Considerations for Using VistA in Small Offices

Every small office, like every VA hospital and every hospital department, is different. VistA can handle differences well, but there are some general conditions that apply in most small offices.

In an office of only a few providers, the staff will usually be cross-trained as much as possible. If every person knows enough about every job to at least get something done, then workflow can be maintained under most conditions and surprises can be handled.

In most states, the provider must sign prescriptions, but almost everything else can be delegated. The provider is still legally liable for every Action in the office, so staff must be checked out on a task before they can be allowed to perform it. This may be informal and simple, and enforcement is also informal and direct. Therefore, most business rules would need to be as broad as possible, mostly centered on "checked out" or "not checked out". And even then, a situation might occur where an assistant is taught a procedure the very morning she will need to use it, and documentation on VistA will need to be enabled before noon.

The roles addressed in OpenVistA Business Rules would be difficult to duplicate in a small office: Provider, User, and Transcriptionist are fine, but who will serve as Expected Cosigner, Medical Information Section, and Clinical Section Chief? This will require discussion.