Projects

Below find the unedited and unprioritized project idea submissions. The project is in process and open for new submissions. This iteration of project submissions will close on 07/06/2006.

Projects
Welcome to the WorldVistA "Brainstorming" Projects Page The Projects page is the working directory of WorldVistA project ideas. All project concept are welcome - new and old.

The Process
1.	Project ideas and description will be collected and published on this page.

2.	High-level benefit analysis will be applied.

3.	Suggestions will be reviewed, prioritized and endorsed by the WorldVistA leadership.

4.	Funding will be sought and teams will be organized for projects that are determined to be of high value and show promise of successful completion.

Brainstorming Rules:
1.	Offer and collect as many ideas as possible.

2.	All ideas are valuable, the more the better. One crazy idea spawns three rational ideas.

3.	Don't spend time discussing details during brainstorming phase. Ideas submitted will be analyzed and deconstructed at length later...

4.	Do not be critical of ideas, it stifles the process and make creative thinkers go back into the box.

5.	Build on other ideas. Linking one idea to another is powerful.

6.	Capture all ideas and make them visible.

7.	Set a time limit. This iteration closes on 07/06/2007.

Project Details requested
Please supply the following:
 * Project title
 * Brief description
 * Benefit provided
 * Your name (so we know who to ask for clarification -- anonymous posts are accepted.)
 * Email address (optional)
 * link to projects.worldvista.org Project page if exists

(If you would rather submit your project ideas via email -- send them to webmaster@members.worldvista.org with the subject line: WorldVistA Projects) Please add your project suggestion(s) here:

List of Projects
1.	Billing

Billing Interfaces
Description: Interfaces with various billing services that can be made open source built and donated to the open source community. Pooling of resources may allow several practices to fund the construction of the interface that would be made available to all who wish to use it. Also, perhaps the billing companies could be persuaded to help defray the costs of development or be convinced to accept the current output from VistA. Benefit Provided: Easier adoption of VistA Name: Nancy Anthracite

2.	Billing

Interface between FreeB and VistA
Description: FreeB is open source billing software written by Fred Trotter. Funding and help is needed to complete and interface between FreeB and VistA. I believe Fred and Dave Whitten are already working on this and could use some help. Name: Fred Trotter, Nancy Anthracite

3.	Billing

WorldVistA open source billing solutions
Description: Software to support HIPAA compliant transactions using WorldVistA HL7 data will be developed and made freely available to provide standardized billing solutions for WorldVistA users. An open source Clearing House* solution will be developed for those users who wish to band together to share expenses and billing expertise by centralizing their billing transaction processing. Variants of the HIPAA transactions will be provided that accommodate the differences imposed by all the US state Medicaid programs and Medicare. Benefit provided: Improve healthcare delivery, especially to underserved populations, by jump-starting projects to implement open source solutions that include WorldVistA in non-profit healthcare organizations in the US and those serving impoverished populations elsewhere in the world. 1. Establish WorldVistA as the standard for electronic healthcare delivery systems for providers on a limited budget. Standardize interfaces and technical architectures for open source environments which include WorldVistA. Name: George Lilly
 * note: “Clearing House” is defined as a “Covered Entity” in the US HIPAA regulations, which specify the rules for their operations. WorldVistA has the opportunity to standardize how they operate technically by providing a supported open source solution.

4.	Billing

GUI Cashiering and Billing
Description: Adapt VistA so that there is a GUI module to take charges and allow cashiers to apply cash/check, credit/debit card, charity/discounts, and dues, in addition to billing portions if applicable to corporate or insurance (with exclusions, co-payments, etc) Benefit Provided: Prepare VistA for usability and adoption internationally Name: William D. Lauesen

5.	Communications

Add abstract/index and improve naming conventions for software on SourceForge
Name: (anonymous)

6.	Communications

Press Kit
Description: An information / press kit needed with key articles, links to demos, etc. Name: (anonymous)

7.	Communications

Combine and edit SourceForge sites
Consolidate SourceForge resources (VOE project, WorldVistA EHR, WorldVistA, and VistAOutreach) Name: (anonymous)

8.	Communications

Marketing and Public Relations
Build a press release contact database that spans from an international level to a grass roots level. Name: Peter Bodtke

9.	Communications

Newsletter
I know that there are several groups, including Ignacio's, but the WV needs a marketing venue. Name: Bob Olmedo

10.	Communications

Newsletter Topics
Description: There should be a newsletter of activities Name: Dee Knapp and Ignacio Valdes

11.	Communications ===WorldVistA EHR / VOE FAQs need to be updated Project topic found on VistApedia (anonymous)

12.	Communications ===WorldVistA.org links to software need to be edited Project topic found on VistApedia (anonymous)

13.	Community

Community surveys
Members skills and needs, adopter registry, and integrators registry Name: Peter Bodtke

14.	Community

Interview groups that are using VistA
Contact groups that are using VistA in their clinics and interview them to gather information on what their experience. Build a reference list from this group and also add them to the User Directory. Name: Bob Olmedo

15.	Community

New Organizations, MDC (new) and VDC (even newer)
Rick Marshall has already laided out the basic format for the New MUMPS Development Committee as an oversight body for the deliberations via a more RFC (Request for Comment) format discussion of new needs and directions for the MUMPS Language. This gives more voice to the end users and more visibility to the evolving standards. By the time the discussion cools down on a topic, nearly all the bugs have been aired and the formalization has been exposed along with the reverse integration of the new idea into the existing code base without breaking much or anything. The VDC is the VistA Development Committee which will operate much along the same lines only for establishing interface agreements and design principals.

Benefit provided:

This methodology provides more popular involvement into the standards process and shortens the deliberation period by expanding the base for review. New ideas are ushered into the standards and conventions with just as much deliberation and more eyes on the emerging product.

