VistA dieing of starvation and neglect

VistA dieing of starvation and neglect

Summary: At a time when organizations around the world are switching from proprietary to open source models of support, an agency which created such a model from scratch is going the other way.

Phillip LongmanThe Veterans Administration (VA) is starving its world-class VistA medical records software to death. At a time when organizations around the world are switching from proprietary to open source models of support, an agency which created such a model from scratch is going the other way. Phillip Longman (right), a senior fellow at the New America Foundation who called VA care the "Best Care Anywhere" in a 2005 Washington Monthly feature, yesterday confirmed what other observers have told ZDNet over the last week.

I just gave 11 addresses to front line VA employees in the last few weeks, and I heard over and over again their frustration over not being able to get to the people at the Department of Defense (DoD) making the hand-offs. Not only can't the computers talk to each other, they can't get the Army doctor in Germany on the phone to answer a simple question.

While VA care is still excellent, Longman said, three forces are killing VistA:

  1. Security concerns are causing the Department of Defense (DoD) to seek centralized systems.

  2. The DoD has its own medical computing system, called AHLTA, built by contractors, and sets its priority there.

  3. Ideology, a desire to privatize all government functions. "John McCain has come out for closing the VA and giving everybody vouchers," Longman said.

Phillip Longman book, “Best Care Anywhere” from the New America FoundationWhen wounded soldiers are discharged they move from the AHLTA system to VistA, and the two systems still don't communicate, Longman said.  (To the left, Longman's book based on the article.)

"They could wire Walter Reed or Bethesda (the two biggest military hospitals) for VistA in an afternoon. Technically there's no big problem, even in creating an interface. Yet there are DoD people who have built their careers on AHLTA and want people to switch to their system."

It's those voices which are being heard. 

"If you look at the recent political appointees to the VA, they're people with DoD backgrounds. And the DoD culture is procure everything – they don't make anything themselves, they procure it. When they get to the VA they don't appreciate the open source culture."

While the VA has been using electronic health records for years, and depends on them, AHLTA is just now starting to make them mandatory, Longman said.

"The doctors don't have buy-in, and some doctors don't even use electronic health records. They're having retention problems as the Department of Defense tries to make Electronic Health Records mandatory .

Security is the other big concern, leading to everything being centralized. It's like waiting for a computer vendor to create a patch and not being allowed to write it yourself, Longman said.

"In the old days, whether you were in Durham or Puget Sound doctors would see an application, call in the local techies, then create a solution. Then they'd share it. That's how VistA came to be. That's why it had buy-in from users.

"That's all gone now. All gone." He gave an example from the Durham VA facility, which he visited recently: 

At Durham, where I was, they have been known for IT innovation and there's just one programmer left. Now if you have an IT idea, it's like the 70s. It has to go to Washington, it will be contracted out to Perot Systems or someone, and any tinkering is all under the domain of central office, which uses security as a pretext to wipe out the innovation.

Ironically the VA has turned its back on VistA just as the commercial market is showing interest in open source health care tools.

T Bass 2008 closeupThe creation of Open Health Tools, a project based on Eclipse, the growing commercial success of Medsphere, based on VistA, and the launch of Tolven Inc., which is expanding the VistA code which Medsphere sells, all point to a growing VistA market.

"Even if the VA doesn't want VistA there's a community of people who use VistA outside the VA and program applications," Longman said.

"I'm watching a standoff in Washington on what will be the standards for electronic health records. Years go by. Why can't we take VistA?" 

Topics: Windows, Health, Microsoft, Operating Systems, Software

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  • ...

    McCain is a f*cking idiot! Gee some patriot he is, eh?

    "[B]Ideology, a desire to privatize all government functions. ?John McCain has come out for closing the VA and giving everybody vouchers,? Longman said.[/B]"

    And privatizing our government... don't you people get it? When you privatize we lose. We go from being a Constitutional Republic to being a Fascist Regime with a weak Democratic process!

    Privatizing is one of the reasons we are in the world of hurt we are now. Because of out sourcing and privatizing we have moved from a well balanced economic base to a service industry. Manufacturing, clothing production, and programming jobs are and have been moved overseas. All that leaves are construction and service industry jobs.

    As a Vet I am pretty tired of people trying to mess with a system that works well and provides a solid reliable service to those of us injured while defending the Constitution. TO allow the the privatization of the VA and other entities within the government is to take the sacrifice of millions of Americans over 232 years and flush it all away.

    Enough with the corporatization of our government! Enough with outsourcing and enough with privatization! It's time we take back our nation, and this debacle with the VA is NOT the tip of the iceberg... but an shining example of just how rotten our nation is currently at the core. ]:)
    Linux User 147560
    • Privatizing doesn't mean off-shoring.

      The work can still be done in this country, but by a private company under contract rather than by a government employee.

      That said, there's a case for privatizing only in some limited situations. When police officers spend time as telephone operators they are not doing the job for which they were hired. The same can apply to some work by soldiers.

