Some VistA Myths and Facts

There is always myths that surround the Veterans Affairs (VA) VistA Electronic Health Record. I have not found a compendium of these myths and the facts so I wrote this list. As well I was partially inspired by Fred Trotter’s recent ‘Antiquated or Proven?’ response to a detractor of VistA. Please feel free to add to this list by replying below.

Myth: The VA is �getting rid of�, �abandoning�, �phasing out� VistA.

Fact: The VA is constantly improving the software and its processes. The base software has stood the test of time and has an enormous amount of research and development put into it. No other Health IT software is currently as scalable, capable or comprehensive as VistA.

Myth: VA VistA is �antiquated�.

Fact: We prefer �proven�. VistA is based on the MUMPS language which was developed specifically for healthcare in the 1970�s. Because of its reliability and speed, it is used by leading healthcare EMR companies such as Epic as well as by the banking and aircraft industries. The Bank of Thailand currently maintains the largest database in the world using MUMPS. Common operating systems such as Unix, GNU/Linux and Windows use at their core a language that is older than MUMPS. The tendency for Americans to equate �newer� with �better� may be at work here. The saying that those who ignore VistA are doomed to repeat VistA in Health IT is appropriate. While the VistA core is MUMPS based, many other �modern� programming languages can and have been used with VistA. Their use in healthcare is frequently an afterthought.

Myth: VistA is text-based roll and scroll. Ugh!

Fact: While many parts of VistA are text-based, many others are GUI based with more being developed all the time. Most clinicians use the CPRS clinical client which is fully Graphic User Interface (GUI) and far more capable than any clinical client we know of. The ultimate in user hostility is to not have a capability at all, GUI or otherwise. VistA is a truly vast piece of software. VistA contains practically every capability necessary to run a nationwide healthcare system, a hospital or a small clinic and is generally liked by its users. No other software we know of is this capable. Many expert users report preferring text based interfaces over GUI because of the speed of entry and ability to focus on a patient in front of them.

Myth: VistA is hard to change, inflexible and cannot be customized.

Fact: VistA has a vast number of configurable options at the hospital, clinic or user level to provide the customized user experience that most people and organizations desire.

Myth: MUMPS/VistA programmers/help/service is hard to find.
Fact: At this writing, there are at least 8 vendors that will support VistA as well as customers being able to hire and help themselves. How many service providers/programmers are available for proprietary systems? Typically 1 company and only the programmers for that company that are *authorized* to work on it. That is a pretty small number.

Fact: There are many things VistA could do better. It is currently difficult to install and configure. It could also communicate better with closed-source practice management systems and be more browser-based. Then again, these are industry wide problems.

Fact: Frequently VistA is the only Health IT software that does some things at all such as massive scalability, connectivity, great performance, compliance with regulations, adherence to standards and legal authority while continuously being subject to rigorous scrutiny. It is one thing to talk tough about what the latest and greatest language or environment can do, it is another to actually do it in Health IT.

Fact: It is easy to criticize VistA. It is actually implemented, anyone can download it and run it and examine every part of it. Rigorous scrutiny of proprietary systems is frequently impossible, specifically precluded by contract, and leads to �black box� medicine. Most purchasers and users of proprietary software have no idea if an EMR’s construction is good or not. Worse, they may be silenced from criticism by service contract. These proprietary systems are therefore immune to criticism.

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