16.	Community

OpenForum
(not sure what this project team had in mind) Project topic found on VistApedia (anonymous)

17.	Community

User Directory Registration
Description: a page where users can document who they are, what they are doing, lessons learned, contact info, etc. Name: Bob Olmedo

18.	CPRS

CPRS - Clinical enhancements
Description: Extending CPRS to a more useful product, not only to include VA omissions necessary for non-VA use (as I understand WV is already doing, like billing and pediatrics); but to make it more relevant and supportive for clinicians. For example, CPRS has no flow-sheeting capabilities; these would be useful in a variety of settings; but particularly for in-patient care. Also a way to help with major management issues; out-patient anticoagulation for example, or diabetes management, or childhood growth charts, etc. I have made some of these to add onto the Portland VA’s CPRS system, so could provide some screen shots, etc. In this vein, I would like to see a members section for clinicians as WV rolls out, to discuss and prioritize enhancements to the product. The VA is slow to respond to these needs, WV should be more receptive, perhaps developing and testing in cycles to correspond to certification (which if I remember correctly, it was every 3 years), so that the product could grow and remain certified. Also, as you get more experienced with certification, you might get a feel for what minor enhancements can be made between cycles. I originally thought these changes would (or could) be done by the venders, but both the certification issue, and the ability to make these changes available to the whole subscription base (as well as a source of revenue), it might be better to be part of WV operation. If WV develops a team of programmers to do this, and to respond quickly to these needs, the product will be untouchable in the marketplace. The VA cannot do this due to their complex bureaucratic structure. • Benefit provided • Better product • Source of revenue • Marketing tool; customers (especially the early adopters) will have input into product’s features. Name: Robert Felder

19.	CPRS

CPRS Enhancement
Description: Now that we have had to modify CPRS in order to pass CCHIT, it has made it practical to consider further enhancements to CPRS. The drawback is that they will need to be maintained which may be expensive in time and money. George Welch and Kevin Toppenberg have been working on this Benefit: Improved functionality for CPRS Name: Nancy Anthracite

20.	CPRS

CPRS for Linux
Description: Getting CPRS written with Borland Delphi running on Wine for Linux. Kevin Toppenberg is currently working on this with the Codeweavers helping with the wine end. Kevin is incorporating TFireFox to replace TWebBrowser to help. Benefit Provided: Much lower cost for deployment of VistA particularly in developing countries.

21.	CPRS

Enhancing CPRS
Description: Enhancing CPRS including working with providers and the system architect to decide what enhancements should be made/incorporated in the WV EHR gold standard CPRS and which might be optional for local modifications. This includes developing a method for maintaining and integrating these enhancements with future versions of CPRS from the VA. We have recently had an increase in the number of volunteers interested in working on CPRS so that this project has a much improved chance of success. Name: Nancy Anthracite

22.	Data Exchange / Elder care

VistA for Nursing Homes
Description: There is a new MDS and data collection instrument coming out of CMS. This would integrate the data collection for those things necessary into the work flow of VistA so the separate tools are not needed to provide this functionality Benefit: Nursing Homes are poorly funded and could use the increased safety, etc., that could be provided by VistA. Integrating this functionality into VistA could increase the ease of adoption. Nursing homes usually need to purchase this software. Better they utilize VistA with the additional capabilities it has instead. Name: Nancy Anthracite

23.	Data Exchange / ePerscribing

ePrescribing
Description: ePrescribing is being aggressively promoted by CMS and almost all large insurers due to proven cost-containment results, following the standards set forth by the Medicare Modernization Act (MMA). This project pursues the provision of ePrescribing capabilities to VistA, which entails online-access to ePrescribing networks from a central service which in turn provides VistA-users with eligibility and drug-coverage (formularies) information, medication histories and all other ePrescribing requirements. ePrescribing requires that we implement a central ePrescribing "gateway" service with access to RxHUB, SureScripts, drug-information databases, formularies, etc. for VistA / WorldVistA EHR users to access since ePrescribing networks do NOT provide access to individual EHR installations. To make this service available inside VistA may require that we extend CPRS (possibly through an extension/module similar to how VistA-Imaging does in the VA). This could also require that interfaces be instituted so prescriptions can be stored in each prescriber's system (as if originating from VistA's built-in Orders and Results.) The service would be provided through WorldVistA. Benefit provided: ePrescribing is touted as the first step for wide-spread adoption of EHRs, so the project extends VistA into ePrescribing and quickly provides WorldVistA with a source of recurring revenue. The project dismisses any VistA-adoption-hesitation or negative-comments which result from lack of "modern-EHR" capabilities. Provide ePrescribing at a lower cost than current ePrescribing players currently in the market. Potentially could even be used to provide ePrescribing-capabilities to other smaller EHR-vendors. Name: Richie Piovanetti

24.	Data Exchange

Ambulatory Care Data Capture
Project topic found on VistApedia (anonymous)

25.	Data Exchange

Biosense for VistA
Description: CDC has a program to collect real time data to support recognition of epidemics and terrorist attacks Benefit: Provide nationwide, opt-in reporting capability to increase the ability of the CDC to pick up a problem. Also, to provide the same capability to the states that are taking an interest in doing their own statewide surveillance and for those world-wide who might like to do the same. Name: Nancy Anthracite

26.	Data Exchange

Genomics Project
Description: Prepare VistA to take in Genomic Data for patients. Benefit: This data will soon be something that patients have for use in helping to make treatment decisions as well as for research. Research companies and universities are looking at WV EHR as a place to gather the date from their research subjects for subsequent analysis and for the necessary record keeping. Name: Nancy Anthracite

