Episode 1 The Layer Cake

The Intracare Implementation Log (Back to Log Homepage) (On to Episode 2)
Like most mature systems, VistA is a combination of old and new. Parts are decades old and other parts are as new and modern as yesterday. This is an attempt to divine the layers for newcomers.

Astronaut is a VistA Installation Suite which consists of:


 * 1) Astronaut server installers -- Install VistA the server as well as a GT.M MUMPS interpreter/client onto an existing Linux operating system. Both .rpm(Fedora)/.deb(Ubuntu) are supported. The details of the directory layout for the installation are defined by a specification called VistA Standard Base: http://astronautvista.com/astronaut-help/manual/vsb-specification/vista-standard-base-vsb-specification
 * 2) * This is a Free and Open Source Software (FOSS) stack. The layers of the cake are:
 * 3) ** VistA
 * 4) ** GT.M
 * 5) ** Linux
 * 6) Astronaut GUI-Client Installer, which is itself FOSS but for now runs only on non-free Microsoft Windows operating systems.
 * 7) * Here the layers are:
 * 8) **TMG-CPRS or other GUI client
 * 9) **Microsoft Windows (non-free), on a network-connected computer or virtualized on the same (Linux) computer
 * 10) * or:
 * 11) **Terminal screen (text-oriented)
 * 12) **Almost any terminal emulator or hardware

By default Astronaut installs all of these, but can optionally selectably install:
 * 1) TMG-CPRS -- Robust and extensive graphic user interface client mainly for clinicians but increasingly for support staff as well.
 * 2) Text client (direct VistA server running on Linux login) -- access to VistA's extensive text-based menu driven applications.
 * 3) Vitals Client -- Graphic user interface vitals only.
 * 4) VistA-Config client -- Graphic user interface user and database manager (overlap with text-based Fileman).
 * 5) Admin client (direct Linux server login) -- Down to the metal access to Linux the server, running VistA the server.
 * 6) Astronaut SSH -- optionally creates an encryption tunnel between client and server for secure access over hostile territory (Internet).
 * 7) Group Notes client -- group therapy oriented note taking.
 * 8) GUI-Mail client -- SMTP e-mail through the VistA server.
 * 9) Shift-handoff tool client.
 * 10) Session manager -- easily and quickly switch server the clients are using.
 * 11) more.

So:

In the beginning, all of VistA was text-based. Clinicians used terminals to enter the patient Record, as did support staff to perform their tasks. Fileman and most other VistA applications were designed for text-based use. They can still be accessed via a terminal session from any computer (or even via dumb terminal) that is network-connected to the VistA server running on Linux. This method is menu based and the number of menus is quite large. For that very reason, as Configuration users begin to memorize shortcuts to their desired tasks, they still find that text-based access is more efficient than clicking through graphical pages, and they prefer it. A map of those menus is here.

But for years now Clinical Users in the VA have relied on the CPRS client, which is fully graphical, for entry of patient notes. Astronaut offers the option to configure the VistA server itself using VistA-Config. The same underlying applications in VistA can now appear as a visual layout of menus, options, and fields, the majority of which can be clicked and edited. Other GUI-based clients are also available for tasks such as entry of vital signs. Get it here.

BELOW IS Historical, OBSOLETE and NOT RECOMMENDED, use Astronaut VistA Installer Suite instead.
Ignacio Valdes  	Jul 11 2008, 4:28 pm

Hello all,

I have received the go-ahead from Intracare leadership to implement VistA at Intracare myself. I have been asked to create a log or a guide to do this so here goes. I'm going to think out loud: The perennial question of Which VistA? reoccurs. After some hunting on http://worldvista.org I found:


 * http://worldvista.org/World_VistA_EHR

which probably isn't a very good page since it leads you to this:


 * http://sourceforge.net/project/showfiles.php?group_id=193652&package_...

really confusing page with about 12 different files to download. Which one? Had to call David Whitten who could not give me an answer just yet because he was at the airport. Then I found this page:


 * http://worldvista.org/Software_Download

which led me to this more reasonable page:


 * http://sourceforge.net/project/showfiles.php?group_id=193652

but I'm still confronted with 2 choices that I do not know which one to get so I'm going to go with the February 1st one. Uh-oh, that puts me back into 12 different files to download page, none of which are obvious as 'the one' to download and install.

Feedback for VistA community:


 * 1) If I wasn't part of this community, have good contacts and persistent I would have already quit.
 * 2) Website and sourceforge are confusing, not very helpful for choosing 'the one' VistA to install.
 * 3) Really need a pointy clicky installer for Linux and Windows. Even Plone has that now.

Stay tuned. If anyone can point to me where to go next, that would be great.

-- IV

2. Greg Woodhouse   	Date: Fri, 11 Jul 2008 14:31:52 -0700

> 1) If I wasn't part of this community, have good contacts and persistent I would have already quit.

I think I would have, too. Things are pretty confusing right now. Let's hope they don't stay that way.

> 2) Website and sourceforge are confusing, not very helpful for choosing 'the one' VistA to install.

Hmm... Maybe someone can comment on the role of WorldvVstA EHR and its relationship to other offerings out there.

> 3) Really need a pointy clicky installer for Linux and Windows. Even Plone has that now.

