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| VistA to community health centers' special needs. | | VistA to community health centers' special needs. |
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| '''From: Hardhats Listserve:'''
| | ==From Hardhats Listserve:== |
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| Here are some recurrent questions us nontechies have about VistA: | | Here are some recurrent questions us nontechies have about VistA: |
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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?]] | | [[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?]] |
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| | [[4) What other concerns should we have regarding adopting VistA?]] |
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| '''4) What other concerns should we have regarding adopting VistA?'''
| | [[5) Are any Community Health Centers currently utilizing VistA?]] |
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| Expect a long learning curve. Get help.
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| I think a factor here is how much you want to put into the system.
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| It is not turn key at this point, although there are installers
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| who can do the work for you. It is not going to have all the
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| bells and whistles that commercial EMR's want you to pay for.
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| It is not currently integrated with a billing system or a system
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| for appointments.
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| [[Matthew King]] adds:
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| On the other hand, a lot of the bell and whistles that seem to
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| exist in many commercial products are actually rudimentary or even
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| vaporware. VistA isn't as pretty, but is very functional, with
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| easily modified clinical and preventive care reminders,support for
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| disease management, advanced drug interaction checks and lexion
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| support. The CPRS module supports drag and drop template building.
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| This makes custom templates a snap, something you pay dearly for
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| in many commerical products. The experts say 1/3 of medical errors
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| can be reduced by intelligent software design. Since the VA
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| product exists for patients, not profits, it is designed for
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| clinical functionality and patient safety, so that is where it
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| shines. Most commercial products have recently added EHRs as an
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| afterthought in an emerging market. The bells and whistles look
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| slick, but don't necessarily add to patient safety.
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| [[Rick Marshall]] replies: | |
| Above all, it is a serious commitment. It is free as in freedom, not
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| free beer. It will save lives, not time. You cannot do this alone; you
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| may think you can, but sooner or later you will run aground without
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| help. To succeed with VistA you need the community in ways you cannot
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| imagine, but the good news is they will welcome and help you, and it
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| will not be long before you can return the favor. The big hurdle with
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| VistA is that anyone used to making medical informatics decisions has
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| learned how to prepare for defeat, to choose vendors on the basis of how
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| deep their pockets are (so you can sue them when the project collapses
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| in failure) instead of on the basis of their expertise and customer
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| service, to choose based on marketing flair and reputation. VistA is
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| the real deal, and for that very reason may be difficult to recognize as
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| such by customers who have learned only how to choose among flashy
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| failures. VistA requires the "customer" to become a partner, a
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| collaborator, words that have all but lost their meaning in the modern
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| marketplace; when you become fully engaged with the VistA lifecycle, you
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| will come to understand that if VistA is broken it is your fault as much
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| as ours, that it is your responsibility to hold the developers and the
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| software to a high enough standard to meet your needs. Unlike with most
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| commercial software products, you will rewarded instead of punished for
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| engaging in the critique, review, and even development of VistA.
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| There is an endless amount to learn about it, and it is under continuous
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| development, continuously patched, continuously changing, as it must
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| be. The static details of VistA are less important than the living
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| process by which its users drive development through their continuous
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| stream of suggestions and complaints. You will not and cannot
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| appreciate how true that is until after you have been involved with
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| VistA for years. The secret to its success is no secret, not specific
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| features, nor the technology used. It is the dynamic, hyperactive
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| software lifecycle that engages the creativity of tens of thousands of
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| users to mold the software over and over so that the longer you wait the
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| better it gets, as opposed to most software which is static by design,
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| updated at best occasionally, and obsolesces with time.
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| That inversion of the norm, emphasizing change instead of stasis, is a
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| repudiation of the core beliefs of the software industry and much of
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| academia, and as such you must expect to hear an endless stream of
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| irrelevant complaints lodged against VistA, usually by those who have
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| not used it. From those who do use VistA, you will generally find an
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| endless stream of relevant complaints together with strong loyalty.
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| Like any experienced VistA professional, I can and will criticize VistA
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| up one side and down the other for hours on end. We like it in part
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| because we know its faults, and so we try to prioritize the work most
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| important to us; when the lifecycle is healthy, if something is broken
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| it's because we think it's more important for the developers to work on
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| something else first. Those who fully engage in the VistA lifecycle
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| know VistA's flaws far more intimately than its critics, but they know
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| its strengths, too, and they can point to features in the software that
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| they personally first brought to the attention of the VistA development
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| community. In a way most software will never be, VistA really does
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| belong to its users, and they know it.
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| So when I echo other writers in saying VistA is free as in freedom, I
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| mean as in the responsibility that comes with true freedom, the
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| expectation to interact with it as an adult, taking responsibility for
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| what we need from it, and helping to chart our own future. To be blunt,
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| many people do not want that, prefer the simplicity of having limited
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| choices imposed upon them by someone more powerful, to recreate the
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| false security of childhood. Others do not mind the responsibility, but
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| cannot spare the time to learn a fully featured medical informatics
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| system, not even just the few parts of the few packages they would use
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| in their medical roles. In general, we find the truth about VistA
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| properly screens our potential clients; the right people respond well to
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| the challenge and possibilities of VistA, and enrich the community and
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| its software when they engage with us.
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| PPS: If I sound opinionated in the above, it is because experience has
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| made me so. For the first half of my career with VistA, I thought it
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| was probably nothing special, that every hospital system must have
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| something comparable. My disgust with the state of the art and
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| appreciation for VistA has accumulated over the years through a series
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| of disillusioning exposures to how most medical software works--or
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| doesn't. I do not know if there is even one feature in VistA that it
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| does better than any other system, but no other system seems to be able
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| to combine them all into such an integrated architecture driven by such
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| a potentially responsive software lifecycle. The experience of patients
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| in New Orleans in the wake of Hurricane Katrina would seem to be the
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| latest dramatic illustration. I have gradually arrived at the
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| surprising conclusion that my friends and I are working on something
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| unusually cool. Who knew?
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