27.	Data Exchange

Interoperable health data exchange
Description: In the futuristic movie Demolition Man, the only restaurant was Taco Bell. In our experience, we are seeing that Epic is looking to be the Taco Bell of electronic health records. One of the key issues we have faced with potential clients of the VistA is interoperability with local hospitals and providers who are using Epic and other EHRs. We can establish agreements to provide access to patient health data to local emergency rooms and hospitals using the read only functionality. We can’t, conversely, electronically access patient data of care rendered from other proprietary EHRs for continuity of care purposes. We need to establish a mechanism for health data exchange, including a master patient index and clinical data warehouse. Benefit provided: Continuity of care, data standardization Name: Khadijah Rashada

28.	Data Exchange

Transport of Medical and Health Records
Description:

The transport of the medical record of a specific patient has been nearly impossible from one VistA configuration to another. The degree of inter-relationship in VistA is huge. This operation is akin to doing a nervous system transplant. But there are tools emerging which will make this an easy task (well, easier) by recursively extracting information about the patient(s) and packaging them in such a way that no detail of that patient is not represented in the transport media. The extraction is the easy part. It is the insertion of the data into a different data structure is where it gets tricky. Fields can exist at one site and not exist at another. Files can exist at one site and not at another. Simlar pointed-to data can be at one site and not at another. The incoming data may be similar to something already there, but not quite, and human intervention is required (with the complete patient record being present this will hopefully be able to be kept to a minimum)..

Benefit provided:

This is the Holy Grail of medical records. Being able to group up all of the information about the selected patient or patients and then transporting them to a new environment is critical to the proper handling of the patient information.

Name: Chris Richardson

29.	Documentation

Vista Functional Specification
Description: This is a functional description of exactly what the vista software system does. It is written in Business executive and doctor administrator language, not programmer or hacker language. The description should include normal operation and degraded and failure modes. Benefit provided: Vista has attracted medical professionals who also happen to be computer geeks. It cannot attract hardheaded business types who make corporate decisions and weigh business alternatives unless it has a clear and complete description that can be compared with alternatives, can permit tabulation of financial advantages and can have business values attached to each capability. As a second benefit, a functional specification will no doubt expose deficiencies in Vista that should be corrected. Name: Edward R. (Ted) Byrne, PhD

30.	Education

Develop educational materials / training materials / books
Name: Peter Bodtke

31.	Education

Develop training CD's
[Note: we are using a product called TurboDemo to create training CD's for our members.(DW] Name: Bob Olmedo

32.	Education

Documentation - VistA for Dummies.
Description: I think, we as technical people, assume the abilities of who is doing this. Name: Bob Olmedo

33.	Education

Skype - use this tool as a support line.
Description: For example, we travel all over Palm Beach County. My users have Skype accounts; we all have wireless cards, so when our users need us (wherever we are) they can ask for help. This same setup can be used to support users that can purchase a Platinum, Gold, Silver or Bronze support contract from WV (with volunteers on line). Does anyone know who owns the Skype account "WorldVistA"? (PB) Name: Bob Olmedo

34.	Education

Test Data
Description: Design and create a solid data set of health records for use in training and demonstration. Record set should cover a period of at least three years. Ability to age data is desired. Records could be created programmatically or as a distributed manual group effort. There are commercial and educational stakeholders that are very interested in this project. Benefit provided: Provide a realistic and reasonably wide spectrum set of test records to the growing population of VistA users.

35.	Education

Training Ideas - Tools, Teachers, and Techniques
Description:

While at China Lake in the early 1980's I developed a tool which could read a MUMPS programmer's code and grade it to a coding standard. It helped to identify potential hotspots in the code and identify such situations as down-stream recursions in large packages. It would point these out to the programmer and the programmer was faced with the coice of documenting all of the non-standard or questionable code or re-writting the code to a simpler and more obvious manor. It was the beginning of an automated software Quality Assurance package. This code was written up in the DECUS Proceedings and the MUG Quarterly for the year 1984 (if memory serves).

Benefit provided:

Clearer code is constructed by the programming staff or there is a lot more documentation available for the hot spots in the code (there it is likely to fail). Also the programmers start programming in very similar styles which make the programmers more interchangeable. The programmers can identify the weak places in their code before they go into production without loss of face. They can evaluate themselves.

Name: Chris Richardson

36.	Education

VistA Demo Appliance V1.2
(next iteration, including "VistA link", Vitals, Patient Registration GUI) Name: Peter Bodtke

37.	Education

VistA Documentation Repository
Description: Design, develop and moderate a VistA and WorldVistA E.H.R. documentation repository. Such a repository could be a collection of reference materials and practical guides for users and developers. The design and implantation would exceed the value of the Veterans Administration’s “VistA Documentation Library” (VDL) or there would be no need for this repository. The materials ideally would be reviewed for accuracy and quality before publication. An index of URL could be prepared for material is published on the Internet which is not available for inclusion in this proposed repository. Collaboration with the current major repositories (VDL, HUI, etc.) would need to be partnered with to make this a successful project. Benefits: Provide a single source of accurate and reviewed information. Create a single starting point for all adopter, implementers, students, developers, venders, consultants, evaluators, etc. Name: Peter Bodtke

38.	Education

VistA Education Server
Description: Demo installations of VistA offered to Universities for Education. Mock patient data and may be entered, etc. Server to be hosted by Hewlett Packard beginning June 26, 2006. Benefit: Colleges have multiple uses for a training EMR from class simulations to demonstrations of the functionality of medical record systems. It will also raise the awareness of this open source record system.