I agree.This seems to be a bit of a touchy subject, and I've found suggestions that there should be an installer (GUI or not) are met with strong resistance. Certainly, creating an installer would be a non-trivial exercise, and I can understand that there is a lot of flexibility in how VistA can be installed and configured, but that hardly seems like a compelling reason not to create an installer. Honestly, I wonder if there is simply no consensus on how to proceed. A secondary issue is versioning and source code control. Unfortunately, this is another area where the necessary consensus is missing.

3. K.S. Bhaskar   	Local: Fri, Jul 11 2008 6:43 pm

I wonder if there is a confusion between *installing* VistA and *configuring* VistA. Installing VistA is truly simple - with a SemiVivA Lite, for example, it is one command. Configuring VistA for a production environment is still way more complicated than it needs to be. However, ultimately, configuring VistA is going to be harder than installing an office suite or an operating system, since it must be configured to the "Business Rules" (yes, I hate that term, as Greg does) of the practice, and the complexity of configuring VistA for a clinic will be broadly comparable to the decisions to be made when setting up a practice.

-- Bhaskar

4. kdtop

Bhaskar, I would like to respectfully disagree. It is "easy" once you figure out which of the many disks to download. Is it Viva? Is it SemiViva? The WorldVistA needs to have a big button that says "Download now" and have that down the version that they need to start using the system, not a demo version.

I agree with Greg that there is resistance to getting a do-it-yourself version ready for users. I get the idea that we want people to go to installers. But even that is confusing. Where is the clear direction of how to contact one? And I have heard that those that have reached installers are being quoted unreasonable rates to install the system for them.

If we are wanting to get the product out the door, it doesn't seem to look that way.

Kevin

5. I, Valdes

No confusion. Installing is one step, configuring another. Thinking out loud about my experience, WorldVistA, the hardhats community and http://worldvista.org website needs to simplify and have a much clearer and easier pathway on that critical first step. Check out http://plone.org/products/plone. Simple and clear. that page services the casual installer and the real techies. One can now have a Ploneserver and website up in 10 minutes with point and click. It wasn't always that way and took years for the community to get there. It is a vast improvement.

-- IV

6. Nancy Anthracite

There is a wiki, and the folks that have access to the WorldVistA web site are limited, in number and in bandwidth, but the wiki at http://vistapedia.net can be edited by many, many people. We could use some help with straightening out this problem. One a wiki page got it straight, it would be a lot less work to copy that page to the WorldVistA site than to write it from scratch. We would appreciate the help.

The Sourceforge site naming "convention" is a mess, and we know it. To change the name of a file on Sourceforge, you have to upload it. The uploads can really be a bear with these large files, and once the upload fails, you have to start it again with a file with a different name, or wait 24 hours and try again. These uploads of several large files can keep the uploader tied up for countless hours, and if you had a naming convention in mind when you started, it is blown out of the water by the time you finish.

That said, we think a nice html page explaining what is what with links to the correct file is the answer, but there are so many pressing things to deal with that nobody has done it yet, so we really would love to have someone take that on as a project.

7. I, Valdes

Why not put it all onto the WorldVistA website? How big is it? -- IV

8. Nancy Anthracite

These files are big and the bandwidth on Sourceforge is huge.

9. Sam Habiel

I agree; took me a while to figure out who's what--Viva, Vivita, SemiViva, VOE, FOIA, OpenVista, and the list goes on. I was going to answer this question, but, where did WorldVista/VOE 1.0 go? There is a source of confusion, and it's simple: there are two sourceforge websites, both called WorldVista! Talk about confusing...


 * http://sourceforge.net/projects/worldvista-ehr/
 * http://sourceforge.net/projects/worldvista/

Anyways, the first one has the released WV EHR. If you are good at GT.M and Vista, install GT.M from its own website, configure it, then download the Global and the Routines (there's a zip file for that) and extract those in their respective directories, etc etc. Nancy has a good guide on how to do that. That's the approach I prefer because I get to do the entire set-up myself, and I could fix problems with it since I did it.

If you want a ready environment to start with, go with the SemiViva Lite. It has GT.M and WorldVista already configured so that you can start rolling... SemiViva Pro needs more work on your part to configure GT.M. Disclaimer: I haven't tried the SemiViva lately.

Sam

10. Nancy Anthracite

If you would like it, there is a script here that will download the files for you and do and install VistA on a Debian or Debian derivative system.


 * http://opensourcevista.net:8888/NancysVistAServer/WVEHR-VOE1.0-Install/

Or you can use these instructions to install it on Cache. Download the Cache.dat and readme file from the WorldVistA EHR site on Sourceforge for that.

-- Nancy Anthracite
 * http://opensourcevista.net:8888/NancysVistAServer/InstallingVistAWithSingleUserVersionCache5.2.doc

11. I, Valdes

How about Fedora 9? -- IV

12. Nancy Anthracite

I think you will have to change the script to useradd instead of adduser for Fedora.

13. Nancy Anthracite

and also I don't think Fedora will use apt

14. r...@rcresearch.us

Fedora uses yum.

15. Rick Jung

My name is Rick Jung and I'm the COO of Medsphere. In an attempt to assist the market in objectively answering precisely this question Medsphere has undertaken the effort to compare the various VistA offerings available. A detailed document will be posted for comments in the near future.

If you'd like a preview feel free to call me. My direct line is [Call Medsphere at 760 692 3700, or log into medsphere.org and search for Jung].

Regards,

Rick

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