Difference between revisions of "CHC Corner"

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  From: "Matthew King" <mking@clinicaadelante.com>  
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  From: [[Matthew King]] <mking@clinicaadelante.com>
 
   
 
   
 
  The Community Health Centers in AZ are forming the Arizona Integrated  
 
  The Community Health Centers in AZ are forming the Arizona Integrated  
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  VistA Office in our EHR evaluation.
 
  VistA Office in our EHR evaluation.
  
  From: "John Leo Zimmer" <jlzimmer@cbchc.com>
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  From: [[John Leo Zimmer]] <jlzimmer@cbchc.com>
 
   
 
   
 
  The Council Bluffs Community Health Center is assembling the hardware
 
  The Council Bluffs Community Health Center is assembling the hardware
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  VistA to community health centers' special needs.
 
  VistA to community health centers' special needs.
  
'''From: Hardhats Listserve:'''
+
==From Hardhats Listserve:==
  
 
Here are some recurrent questions us nontechies have about VistA:
 
Here are some recurrent questions us nontechies have about VistA:
  
'''1) Is Mumps a serious limitation to complete EHR functionality, code maintainence, HL7, or PMS interfacing?'''
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[[1) Is Mumps a serious limitation to complete EHR functionality, code maintainence, HL7, or PMS interfacing?]]
  
      There are several major commercial EHRs that use MUMPS.  In fact,
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[[2) What is the fundamental difference between a relational database and a hierarchical database and how does that effect the end-user? (Should we even care? If so why?)]]
      the language was developed expressly FOR the health care  
 
      environment. There are far more limitations (and serious ones at
 
      that) in most other languages and especially strict SQL
 
  
      Absolutely not.  I will go one step further than Cameron.
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[[3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?]]
      I have heard that M is the #1 language used for EHR's.
 
      Epicare, which just contracted for EHR for Kaiser, is based
 
      on M, for example.
 
  
'''2) What is the fundamental difference between a relational database and a hierarchical database and how does that effect the end-user? (Should we even care? If so why?)'''
+
[[4) What other concerns should we have regarding adopting VistA?]]
  
    While MUMPS has been characterized as "hierarchical", the
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[[5) Are any Community Health Centers currently utilizing VistA?]]
    DBMS that VistA uses, VA FileMan, provides what is more accurately
 
    characterized as a polymorphic view of the database.  One can
 
    readily use relational projections (indeed there are commercial
 
    add-ons that give a strict SQL view of the database).  The more
 
    advantageous view through VA FileMan is more like an object view
 
    of the data with abstract data types being highly specialized for
 
    optimal use and performance.  End users usually need not care
 
    (except that performance of VA FileMan is demonstrably superior
 
    (there are published reports) to SQL on the same hardware and
 
    configuration.)
 
 
 
    Another difference is the way the data is stored.  M data is stored
 
    in b-trees, as compared to flat tables (I believe).  This leads to
 
    faster data acess, and less CPU power needed.
 
 
 
    Also, the database in M is called by some a "sparce array."  This
 
    means that there are no "blank spaces" left for data to be later
 
    filled into.  So with M, if there is no data present, then no space
 
    is wasted.  I find this to lead to many many fields being defined
 
    for a given file.  With a traditional database, having all these
 
    fields with empty/wasted space, would lead to huge database files.
 
    But with M, one can can store years of patient information on a
 
    relatively small disk.
 
 
 
'''3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?'''
 
 
 
      Learning MUMPS is as simple as learning BASIC.  Learning about all
 
      the utilities and capabilities of the common services in VistA is
 
      a years long process.  And learning the functionality and setup
 
      for the clinical and administrative functions in VistA would
 
      probably take several life-times. Are there enough experienced
 
      programmers and application consultants?  So far I believe you'll
 
      currently pay more for a Java programmer.
 
 
 
      I am a physician and have taught myself M.  It is a very simple
 
      language.  I consider it to be a scripting language.  But it gets
 
      the job done, and has run hospitals safely for decades.
 
 
 
      There are many people on the list that would like work as
 
      programmers, so I don't think there will be any limitation there.
 
      And when CMS releases VistAOffice, there should be even more
 
      interest and consultants available.
 
'''
 
4) What other concerns should we have regarding adopting VistA?'''
 
 
 
      Expect a long learning curve.  Get help.
 
 
 
      I think a factor here is how much you want to put into the system.
 
      It is not turn key at this point, although there are installers
 
      who can do the work for you.  It is not going to have all the
 
      bells and whistles that commercial EMR's want you to pay for.
 
      It is not currently integrated with a billing system or a system
 
      for appointments.
 
 
 
 
 
      matthew king adds:
 
      On the other hand, a lot of the bell and whistles that seem to
 
      exist in many commercial products are actually rudimentary or even
 
      vaporware. VistA isn't as pretty, but is very functional, with
 
      easily modified clinical and preventive care reminders,support for
 
      disease management, advanced drug interaction checks and lexion
 
      support. The CPRS module supports drag and drop template building.
 
      This makes custom templates a snap, something you pay dearly for
 
      in many commerical products. The experts say 1/3 of medical errors
 
      can be reduced by intelligent software design. Since the VA
 
      product exists for patients, not profits, it is designed for
 
      clinical functionality and patient safety, so that is where it
 
      shines. Most commercial products have recently added EHRs as an
 
      afterthought in an emerging market. The bells and whistles look
 
      slick, but don't necessarily add to patient safety.
 

Latest revision as of 00:05, 7 July 2012

From: Matthew King <mking@clinicaadelante.com>

The Community Health Centers in AZ are forming the Arizona Integrated 
Network (AIN) to formally integrate information technology services, 
financial management, and clinical initiatives. We are have included 
VistA Office in our EHR evaluation.
From: John Leo Zimmer <jlzimmer@cbchc.com>

The Council Bluffs Community Health Center is assembling the hardware
and software to implement VistA Office or FOIA VistA in this one small
center. We hope to participate in an open development process that tailors
VistA to community health centers' special needs.

From Hardhats Listserve:

Here are some recurrent questions us nontechies have about VistA:

1) Is Mumps a serious limitation to complete EHR functionality, code maintainence, HL7, or PMS interfacing?

2) What is the fundamental difference between a relational database and a hierarchical database and how does that effect the end-user? (Should we even care? If so why?)

3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?

4) What other concerns should we have regarding adopting VistA?

5) Are any Community Health Centers currently utilizing VistA?