39.	Education

WebEx courses
I bought a 10 user unlimited WebEx account for $39.95/mo. and I'm using it to provide weekly classes that 10 users can register for. You can charge $25 a class - good return on the investment. Name: Bob Olmedo

40.	Education

Wiki Expansion
Description: Expand scope of Wiki to cover informatics topics that are not (obviously) VistA-specific Benefit provided: Much of the material on the Wiki today is narrowly focused on VistA Applications, APIs and such. It is understandable to want to keep the scope of the Wiki narrowly focused, but there are problems with being too narrowly focused. For example, important topics of general interest to the community (network administration, data modeling and database design, programming topics, ontologies, interface design, etc., are either not included at all or (more likely) treated incompletely with information scattered throughout the Wiki where it is difficult to find. Restructuring the Wiki and encouraging a more systematic treatment of informatics topics could enhance its usefulness. Name: Greg Woodhouse

41.	Framework / Architecture

Demographic and Insurance Information Improvement Project
Description: Identifying and creating an appropriate place for all of the data that various types of practices need to collect for demographics and insurance and trying to reach a consensus as to where everything should be mapped to. Benefit: Increase ease of adoption and use for everyone interested in VistA Name: Nancy Anthracite

42.	Framework / Architecture

HL7v2 enhancements
Description: Provide an expanded framework for HL7v2 development Benefit provided: VistA HL7 focuses primarily on message transport, providing only minimal support to developers. In this sense, it is more analogous to an MTA like sendmail or qmail to a development framework. Although it is possible to off-load quite a bit of work to an interface engine (like Mirth), not everyone will be able to (or want to) use the same product, and even then development work is still required on the VistA end when creating new interfaces. Areas for improvement include better message parsing and generation capabilities, more HL7 knowledge, support for entire transactions (not just individual messages), the ability to auto-generate the relatively large amount of repetitive code that has to be crafted by hand today (or, as an alternative, a run-time processing engine), template capabilities and more support for database integration. Name: Greg Woodhouse

43.	Framework / Architecture

HL7v3
Description: Develop an implementation of HL7 version 3 Benefit provided: At present, VistA only supports HL7 v 2.x. That has worked well for the way HL is used now, but factors such as scale, interoperability, and new developments in medicine are likely to make adoption of v3 increasingly important. Even now, the CDA (and therefore the CCD) is v3 based. Name: Greg Woodhouse

44.	Framework / Architecture

Next steps in standardization
Description: Develop a set of semantically driven tools for developing standards based interfaces Benefit provided: At present, standards such as HL7 are supported through ad hoc mechanisms, such as developing message based interfaces that are product specific and closely tied to specific use cases or scenarios. There is very little support for generic tools, much less a framework to support semantically driven interface development. This project would develop tools and techniques that will reduce the amount of effort that must be expended on repetitive (and non-reusable) tasks through development of appropriate tools. A second aspect of the project (and they cannot really be separated) is developing a suitable language for describing concrete realizations of standards. Current work is generally hobbled by the lack of general concepts and tools, wit the result that projects become labor intensive and error prone, essentially starting from the beginning with each new project Name: Greg Woodhouse

45.	Framework / Architecture

Ontologies and how VistA fits in with them.
Description: Benefit provided: Name: Chris Richardson (David Whitten and Greg Woodhouse also interested)

46.	Framework / Architecture

Open Source Lab Interfaces
Description: Collecting and collectively creating lab interfaces to be used with Mirth for those la Benefit: Ease of adoption and lower cost per practice if the programming work is paid for collectively or done by volunteers Name: Nancy Anthracite

47.	Framework / Architecture

Scaleable interoperability and portability
Description: Develop a viable alternative to the current namespace framework Benefit provided: The current framework of allocating 2-4 character namespaces and corresponding number spaces to each project and adopter does not scale well to a world where VistA is widely adopted (and leads to less than transparent code). We need a new framework, one that can grow with VistA while maintaining backward compatibility. Name: Greg Woodhouse

48.	Framework / Architecture

Spread Sheet/Flow Sheet capability for VistA
Description: The VA is working to include this is VistA. It may be some time before it is ready and we could use it now. Hopefully we could accomplish this without stepping on what they are doing Benefit: Allowing improved functionality for VistA in several areas, especially in ICU, OB, and long term care Name: Nancy Anthracite

49.	Framework / Architecture

Update the race and ethnicity file according to standards
Description: Enhance the current race and ethnicity file with a standards based file that makes sense from a medically and takes into consideration making changes in the future as the science advances. Benefit: The race an ethnicity file has virtually no medically beneficial elements to it at this time. It more closely tracks political designations than those that might be helpful for the patient and the providers. ASTM and perhaps HL7 are both tackling this in a way that should help with this and, in my opinion, enhancing the system with one of these standards is needed. As genomics advances, we should be advancing with it. Name: Nancy Anthracite

50.	GUI / All

GUI Interface
Description: All new development projects should be done with GUI interfaces. Existing roll & scroll interfaces should be converted to GUI interfaces as-soon-as possible Benefit Provided: GUI Interfaces will help WorldVistA better compete with commercial EMR Applications and help WorldVistA gain more market share. It is also better for the end-user physicians and their staffs. Name: Ed Salvador

51.	GUI / All

GUI Rest of VistA
Description: Adapt VistA so that the rest of VistA is GUI Benefit Provided: Prepare VistA for usability and adoption internationally Name: William D. Lauesen

52.	GUI / Labs

GUI Laboratory
Description: Adapt VistA so that the Laboratory module is GUI Benefit Provided: Prepare VistA for usability and adoption internationally Name: William D. Lauesen

53.	GUI / Patient Portal

Patient Portal
Description Bring the MyHealtheVet functionality to WorldVistA EHR • Obtain electronic copies of key portions of their electronic health records • Have confidence that their health information is stored in a secure and private web environment • Add structured medical information • Track personal health metrics, such as blood pressure, blood sugar, weight, heart rate, and cholesterol • Access a Health Education Library and health assessment tools • Grant access to all or some of their health information to others, such as family other healthcare providers • Send and receive electronic communication between patient and provider Benefit provided • Patient has electronic access clinical data as well as provider interaction • Your name (so we know who to ask for clarification -- anonymous posts are accepted.) Name: Khadijah Rashada

