Frequently Asked Questions

This is a list of some common Frequently Asked Questions (FAQs)

Q: Where can I find answers to Frequently Asked Questions?
A: Right here, as soon as others put data on this page!

This page is http://www.vistapedia.com/index.php/Frequently_Asked_Questions
(note: there is a dynamic automatically created list of FAQs under the FAQ category )

Thanks to Michael Atchison for his help on this.

'System Description' and 'Technical Requirements' questions
Here are some of the 'System Description' and 'Technical Requirements' type of questions you thought you could also help me with. If you don't know the answers to these questions or are not sure about answering them, could you let me know who I might be able to speak to with regard to some of these questions relating specifically to the Vista software I would appreciate it.

Is the Vista system built or is it comprised from "commercial off-the-shelf software" or both?
Schlehuber, Cameron All but a few components of VistA are in the public domain. The Dental package is now for the most part a COTS package. Also, the CPT codes and prescription instructions (in English and Spanish) are copyrighted and not included in the VistA FOIA.

Is any or all of your system software COTS (Commercial off-the-shelf software? e.g. middleware?
Schlehuber, Cameron See response below.

List the server platform(s) utilized by your system?
Schlehuber, Cameron The VistA MUMPS code (which is in the public domain) requires an environment as specified in the ANSI MUMPS X11 standard. There are several vendors that can provide that environment on a wide variety of OS platforms. Most notable among them are Intersystem's Cache and Fidelity's GT.M, which both run on a variety of OS platforms from Linux, Unix, VMS, Windows, Sun Solaris, etc. The various GUIs currently run only on Windows 2K or "higher" (e.g. XP). But most of the s in VistA only require a Telnet session or an ssh connection.

What are the minimum (and recommended, if known) hardware requirements for the software?
Schlehuber, Cameron That naturally depends on the size of the care provider and patient population. The Salt Lake VAMC is at about the median size of VA Medical Center facilities. They run the server on 4 ES40 computers (each has a single Alpha 64-bit cpu from HP) and I believe about 100 Gigabytes of disk (about half full with about 25 years of accumulated data). That does not include Imaging requirement, which use Jukeboxes for storage.

a) Servers?
Schlehuber, Cameron For a clinic with up to 7 "users", the following would be more than adequate:

Server Hardware/Platform Requirements
Minimum processor speed is 1.4 gigahertz Minimum memory requirement is 512 megabytes Minimum hard drive space is 60 gigabytes Compact Disk (CD) drive Network capability (if more than one computer is used)

b) Desktops/Laptops?
Schlehuber, Cameron Yes

Workstation Hardware requirements
Minimum processor speed is 1 gigahertz Minimum memory is 256 megabytes Minimum hard drive space is 10 gigabytes Network Capability

Workstation Operating System Requirements
Microsoft Windows 2000 or higher

Describe the minimum (and recommended, if known) optimum operating system of the software.
Schlehuber, Cameron See above response on server platforms.

a) Users?
Schlehuber, Cameron No.

b) System Administrators?
Schlehuber, Cameron No.

In what language(s) is your system software developed? What version? Different language up front?
Schlehuber, Cameron VistA on the server side is written in ANSI Standard MUMPS (ANSI 1995 standard). The few s that use a GUI interface have the client side written in Delphi versions 5 and 6.

a) GUI and table driven?
Yes. There are several Graphic User Interfaces s, with a notable one being.
 * What is CPRS?
 * What computer language is CPRS written in ?
 * What human language is CPRS written to use ?
 * Is CPRS the only way to access Vista with a GUI interface ?
 * Does Vista exist with MUMPS roll-and-scroll and the GUI interface is CPRS, a separate program ?
 * Which options in Vista can be used with a GUI interface ?
 * Where are the best directions for installing CPRS ?
 * Is CPRS self-contained (requiring only fundamental knowledge of computers) ?
 * Do I have to know Windows internals to install CPRS ?
 * I installed Vista under Microsoft Windows using InterSystems Cache using a CACHE.DAT file. Do I now have the CPRS program?
 * Where do I get the CPRS program?
 * What is the RPC Broker?

b) Client/Server based?
Schlehuber, Cameron Yes.

c) Include the use of up-to-date industry standard codes, e.g. ICD-9, CPT4, DSM-4, NDC, others?
Schlehuber, Cameron Yes. In addition to the list below, VistA is gradually being fitted with SNOMED CT.

