A whole new era for Veterans Affairs VistA has begun with Kevin Toppenberg, MD’s new TMG-CPRS 18.104.22.168 (TMG v1.1) client. The new tmg-cprs client enables clinical notes to be rendered in html. This allows mixed typefaces, bold, center, right justification, left justification and italics in clinical notes while maintaining compatibility with Veterans Affairs cprs.
Dr. Toppenberg announced on the Hardhats list.
A broad range of VistA community members with diverse VistA backgrounds have proposed VistA Standard Base specification release candidate 8. The proposed document is intended to guide installation of Veterans Affairs VistA system on Linux using the Free/Open Source GTM mumps compiler. The text and public comment can be found here under the auspices of the Liberty Health Software Foundation a 501 c3 corporation.
For you VA VistA fans, here is the status of GUI-registration which has recently changed with tmg-cprs. In case you didn’t know, patient registration up until recently was text-based and somewhat annoying in an otherwise good system:
Tom Munnecke the designer of VA’s Mailman has a remarkable article with some fascinating history of VA’s Mailman, what the future for Health ITcould hold and some warnings of unintended consequences: ‘…Beware Stimulating the Perversity of the Health Care system. Their are huge perverse incentives are “baked in” to our Disease Industrial Complex. The commodity of this industry is disease, not health. Regardless of the good intentions and expectations of individuals, the system forces them into less-than-virtuous behavior. The current stimulus effort runs the risk of unintended consequences of stimulating the perversity of our system rather than the virtues we seek. For example, it would appear that the greatest financial value derived from a universally available health record would be increased malpractice suits, because they would be able to program scanners that could automatically scan historical records with 20/20 hindsight and find some instance of an activity that in retrospect was the wrong path to take. This in turn will lead to an even greater emphasis on defense medical practices…’
Buried in the NEJM article Use of Electronic Health Records in U.S. Hospitals is the statistic that the proportion of hospitals that have full
implementation of EMR’s nearly doubles from 1.5 to 2.9% of all hospitals when the public domain VA VistA system is taken into account:
Full Press Release here. CARLSBAD, Calif. – March 4, 2009 – Since the implementation of Medsphere’s OpenVista electronic health record (EHR), Midland Memorial Hospital (MMH) has realized a host of improved clinical results, including fewer patient deaths and medical errors and decreased infection rates, an independent case study confirms.
The 2008 study (summarized in a PowerPoint presentation) was initiated by Medsphere to evaluate the effectiveness of OpenVista and was conducted by a third-party organization without Medsphere involvement.
RPMS is a VistA derivative used in the ambulatory care setting for the Indian Health Services. According to this announcement, it is now CCHIT certified. “The Indian Health Service (IHS) has been notified that the newest version of the IHS health information system
has earned certification by the Certification Commission for Healthcare Information Technology (CCHIT).
Must read article by Joseph Conn here: “…The question is whether the Veterans Health Information Systems and Technology Architecture, or VistA—the clinical information system that powers the VA health system—will wither or bloom in the months and years ahead. It’s an issue that has implications not only for millions of veterans but also millions of other potential users of open-source and proprietary versions of VistA, both in the private and public sectors in the U.S. and abroad…”
Kevin Toppenberg’s VistA Menu Map can be found here and it is spectacular in how much it has. Everything for running a national hospital system including all the software to run a hospital cafeteria and dietetics service to a library. The amount of software is simply breathtaking. From the page: “A note of explaination about this file:
The VistA system is menu driven. There are over 9,000 separate options that could be directly called. Obviously this is too many to make any sense of. This document is a printout of all these options, organized into menus, as found in VistA. I created this file because I wanted a way of looking at the “forest” as well as the individual “trees”. I hope it helps someone…”
The latest GAO report on VistA modernisation efforts ca be found here.
There has been much discussion in the Open Source health world about the VA reorganization. While many feel the centralization of development will stifle the innovation that created VistA, the current report cites the need to fix organizational leadership and project management gaps as key issues throttling VistA upgrades and modernization. This report can be an interesting focal point for discussion on the proposed upgrades as well as the implications for OpenVistA.