54.	GUI / Pharmacy

GUI Pharmacy Module
Description: Adapt VistA so that the Pharmacy module is GUI. Allows for example OP medication orders to print prescription and drug labels immediately upon the doctor's order verification in the hospital Pharmacy (for tablets and liquids, for example, not for injections) so that the drugs are prepared and ready when the patient comes to the Pharmacy. These are all English-only; Arabic is not required. (In fact, accreditation requires documentation be in one language; and as most of the staff are expatriates throughout the region, English is the common language.) Benefit Provided: Prepare VistA for usability and adoption internationally Name: William D. Lauesen

55.	GUI / Practice Management

Open Source Practice Management Interfaces
Description: Collecting and perhaps collectively hiring folks to make interfaces with practice management systems that will allow the interface to be open source Benefit: Ease of adoption and lower cost per practice if the programming work is paid for collectively Name: Nancy Anthracite

56.	GUI / Practice Management

Scheduling GUI
Description: Interface between Fred Trotter's open source scheduling software and VistA. I believe Fred and Dave Whitten are already working on this and could use some help. Name: Fred Trotter, Nancy Anthracite

57.	GUI / Practice Management

Scheduling GUI
Description: Completion of the scheduling GUI started by George Welch written in Delphi. Name: George Welch, Nancy Anthracite

58.	GUI / Registration

GUI Registration and Pre-Registration
Description: Adapt VistA so that there is a GUI module to register patients and their visits (IP or OP), pre-register (such as for appointments or IP visit if needed), including where relevant payer (such as patient self-pay or selecting a particular corporate account or insurance policy). Benefit Provided: Prepare VistA for usability and adoption internationally Name: William D. Lauesen

59.	GUI / Scheduling

GUI Scheduling
Description: Adapt VistA so that there is a GUI module to schedule appointments for patients (such as for X-Ray or Clinic or Physiotherapy visit); with type of appointment determining amount of time needed, which doctor or resource provides that service, etc; allowing patients to select among multiple doctors along with various scheduling criteria such as mornings or Wednesdays. Benefit Provided: Prepare VistA for usability and adoption internationally Name: William D. Lauesen

60.	Imaging

VistA Document Management
Description: Take the real VistA imaging rename it to VistA Document Management and remove all references to FDA approval, ensure Dr. Dayhoff understands that the system will not be used for diagnosis, but rather document management, record management and capturing pictures of patients as needed. Benefit provided : This is one of the critical areas that has been successfully addressed by the VOE. Driving towards a paperless offices can only be accommodated it the office has a path to get rid of the paper, using VistA imaging is a great solution. Name: Jim Pietila

61.	Implementation

Configuration and Installation
Project topic found on VistApedia (anonymous)

62.	Implementation

Develop a self installing CD for WV EHR for both Cache and GT.M
Name: Bob Olmedo

63.	Implementation

Installers (WorldVistA EHR VOE w/Registration GUI, VistA/G.TM/Linux)
Description: Develop a suite of installers/set-up files, to assist in copying VistA, WorldVistA EHR files and clients to servers and desktops. This is a multiple stage development effort. First step - define installer types/classes (production, educational, demonstration), standardize deployment directories, learning installer tools and records clean-up (VistA). Second step - design and develop basic GUI wizards to localize/customize implementations, establish large scale resource hosting. Third step - design and develop advance GUI wizards to localize/customize implementations and provide administrative support interfaces for tasks such as journaling management and database back-up. Name: Peter Bodtke

64.	Integration

LabCorp Interface
Description: Working with LabCorp to make their interface for VistA with the VA generally available. Benefits: Very fast hookups to LabCorp anywhere in the US Status: A programmer is working on making it easy to import the LabCorp Compendium into VistA and to take in unsolicited results. This will be an HL7 interface NOT utilizing Mirth because it is already virtually completely built to interface with VistA as is. Name: Nancy Anthracite

65.	Internationalization

Achieve United Nations NGO status
Description: complete any outstanding tasks or Application steps to achieve recognized United Nations Non-governmental Organization status. Below are the published requirements: What are the Criteria for NGOs to become associated with DPI? The NGO must support and respect the principles of the Charter of the UN and have a clear mission statement that is consistent with those principles; • The NGO must be recognized nationally or internationally; • The NGO should operate solely on a non-for-profit basis and have tax-exempt status; • The NGO must have the commitment and the means to conduct effective information programmes, with its constituents and to a broader audience about UN activities; • The NGO should have an established record of continuity of work for a minimum of three years and should show promise of sustained activity in the future; • The NGO should have a satisfactory record of collaboration with UN Information Centres/Services or other parts of the UN System prior to association; • The NGO should provide an audited annual financial statement, conducted by a qualified, independent accountant; • The NGO should have statutes/by-laws providing for a transparent process of making decisions, elections of officers and members of the Board of Directors. Benefits: Raise the status and credibility of WorldVistA on an international level. NGO status will hopefully open doors to foreign governments and provide opportunities to collaborate with the World Health Organization. Name: Peter Bodtke

66.	Internationalization

I18N (Internationalization) - Issues and Answers
Description:

Internationalization was designed for VistA by Marcus Werners of the German Heart Institute back in the early 1990's. The DIALOG file was produced to hold the international text strings. As such, the VA Software Developers were derailed in this attempt by the Clinger-Cohen Act. Only 1900 entries were ever put into the DIALOG file by hand and it is very spotty. In recent years, code has been developed to provide automated extraction of the text in the routines which could be inserted into the DIALOG file. This code extracts the code, identifies the string to be added (recognizing that the text may already be defined), makes the entry into the DIALOG database, and then instruments the code with the proper reference and call into the code to replace the text. This code took 45 minutes to convert 30,000 routines into 165000 entries in the DIALOG file. These entries in the DIALOG file can be generated in to 500+ spread sheets of 300 terms each with the Index, the English, and the other language traslation onto the spread sheet. At this point the 500+ sheets can be spread out to 500+ translators. They fill in the missing foreign language equivalent into the spreadsheets. These spreadsheets can be reloaded and the model has immediate translation of a new language which can be selected by the user. Are there more issues than this? Yes, you bet. This is not 100%, but it is a great start.