ICD-10-CM  International Classification of Diseases, Diagnosis ICD-10 Proc International Classification of Diseases, Procedures ACR        Index for Radiological Diagnosis AI/RHEUM   Disease/Findings Knowledge Base COSTAR     Computer Stored Ambulatory Records Term File HCPCS      Current Procedural Codes CPT-4      Current Procedural Terminology CRISP      Computer Retrieval of Info. on Scientific Projects COSTART    Coding Symbols Thesaurus for Adverse Reaction Terms DODFAC     DoD DMIS ID's   DORLAND     Dorland's Medical Dictionary DSM-IIIR   Diagnostic & Statistical Manual of Mental Disorders DSM-IV     Diagnostic & Statistical Manual of Mental Disorders DXPLAIN    Diagnostic Prompting System HHCC       Home Health Care Component, Diagnosis/Interventions ICD-9-CM   International Classification of Diseases, Diagnosis ICD-9      ProcInternational Classification of Diseases, Procedures CONGRESS   Subject Headings LOINC      Logical Observation Identifier Names and Codes MCMASTER   Glossary of Epidemiology Terms MeSH       Medical Subject Headings MTF        DoD Military Treating Facilities META       Unified Medical Language System Metathesaurus NANDA      Classification of Nursing Diagnosis NIC        Nursing Intervention Classifications NOC        Nursing Outcomes Classifications OMAHA      Omaha Nursing Diagnosis and Interventions PROBLEM    Problem List Code Set RVC        Reason for Visit Classification for Amb Care TITLE 38   Service Connected Disabilities SNOMED 2   Systematized Nomenclature of Medicine SNOMED CT     UMDNS       Universal Medical Device Nomenclature System UNDEF      Undefined Code/Coding System (Code = "None") UWA92      Glossary of Neuronames

Does VistA include mental health and substance abuse/addiction services?
Yes.

What is there for Screening and Intake/Enrollment?
There is support for completing a group of initial administrative functions necessary to provide behavioral health services to an individual, e.g. capture data related to initial screening, incoming referral(s), registration/admission, financial eligibility, program eligibility, releases and notices, service authorizations, maintain data.

There is a full range of screening tools available along with narrative summaries etc. In substance abuse there is a computerized Addiction Severity Index. Using the Clinical Reminders package one can screen in Primary Care all patients for substance abuse and depression.

What is there for Clinical Evaluation and Assessment?
There are modules for initial and ongoing clinical evaluations and assessments to determine an individual's service and support needs, e.g. capture data related to scheduling, mental health and addiction evaluations and assessments, individual medical data, level of care, clinical diagnoses, program enrollments.

VistA supports the full multi-axial DSM-IV diagnosis and it is part of mental health package. Scheduling is a separate function but all visits are tied to providers, procedure and diagnosis for documentation and third part billing. GAF scores are central to disability assessments. Clinical Reminders and Mental Health packages together provide reminders for follow up care.

What complete behavioral health assessment instruments and scoring is included in the FOIA version of VistA?
Schlehuber, Cameron The following MH Assessment Instruments are in the FOIA VistA:


