health and disease management feasible. They also own the hospitals and everyone who works there. If you have a system like that, perhaps VISTA is for you. If not, well, maybe. It’s worth looking at, but don’t just jump in.
Hospitals and doctors’ offices have computers for sending bills, because there is a strong business case for them. Some larger hospitals and a few doctors’ offices have EHRs, but the business case is less clear. It’s not purely because of the cost--it’s the small return on investment. As Longman chronicles, when done well, with strong user input, EHRs make sense. The VA has done this well, with outstanding results.
In this case, however, the guerillas won, but only after someone from Central Command dared to actually look at what they had been fighting. In part, this was a war between the users and the nerds. VISTA was developed by users--one of its great strengths. It is also “open source” software, which some see as another advantage. (Think Linux.) Finally, it represents “distributed computing.” When I was a kid, all computing power was housed in a mainframe at “the computer center.” A few labs were fortunate enough to have terminals, but the programs ran at the CC. Steve Jobs and later IBM moved that power to desktops, and the IT people have been working ever since to return to the days of a mainframe (theirs) and dumb terminals (users).
Fortunately for the VA (and the rest of the healthcare world), someone recognized the value of what the users were doing. There was once an active program in the VA to distribute VISTA to others. One impediment was that it was written in MUMPS--an obsolete programming language. Database software has gotten better over time. Remember here, we’re talking about 1970.
Probably the most important advantage of VISTA is that it allowed the VA to move on and address quality of care and patient safety issues with the EHR behind them as infrastructure.
Will VISTA work for everyone? It’s available. HHS is pushing it. Remember, though, that the VA is a healthcare system. Inpatients, outpatients, office patients, nursing homes--the whole banana. They own their patients forever, making investments in health and disease management feasible. They also own the hospitals and everyone who works there. If you have a system like that, perhaps VISTA is for you. If not, well, maybe. It’s worth looking at, but don’t just jump in.
Hospitals and doctors’ offices have computers for sending bills, because there is a strong business case for them. Some larger hospitals and a few doctors’ offices have EHRs, but the business case is less clear. It’s not purely because of the cost--it’s the small return on investment. As Longman chronicles, when done well, with strong user input, EHRs make sense. The VA has done this well, with outstanding results.