Benefit provided:

Some code already exists. Adding new languages becomes a sweat-equity issue for the receiving country. Many languages could ultimately be supported

Name: Chris Richardson

67.	Internationalization

Internationalization
Description: Provide language, date, currency, and support resources for non-English speaking users, both domestic and international. This would include an interface translation process for VistA and WorldVistA EHR systems, client interface translations, documentation translation, and organize a team of foreign language speakers to communicate with and support non-English speaking users. Benefit: Extend the reach of VistA and WorldVistA user population. Provide an affordable electronic health care to emerging countries. Name: Peter Bodtke (support foreign languages, i.e. Spanish) Name: Kevin Toppenberg Multiple language support (I am working on this)

68.	Internationalization

Postal Codes for non-US countries
Description: Developing a Method for handling the Postal Code files considering that non-US countries have other systems. This project is well underway and being tested. More testers welcome. Name: Nancy Anthracite

69.	Market Place

International Vendor Services
Description: Setup a large capacity training/implementation/help-desk capability for VistA for global deployment. Name: Vipen Mahajan

70.	Market Place

EHR Market Place
Medikin’s EHR marketplace is an economic catalyst* that will accelerate WorldVistA adoption by: - enabling EHR solution buyers to find vendors with proven expertise - providing vendors with unique opportunities to prove their expertise - exposing buyers of other EHRs to WorldVistA’s disruptive value proposition Key benefits to the WorldVistA organization: - adoption - demand - exposure - valuable information (for policymaking) Key benefits to WorldVistA solution buyers: - lower cost - predictable results reduced risk - unique predictive, comparative data re vendors - simple RFP submission process - access to comprehensive database of vendors Key benefits to WorldVistA vendors: - jobs - leads - exposure - networking contacts - free advertising -advertising income -enhanced business profile Economic catalyst. An entity that (a) serves two or more groups; (b) who need each other in some way; but (c) who can't capture the value from their mutual attraction on their own; and (d) rely on the catalyst to facilitate value-creating reactions between them. Excerpted (with paraphrase) from http://catalystcode.com/thebook/chapter1.php The two groups being brought together in this case are the buyers and sellers of EHR solutions. Obviously they need each other to fulfill their objectives, but without an effective marketplace to catalyze their interactions, the numerous functional benefits of the marketplace which drive adoption are on a best efforts basis. Name: Daniel Herschlag

71.	Market Place

Web-site advertising board
(generates revenue) $100/month (or what you decide) for a consultant to post their availability, this could be part of membership dues to be able to access this site, the person that hires the consultant can fill a "How did he do?" form that can help maintain the quality of service and consultants that are provided. Name: Bob Olmedo

72.	Module / Acupuncture & Chiropractic

CAM Enhancements to VistA - Chiropractic & Acupuncture Modules
Description: For VistA to remain at the forefront of EHR systems, it needs to encompass Complementary and Alternative Medicine (CAM) modules. CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Patients are increasingly turning to complementary and alternative medical (CAM) in order to enhance their health and well-being. CAM includes acupuncture, chiropractic medicine, osteopathic medicine, use of herbal remedies and other practices as an augmentation to more conventional medical treatments. The marketplace reflects this growing acceptance of complementary medicine by many patients and a small, but growing number of health care providers. By gathering and integrating health care information associated with the Application of CAM procedures into a patient's electronic health record (EHR), more accurate measurement of outcomes can be generated. Best practices can then emerge showing which complementary medical practices are most effective when coupled with conventional medical treatments of specific disorders. In a recent report on Complementary and Alternative Medicine (CAM) in the United States (2005), the Board on Health Promotion and Disease Prevention states that the total visits to CAM providers exceed total visits to all primary-care physicians. Out-of-pocket costs for CAM are estimated to exceed $27 billion, which shows that CAM is now big business. That does not include those therapies or treatments covered by insurance. Hospitals, managed care plans, and conventional practitioners are now incorporating CAM therapies into their practices. Medical schools, nursing schools, and schools of pharmacy are teaching their students about CAM. It's hard to get an exact handle on the market for CAM, however, according to a recent article published on the Investors.Com web site, consumers snapped up about $54 billion worth of CAM services and dietary supplements in 2003. Of that figure, they claim that $34 billion went to all types of alternative services such as chiropractic, naturopathy, osteopathy and massage therapy, up from $25.5 billion in 1999. The U.S. market for dietary supplements isn't far behind, generating sales of $19.8 billion in 2003, up from $16.5 billion in 1999. Benefit provided - It will enhance the capabilities and reputation of VistA in the world marketplace. It will include modules of CAM practices/treatment that patients and provider organizations are embracing whole heartedly. It will capture patient care information that is not being captured. It will allow providers to generate more revenue by charging for these CAM treatments. I suggest starting with the chiropractic and acupuncture modules. Name: Peter Groen

73.	Module / Acupuncture

Acupuncture Support additions to VistA
Description: Provide support for acupuncture practitioners in VistA Benefit: Acupuncture is being added to some traditional medical settings and there is a growing need to provide support for gathering data for care and research for those providers and their patients. Name: Nancy Anthracite