 * AIMS - Abnormal Involuntary Movement Scale''
 * ALCO
 * ANGR
 * APPB
 * ASI - Addiction Severity Index
 * ATQ - Automatic Thoughts Questionnaire
 * AUDC - Alcohol Use Disorders Identification Test - Condensed
 * AUDCR - Alcohol Use Disorders Identification Test - Condensed & Reviewd
 * AUDIT
 * BUSS
 * CAGE
 * CESD
 * CESD5
 * CLERK
 * CRIS
 * CRS
 * DEMO
 * EATP
 * ERS
 * HLOC
 * HX2
 * HX3
 * ICL
 * IEQ
 * JENK
 * LEGL
 * MARP
 * MEDH
 * MHLA
 * MHLB
 * MHLC
 * MISS
 * MROS
 * NEUR2
 * PAIN
 * PCLC
 * PCLM
 * PHYD
 * PROB
 * PSOC
 * RLOC
 * SAI
 * SDES
 * SEXF
 * SEXH
 * SEXS
 * SHARI
 * SHUD
 * SLEP
 * SMAST
 * SOCW
 * SOHX
 * SOMP
 * SPTSD
 * SURV
 * SWS
 * TENS
 * TRMT
 * VALD

What is there for Counseling and Care Management?
There is support for developing, implementing and tracking behavioral health plan(s) for service(s) and support(s) for each individual, e.g. capture data related to counselors, plans, support services, referrals out, transfers/ closures.

plans in MH is a feature still under active development by VA. Currently plans are taken care of by using Progress Notes and the use of templates authored locally at each hospital. Such templates still need to be standardized and the output is simple text.

What is there for Treatment and Recovery/Aftercare Support Services?
All episodes of care are available for tracking an individual's behavioral health (mental health and addiction) services, and recovery/aftercare support and maintenance services once active  has been completed, and ]/recovery/aftercare support plans, discharge readiness and follow-up.

What is there for Medication Management?
The Pharmacy package supports tracking medications administered in the of mental health and addiction disorders.

What is available for Education, Prevention and Outreach Services?
Patient education, prevention and outreach each have components in the Mental Health package for of individuals as well as groups.

Please describe the search engine and search capabilities of your system.
Schlehuber, Cameron The ad hoc search capabilities are best detailed in the document for the Advanced VA FileMan user found at http://vista.med.va.gov/fileman/docs/u2/index.shtml Note that many s have specialized search and report capabilities as well.

Please describe the developers of the software, e.g. agency technical personnel, contract personnel.
Schlehuber, Cameron Federal employees and contract employees.

Does your agency personnel populate/maintain the tables in the system software?
Schlehuber, Cameron Tables that are standard across the VHA enterprise are maintained centrally and updates are distributed regularly (some essentially in real time). Tables specific to local facilities are maintained by personnel local to the facility.

Did your agency (the VA) require any external assistance(contractor) to implement the software?
Schlehuber, Cameron No.

What type of training was required for the VA's system software implementation (user training, system administrator/technical training)?
Schlehuber, Cameron Extensive training is required for system administration. Training for users varies depending on the and the user's duties. Depending on their familiarity with computers, care providers may require no more than an hour of training, though most will pick up what they need by exploring the s and learning from their peers.

Has the VA developed training materials specific to your system, e.g. computer based training (CBT) materials and manuals.
Schlehuber, Cameron There are extensive training materials. See http://www.vehu.med.va.gov/

Who maintains your software, e.g. agency personnel, contract personnel?
Schlehuber, Cameron VHA personnel are responsible for developing and maintaining all VistA software.

Does the VA have User Help Desk Support?
Schlehuber, Cameron Only for Veterans Health Administration facilities. It does not extend to the private sector. See http://www.worldvista.org/ for guidance on getting contract support for VistA.

How many users does the VA support?
Schlehuber, Cameron VHA has over 200,000 employees, all use VistA.

Does the VA provide Technical Help Desk Support?
Schlehuber, Cameron Only for Veterans Health Administration facilities. It does not extend to the private sector. See http://www.worldvista.org/ or http://www.osehra.org or http://www.hardhats.org for guidance on getting contract support for VistA.

How many system administrators (full time equivalents) does it take to support the fully implemented system software?
Schlehuber, Cameron That naturally depends on the size of the organization using VistA and the number of s implemented and used. A small clinic using only part of VistA would be able to easily get by with a part-time position.