      Governments could hire telephone operators and others at rates appropriate to the job. But for some reason, contracting with a private firm can gain approval more easily. My best guess is that those making the decisions are often in elective office. And there are no qualifications in intelligence, experience, or common sense for those jobs.

      In the VA situation, it's possible that people working on (the far less popular) Vista endorsed the software enthusiastically, and campaigned for more widespread recognition of their ideological preference. With results seen in a number of places.

      The VA was a pioneer in showing the usefulness of open source. Perhaps it's also a pioneer in demonstrating open source's future.
      Anton Philidor
  • Why not procure VistA?

    If the VA wants to procure, rather than build, why not procure VistA? The code is out there open source, and Medsphere is advancing the system faster than the VA anyway. Witness Medsphere OpenVista CIS (, a modern cross-platform client for VistA. The VA has NOTHING like it. Why don't they just use it? I'm sure Medsphere would be happy to support the VA for a fraction of what the VA currently spends on VistA (and gets nothing for).

    Medsphere just went live at yet another hospital:

    • Not that simple

      OpenVistA CIS is relatively untested compared to CPRS. At least at the time of the 08 HIMSS Medsphere had not actually rolled out OpenVistA CIS to its own clients.

      OpenVistA CIS has a badgeware license, which means you have to display an ad for Medsphere on the client. That will make many of the contractors who work for the VA (and compete with Medsphere) very uncomfortable.

      Generally, the community has good reasons not to trust Medsphere.

      Those are just a few reasons.

      • You are wrong

        You state:

        "OpenVistA CIS has a badgeware license, which means you have to display an ad for Medsphere on the client."

        Please now. Be fair. We are not stupid. The Medsphere License requires you to retain the Medsphere branding/logo. That's all. It does not require you to display an "ad". You may not like having to see the Medsphere logo on the screen. That's your choice. Of course, you are using ZDNet right now and their logo is displayed on the screen. Presumably you have the same problem with ZDNet and won't be using this site again.

        But don't spread half-truths and lies to further your own political agenda. I can't stand it when self-righteous religious zealots like you re-interpret facts to support their own agenda.

        As for procurement, what you're really saying is that the contractors who work for the VA might lose their jobs if the VA buys from Medsphere, and therefore they won't let the VA buy from Medsphere. That's the kind of government BS and entitlement thinking that causes us to waste billions in taxpayer money. The VA should procure their software in the most cost effective way. If building it is the best way to do it, they should build it. If buying it is the best way, they should buy it. This is not a religious discussion.
  • It's spelled "dying", not dieing.

  • RE: VistA dieing of starvation and neglect

    I'd like to separate some issues here: None of the veterans that I know are complaining about VistA. To talk about AHLTA in comparison is a waste of time. The lesson to be learned from AHLTA thus far is that the DoD can make $3,000,000,000.00 disappear without getting a functional system. Some of that three billion had to to go somewhere else. Who got that contract? What a story! How not to spend $3 bil. and get nowhere. The conclusion that a Dod official said was that they they were going to back migrate AHLTA to VistA. The real lesson to me is that although MUMPS has deep roots, it is revolutionary in its implementation. VistA is not DP the terminals are more like switch boards than they are repositories. Imagine all the functions that come a single user. Schedule a patient,order a med, notify the Er about a patient and on and on. This makes a mountain of quadruplicate forms that sit in bins and are not processed in real time. In the paper system doesn't even have a central. Users can create new forms in a matter of hours. And there's a lot of expensive equiptment and people that are relying that they get the right information at the correct time. I guess to some degree the communication aspect of the system is more like air traffic control. Data is critical at one moment and trash in the next. The overall system is said to be improving a the rate of 6% a year. The idea being the more people who learn to use it the better it gets and it is now being considered a positive feature to not have any system people working on it.
  • RE: VistA dieing of starvation and neglect

    Dana Blankenhorn needs to step-up and not use a single
    source (abet an author selling a book) to write for a
    respected ZDNet publication. AHLTA or the tactical
    version AHLTA-T will never talk directly to VistA.
    However both AHLTAs (CONUS and Tactical) send health
    care information to the DoD's CDR (Common Data
    Repository). Both Military and VA health care providers have access to this information at their fingertips. This access is not integrated into the
    VistA application and this is the reason VA providers
    claim that the information is not available to them.
    It is a minor inconvenience but Doctors and Physicians Assistants are a pampered lot. As for the demise of
    VistA, AHLTA is far from ready for "prime time" use by
    the VA. It is common practice to suspend active
    development on the old application for years before
    phasing in a new system. The Army's CHCS program is
    an excellent example of this. CHCS was supposed to be
    replaced by AHLTA years ago yet it is still in use
    both in garrison, as well as Iraq and Afghanistan.
    Why? Because AHLTA is being developed in phases and
    critical portions of the program haven't been
    completed yet. Thus CHCS lives. Dana really missed
    the boat here...