74.	Module / Chiropractic

Chiropractic Support additions to VistA
Description: Research and develop the additions to VistA that will support the practice of chiropractics Benefit: Chiropractics is being incorporated into many traditional medical practices and a need to provide for those practitioners is growing. Name: Nancy Anthracite

75.	Module / Mental Health

Mental Health Assistant
Description: Mental Health Assistant does not currently fully function with VistA. It will take a little more work to get everything working properly and it may mean waiting for the next iteration to be released in the future. However, we are making progress. Benefits: Mental Health Assistant provides for the administration and scoring of Mental Health tests both by staff and by patients. This has become particularly important because public mental health hospitals and programs are taking a big interest in using VistA and because of the push to have the public sector help to support the returning veterans with PTSD Name: Nancy Anthracite

76.	Module / Portal

WorldVistA Zimbra Integration
Description: Integration of WorldVistA with the Zimbra HIPAA secure open source collaboration suite to synchronize messaging, users, patients, and calendars. Zimbra users will be able to schedule patient/client appointments which will automatically be reflected in the WorldVistA database, supporting the creation of clinical records at the time of the visit and effecting timely billing associated with the healthcare provided. This integration will allow all authorized personnel of healthcare providers and social service organizations, even those whose workforce is dispersed, to use local and remote HIPAA secure email and electronic patient scheduling Benefits provided: Improve healthcare delivery, especially to underserved populations, by jump-starting projects to implement open source solutions that include WorldVistA in non-profit healthcare organizations in the US and those serving impoverished population elsewhere in the world. Establish WorldVistA as the standard for electronic healthcare delivery systems for providers on a limited budget. Standardize interfaces and technical architectures for open source environments which include WorldVistA. Name: George Lilly

77.	Module / PTSD

Post-Traumatic Stress Disorder - Developments and Impacts
Description:

PTSD is a major issue that his plaguing our returning troups. VistA currently has a Mental Health package and that can be expanded to include PTSD support. This is critical to be outside and inside the VA. Most PTSD manifests itself after getting home and disbursed back to their homes which might be many miles from a VA. When the PTSD patient presents himself to his doctor, he needs to be further tested and those tests compared with those tests taken before the battle exposure and those tests after his return from the battle exposure.

Benefit provided:

Much improved health support for the PTSD patients with significant savings in early intervention should a patient before they become a danger to themselves or others. The savings in family tradgidy alone is worthwhile.

Name: Chris Richardson

78.	OB-GYN

OB flow sheets (ACOG style)
Description: OB Flow sheets- See ACOG (American College of OB) paper charts: These are the standard. Apparently, in the VA, there are some Nursing Flow Sheets for ICU. These might be adaptable. Otherwise, you could pull data from the patient record and build it using XML and a Web server, like the approach they are taking for the Peds charts. Name: Matthew King

79.	OB-GYN

OB-GYN project
Description: OB-GYN enhancements for VistA including Hollister like flow charts Name: Nancy Anthracite

80.	Organizational Design

Organization Growth framework
Description: We do need a structure and a process to spread VistA to its true potential. Many people, with diverse skills and experience will have to be involved. A similar situation exists with Open Source ERP/CRM, Compiere. I have a dated web site ( www.leo-systems.com), which deals with Compiere, learning it, implementation and training. It covers : An ERP implementation is a complex project with several inter dependent activities, performed by many people, from various departments, who may be at several locations and often have different hidden agendas! To improve your chances of success good project planning and effective project management are a MUST. We strongly recommend that you follow a suitable process. Many Consulting Organizations like Price Water House, Deloitte, and ERP Vendors, like SAP (ASAP), or Oracle (AIM) have their own implementation methodologies, based upon the way they work and are structured. For Compiere, Leo Systems has put together this draft Implementation framework. It is based upon over three decades of experience in developing and implementing large custom developed and Application packages, like in SAP, Oracle and Siebel. A spreadsheet has been provided to help estimate the role-wise hours required for the various tasks. We will also be making a MS Project Template. As your projects start, we would like feedback so the framework can be fine tuned, and metrics for Project Planning can be collected. This will help, in the spirit of Open Source to share your experience and help others who follow. • The Process  • The Roles  • The Process-Role Matrix  • Project Planning Spreadsheet  • Structured Role based approach to learning Compiere  I would be interested in a project to develop a suitable structure using our experience form the above for VistA. Incidentally Open Source Compiere, or its forks, OpenBravo and Adempiere, which support multi-languages and currencies may also be good platforms to develop the missing links to commercial competition to VistA. A world, standardized on one Open Source system, VistA would be a good place to live in vs the babel of closed source (expensive) solutions which do not talk to each other. I am also working on a framework UDoIT which helps in the management consulting, organization/process/workflow documentation (As-Is and To-Be), which should be a prelude to an implementation of VistA. It may be a big help to document the clinical processes of VA which have been implemented in VistA, to facilitate re-engineering the work flows built into VistA, to meet the localization needs of different clients, environments and countries. I expect 50-80% of the processes would be common across the world. A common base would also help WorldVistA from forking. I personally am confused with the various versions and variants. This will become a nightmare with no one single code base for future development. Name: Vipen Mahajan

81.	Pediatrics

Pediatrics Project
Description: To implement the suggestions of the HL7 Pediatric SIG and others for improving Pediatrics for VistA Name: Nancy Anthracite

82.	Pediatrics

Pediatric Growth Charts for VistA
Description; Integration of the ability to display, initially the CDC growth charts, but eventually WHO and growth charts for diverse ethnicities and world locations in VistA Benefits: Needed by pediatricians everywhere. CDC level capability needed for CCHIT certification. Name: Nancy Anthracite

