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Re: Top "10 or more" Reasons the VA Should Protect
by Joseph Dal Molin on Sunday November 11, 2007 @ 09:52 AM
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| Will, it is extremely unlikely that this will "kill" VistA....there is a very large community of experts and committed users that will ensure that doesn't happen. In fact, even though this may not be the right decision, there is a positive element to it as it will accelerate the maturation of the community in the right direction for long term sustainability.... ironically, looking at past history the VistA community does best when it is most "threatened".
Joseph |
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Re: Top "10 or more" Reasons the VA Should Protect
by Will Ross on Sunday November 11, 2007 @ 10:47 AM
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Joseph -- I admire your confidence that the VistA ecosystem will thrive in spite of the new Cerner contract. I concede that a single contract to insert a single proprietary sofware module into the VistA ecosystem horizontally at all VA sites is not enough, by itself, to kill VistA. On the other hand, if Cerner can push their software into 50% of the VA installations over the next five years, then there is no reason that other "beltway bandits" (to use the memorable term uttered by the CEO of Cerner in reference to large health care software contractors who sell to the federal government) cannot similarly threaten the VistA suite one application at a time. I'm not making any predictions, just observations. -- [wr]
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Re: Top "10 or more" Reasons the VA Should Protect
by Joseph Dal Molin on Sunday November 11, 2007 @ 12:53 PM
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Thanks for the complement Will. The Beast of Breed strategy (aka "best of breed") has failed miserably in the marketplace as far as creating effective integrated systems. While the Lab system may be somewhat invisible to the user community, going much further into the application portfolio will likely generate a change management challenge of stupendous proportions. So yes the "bandits" are likely drooling...and are more likely to drown in it than swim in it.
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Re: Top "10 or more" Reasons the VA Should Protect
by Tim Cook on Tuesday November 13, 2007 @ 05:28 AM
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A point to note is that somehow no matter how "in over their heads" these bandits seem to get. They never seem to actually drown. I guess "dollars" are real flotation devices even when misused. :-)
I am concerned about this contract; personally because I am a retired veteran, and also because it seems to be the follow on to a project 4 -5 years ago that attempted to replace VistA with proprietary off the shelf products. Sorry I don't have a reference at hand but I'm sure you can Google it. The attempt was ill formed and failed miserably after lots of money was spent.
Is there an effort somewhere within the VA to get out of the software development business?
Apologies to those who are not like this but is there some idiot MBA thinking on short a term basis that they can save lots of money by getting rid of those useless programmers and IT staff. I mean, isn't outsourcing the best idea in business the past few years?
I do not believe it is a conscious effort to replace VistA with commercial software. I believe it is a (or group of) clueless business people that THINK they are doing the right thing.
An educational approach is best used. Let's find out who is involved in this drive to change and let them know "why" that this is unacceptable. Simply, let's find a key person and offer to make them the hero of saving VistA and the VA healthcare IT system.
Those inside the VA should start providing names and email addresses of these people so we can contact them directly in a letter writing campaign.
Regards,
Tim
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Re: Top "10 or more" Reasons the VA Should Protect
by Tim Cook on Tuesday November 13, 2007 @ 07:11 AM
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I would be HUGELY remiss if I did not point out the very knowledgeable and hands-on remarks of Dr. Scott Sheeve:
http://crossoverhealth.wordpress.com/2007/11/07/diabetic-vista-the-first-amputation/
This is a MUST read.
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Re: Top "10 or more" Reasons the VA Should Protect
by Matt King on Tuesday November 13, 2007 @ 01:32 PM
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Hmm. Top ten reasons to allow the VA to develop it's own spftware:
1) Demonstrated best quality (I don't want to have to list references for all these. It someone whats references, please ask.)
2) Demonstrated lowest cost.
3) VA workforce know the existing software and therefore the potential problems better than an outside firm.
4) VA workforce more likely to review what all the stakeholders will want. This includes researchers, lab personnel, supervisors, ward clerks, clinical providers. The VA programmers learned a long time ago that they need direct access to front line users to ensure the best product and by in. For Cerner, it is a technical project. They will create an interface to existing software.
5) Software cycle time for the VA is probably 100 times faster than the software cycle time for Cerner. This means the VA will fix a problem in 24 hours, while Cerner may take months. In fact, some people believe this re-iterative software development technique allows the VA software to reflect the dynamic healthcare environment more accurately and quickly. This may be part of the secret of their success. Implied here is a "perfect EHR" (or piece of healthcare software) is only perfect for a blink of an eye. The the healthcare environment changes and so must the software.
6) Avoidance of "vendor lock-in". Once the VA commits a large amount of resources to one vendor, and no one else is allowed to even look at the code, the vendor has a "monopoly" on that project. It is too costly (and embarrassing) to discard, so the vendor can dictate terms. Paradoxically, this stifles free market behavior exactly at the point of contract execution.
7) Better coding standards. The VA programmers are held to a higher coding standard than proprietary vendors. This leads to better security, execution and portability.
8)Trickle down via Public Domain. Although, this may not be a consideration by the VA, it should be. Tax-payers buy that software and we should own it. Already there are innovative privite enterprise projects that will certainly lower costs of delivering EHRs to the safety net providers of the United States. Moreover, it projects using this software could be transformative; or at least provide a blueprint to solving healthcare data fragmentation. This trickle down should be a boon to any astute VA administrator. Indirect saving to the American taxpayer should increase their "good press" and help justify their budgets. Choking it off will eventually cause the opposite, once the public catches on.
9) If it's not broke, don't fix it. WHAT ARE THINKING! They have the best outcomes with the lowest costs at a time when every other government program seems to be under fire. Of course, this administration's basic premise is that private industry can do it better than the government. Never let the facts get in the way of your position.
10) I can't think of any others.Anyone what to help me out?
m
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