VistA continues to be promoted as a foundation element in the National Healthcare Information Infrastructure. A recent public announcement from the Veterans Administration regarding the potential utilization of VistA as a means to establish a ubiquitous electronic health record will be of interest to the OpenVista Community. In addition, OpenVista 2.5 will soon be available to the community. Editor’s Note: OpenVistA is VistA with no proprietary elements needed to run it.

Today marks the 21st anniversary of the Veterans Administration DHCP/VistA, electronic medical record software. On February 18, 1982, Administrator Nimmo signed an executive order making it official. Read here for a complete history of the project. The software is available in the public domain at www.hardhats.org and is being used and supported in the private sector and several foreign countries. Thanks to KS Bhaskar for this link and comments.

So says Paul Ellwood, MD of the influential Jackson Hole Group regarding the Veterans Administration and its VistA clinical computing software. He advocates its use as general-purpose clinical computing software in this AMNews article. He urges: ‘…consider using the electronic medical records system of the Veterans Health Administration as a starting point…’ You can find out who the VistA players are including those who will support it for you here. Thanks to David Derauf for this link.

The MUMPS programming language, also known as M, was specifically designed for use in healthcare and has a long history. It is the basis for the Veterans Administration VistA software as well as many other commercial healthcare applications. Because of its unique properties, it is used in banking as well. Open source bindings to CORBA exist (see below) and a complete open source M compiler, GT.M, is available on Sourceforge. There is much activity surrounding M in healthcare, perhaps more now that there is a Free/Open Source M compiler available. Read on for links to books and resources for programming in M

The hardhats maintain a comprehensive web page of M links here. Thanks to Chuck Link for the pointer to this.

KS Bhaskar, recent recipient of the 2002 Linux Medical News Software achievement award writes: ‘A good book for M programming is: Walters, Richard F. M Programming: A Comprehensive Guide. Digital
Press, 1997. ISBN: 1555581676. In the US, Amazon lists it for $39.95 and claims to be able to ship it in 24 hours. An advanced online reference is Ed de Moel’s MUMPS By Example http://jacquardsystems.com/Examples, but don’t look to it as a tutorial.’

Alexander Caldwell of tk_family_practice writes: ‘The documents that come with GT.M from source forge are very good for installing it and getting an overview of how the database works, and how a system administrator would maintain it, but without something like this you won’t get far past just getting it installed: http://www.geocities.com/SiliconValley/7041/mwm999/mwm.html
start with the MWM001 link and look for the “teach you, teach me” link…

KS Bhaskar further writes: ‘There is plenty of M expertise Down Under, and there is even an
implementation of M developed in Australia that just went open source
(http://mumps.sourceforge.net)…Open source nuts and bolts for connecting to VistA with CORBA exist: esiobjects.sourceforge.net and while a binding to VistA has not been released yet, perhaps one will emerge in 2003…’

The Veterans Administration maintaines this page which contains a monograph on the VistA clinical computing software: ‘…A collection of monographs has been developed as an introduction to VHA developed software that comprises a large part of our integrated hospital information systems..’ Thanks to Peter Groen for this link. This is also the first new entry in the newly created ‘VistA’ subject category.

Here’s a list of adopters of the Veterans Administration VistA software from the hardhats site which includes the Indian Health Service, The National Cancer Institute, Cairo, Helsinki University Hospital, University Hospital of Kuopio, Finland, German Heart Institute, Berlin, Obafemi Awolowo University Teaching Hospitals, Nigeria. Quite a list.

The Veterans Administration VistA clinical software now has documentation available to everyone, even people outside of the VA. You can get to it here.

OSHCA 2002 brought a slew of announcements and speakers about VistA. The following is a short guide to the VistA players as seen at OSHCA: Hardhats, OpenVistA, WorldVistA, MedSphere and The Pacific Teleheath and Technology Hui. VistA is the Veterans Administration full-featured electronic medical record which has been developed and used by the VA for decades. It is public domain and available under the Freedom of Information Act (FOIA). Many individuals and organizations are working to get it into the private sector. OSHCA provided a good opportunity to find out who the players are and what they are contributing.

Hardhats : a group of volunteers that are available for help with installing and using the FOIA VistA code. Lots of information and history on their web site as well as an active discussion list.

OpenVistA: There is no clear URL for this organization yet. It is an organization that is creating ‘the stack’ a complete Free/Open Source version of VistA. An example would be a Linux workstation, running GT.M, which runs the FOIA VistA code.

WorldVistA: Recently incorporated entity ‘will not sell services or engage in other revenue generating project activities.’ Instead it will help coordinate and facilitate the efforts of other organizations and individuals in meeting these needs. It is working with groups such as MedSphere, OpenVistA and international organizations using VistA. Recently featured on LinuxMedNews here.

Medsphere Systems Corporation — For profit company that provides VistA configuration, deployment, support, and maintenance for domestic and international healthcare organizations. Recently featured on LinuxMedNews here.

Pacific Teleheath and Technology Hui: A joint DoD/VA venture, it ‘…conducts research, develops prototypes, demonstrates, tests, evaluates, validates, then disseminates and institutionalizes applications of technologies in support of innovative health care processes in the area of telehealth.’

Joseph Dalmolin has announced that: ‘…WorldVistA is a non-profit organization incorporated in California with the mission of furthering the cause of affordable health care
information technology worldwide.

Our current efforts are targeted to championing the use of VistA outside the VA [Veterans Administration]. Part of what we hope to achieve is to act as a coordination point for work on VistA done outside the VA, to ensure that all such software changes are available under an appropriate open-source license,
and to feed bug fixes and enhancements back to the VA for consideration
for inclusion in the VA’s VistA. Our goal is to help establish for VistA
the virtuous spiral of open source by bringing together a critical mass
of developers and users…’ The complete text of the announcement is within.

Over the last year, since the release of Sanchez GT.M on Linux, a community of VistA enthusiasts including members of the Hardhats, some of whom were involved in the original creation of VistA, representatives from IBM and HP (Compaq) and other supporters have been gathering on a regular basis to work together to port VistA to GT.M on industry standard x86 GNU Linux open source platform as well as HP Alpha/AXP Open VMS and IBM eServer iSeries (formerly AS/400) OS/400 PASE.

At the OSHCA 2001 meeting in London the idea of forming a not-for-profit organization that would act as the steward for full open-source implementation of VistA was introduced by Rick Marshall, Chris Richardson and K.S. Bhaskar, three members of this community. The original name for the organization “Health Care for Humanity” became WorldVistA and as we wrap up the latest in the series of development meetings, and given the latest discussion thread on VistA, it is both timely and synchronistic to announce the formal incorporation of WorldVistA.

WorldVistA is a non-profit organization incorporated in California with the mission of furthering the cause of affordable health care information technology worldwide.

Our current efforts are targeted to championing the use of VistA outside the VA. Part of what we hope to achieve is to act as a coordination point for work on VistA done outside the VA, to ensure that all such software changes are available under an appropriate open-source license, and to feed bug fixes and enhancements back to the VA for consideration for inclusion in the VA’s VistA. Our goal is to help establish for VistA the virtuous spiral of open source by bringing together a critical mass
of developers and users.

WorldVistA, will not sell services or engage in other revenue generating
project activities. Instead it will help coordinate and facilitate the
efforts of other organizations and individuals in meeting these needs.

We welcome and look forward to comments and suggestions from the broader
open-source health care community in helping WorldVistA evolve.