83.	Pediatrics

Peds Growth Charts
Description: Peds Growth Charts and expansion of vitals package to include OB and Peds parameters Name: Matthew King

84.	Pharmacy

Prescription Autofinish
Description: Use Microsoft Windows Printers. Reconfigure prescription autofinish to pipe data to windows printer instead of VistA drivers. This is dependent upon the version MUMPS used (Cache or GT.M)

85.	Pharmacy

True Fax functionality
Description: Fax service in autofinish nearly unusable. The Pharmacy Directory should be maintained in the windows fax software, so non-techies at each site can maintain their own lists. Name: Matthew King

86.	Repository

Template, Reminder and Object Repository
Description: A source and hopefully some sort of rating system to point out the best of the best templates and objects for VistA Benefit: Improved functionality for all users of VistA Name: Nancy Anthracite

87.	Repository

Vista Software Archive
Description: This is an official version of Vista that is deposited with a software archiving organization. Benefit provided: Business managers will be unlikely to approve the use of Vista in their organization if they feel that it could change or disappear tomorrow leaving them out on a limb. An archived version would be always available even if the present vista organization changes direction of gives up support. Name: Edward R. (Ted) Byrne, PhD

88.	Revenue

Corporate support
Leverage the CCHIT to contact different companies (Dell, IBM, etc). I am using Rackspace and trying to get a group discount for using them as a VistA ASP. Name: Bob Olmedo

89.	Revenue

Grants
There are billions available in grant funding and we can send these out to our registered membership as a service. We can also offer grant writing as a service (there are grant writers out there that charge $5 - $10K). Name: Bob Olmedo

90.	Revenue

License Qualified & Preferred Vendors
Description: Establish a royalty or licensing agreement for vendors to be listed as preferred solution providers. Name: Peter Bodtke

91.	Revenue

Stratware* - WorldVistA Grant Application Support for non-profit healthcare providers
Description:

Sample grant Applications that follow the Foundation Center format will be developed/gathered and made freely available to assist US non-profit healthcare providers and those in other countries that might qualify to obtain funding from US foundations for their technical infrastructure that will include WorldVistA.

A database of all foundation grants made to date for health care technology projects will be developed to allow non-profits to research and locate funders whose interests meet their funding needs. (I have the start of such a database already based on research at the Foundation Center in spreadsheet format – all 939 grants since 2000 for healthcare and technology are categorized and represented.)

Benefits provided:
 * note:Stratware, short for "Strategy Wares" are management consulting products that are not code, not documentation, not training, but rather presentations, project plans, grant Application templates, and other deliverables which can be used to accomplish a successful implementation.
 * US non-profit healthcare organizations and those that qualify in other countries will get the funding they need to implement state of the art technology that includes WorldVistA, resulting in improved service delivery and operations.
 * Funders will begin to identify WorldVistA funding Applications as ones that deliver cost effective benefits with low-risk projects.
 * WorldVistA will accelerate adoption of its solutions in this important sector.

Name: George Lilly

92.	Revenue

WorldVistA Business Development
Create a business development group. Contact VAR's (Value Added Resellers). Name: Bob Olmedo

93.	Tools

Program Execution Simulator
Description:

Give it a MUMPS routine as a starting point, and it simulates the execution.

1. Diagnose bugs e.g. an undefined variable would be traced back to where the variable was last set or killed.

2. Give it integrity constraints e.g. the variable A is a number, and the program execuation simulator stops when the integrity constraint is first violated, the source of the problem.

3. Test live programs without changing live globals – all global changes are simulated only.

4. Make sure all code is tested – tells you what lines were never executed and logical paths to get to them to test them.

5. Improve efficiency e.g. variables set to the same value repeatedly in a loop.

6. Diagnose infinite loops – tells you the range of code being executed and the FOR or GOTO that repeats.

7. Tells you the net result of a subroutine (writes, global sets, local variables passed) to create documentation.

8. Reruns using the input entered at reads to repeat tests after you make changes to the MUMPS routines.

Name: Charles Volkstorf

94.	Tools

Intelligent Database of VISTA Global and Routine Documentation
Description: Allows you to:

1. Print Global documentation for any given global.

2. Describes what is at a given global, subscript and piece.

3. Lists the globals that contain a given field.

4. Finds a field based on knowing a given value e.g. “Blue Cross” or its format.

5. List all places (routine, tag, offset) where a given field is used, set, read, edited, deleted.

Name: Charles Volkstorf

95.	Tools

Mailman email encryption using a widely accepted standard
Purpose: To allow transmission of patient related information securely via email between VistA and other medical record system and between providers and patients Name: Nancy Anthracite

96.	Tools

Patch stream updating system
Description: As WorldVistA is now the steward of the WorldVistA EHR code a system needs to be designed to incorporate enhancements from the VA and the VistA community. The process requires an evaluation step, integration and testing. Finally, the system requires stable equipment to host the resources. Name: Peter Bodtke

97.	Tools

Server data "Save As"...
Description: i.e. ability to export site-specific data, for import into another installation. This would make VistA analogous to Word, which could open, close, transfer, share etc. data sets. • Better installation and configuration tools • Enable CPRS to run on Linux Kevin Toppenberg

98.	Vitals

Additional Vitals Measurements
Description: Need Head Circumference, Need Fundal height, (See IHS vitals) Name: Matthew King

99.	Vitals

Vital Signs Enhancement and Standardization
Description: Gather and then try to standardize new vital signs needed. Contacting the VA to see if they are following any standard other then their own, finding out about IHS measurement file, and finding out what others are needed in the community, then harmonizing them all to make something suitable, hopefully for all but maybe just for WV-EHR Name: Nancy Anthracite