Thanks to Nancy Anthracite for this information: Use of VA’s Electronic Health Records Expanding July 23, 2004
WASHINGTON – One of the world’s most sophisticated systems for keeping
electronic health records will soon be easily available to doctors,
hospitals and clinics around the country, courtesy of the Department of
Veterans Affairs (VA) and the federal Center for Medicare and Medicaid
Services. “VA is proud to lead the health care industry in the use of
information technology. The expertise we have gained, however, belongs to
the American public,” said Dr. Jonathan Perlin, VA’s Acting Under Secretary
for Health. “With our federal partners, we’re making it easier for the
private-sector health care industry to make use of this electronic system
for health care records.” The system, called VistA-Office Electronic Health
Record, was developed by VA. A version of VistA is used at more than 1,300
VA facilities throughout the United States to maintain records on 5 million
veterans who receive their health care from VA. Under the plan announced
today, private-sector health care providers can obtain a version of VistA at
nominal cost. Distribution of the software is expected to begin in late
2005. VistA offers health care providers a complete electronic record
covering all aspects of patient care, including reminders for preventive
health care, electronic entry of pharmaceutical orders, display of
laboratory results, consultation requests, x-rays and pathology slides.
Besides the VA system, VistA is currently used by the Department of Health
for the District of Columbia, plus health care systems in Finland, Germany,
Egypt and Nigeria. People wishing to receive e-mail from VA with the
latest news releases and updated fact sheets can subscribe at the following
Internet address: http://www.va.gov/opa/pressrel/opalist_listserv.cfm

Past recipient of the Linux Medical News Achievement Award KS Bhaskar wrote on the hardhats list: ‘On Tuesday, July 20, Oleen Healthcare in Silver Spring, MD, hosted a meeting of a number of VistA related vendors (see organization list below) and WorldVistA to discuss how WorldVistA and VistA vendors could collaborate better, whether and how WorldVistA (a non-profit 501(c)(3) corporation could accommodate vendor participation, etc.)…One of my action items from the meeting was to create a Yahoogroups list for the vendors to carry out discussions, and I have created a group called vista-vendors. So e-mail to vista-vendors@yahoogroups.com will go to all registered there, and will be archived for the future…’ The list of vendors and groups attending was impressive and included: Document Storage Systems, Fidelity Information Services, Global Technologies, Hewlett-Packard, InterSystems, Medical Alliances, Medsphere, Oleen Healthcare, Perot Systems, Sea Island Systems, WorldVistA

Houston, Texas: Executive Software Systems, Inc. (ESSI), a
leader in VistA development and implementation outside the Veterans Administration, announces a successful implementation of Free/Open Source VistA medical information software in a family practice outpatient clinic. The implementation has had no downtime since May 2004 when it was introduced to the Spring Branch Community Health Center (SBCHC) established by Dr. Patrick McColloster. Dr.McColloster has stated that the software is very successful for SBCHC. The recently opened Spring Branch Community Health Center Dedication is scheduled for June 30, 2004 at 7:00 p.m. at its location on the corner of Kempwood and Blalock, Houston, Texas.

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June 14, 2004 — The Veterans Health Administration is working with Centers for Medicare & Medicaid Services (CMS) on a project to offer the benefits of electronic medical records to other providers, Federal Telemedicine News reports. VistA-Lite, a version of the Department of Veterans Affairs’ VistA system that incorporates EHRs and computerized physician order entry, will be updated to meet the practice needs and financial considerations of outside clinics and physician offices. Thanks to David Derauf for this article.

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Great article in the Star about the eHealth Asia conference and OSS. The article quotes from Rick Marshall and Dr. Molly Cheah: “Studies have shown that about 85% of software development projects fail due to late completion, cost overruns and non-delivery of all promised features,” said Marshall. “However VistA succeeded in becoming the largest hospital management system in the world. It is currently used by over 10,000 users in hospitals and clinics worldwide, including 170 veterans hospitals,”

We are reporting live from the 9th annual VistA community meeting on the campus of Rice University in Houston, Texas. According to WorldVistA President Rick Marshall, this meeting originally grew from the need for the people inside the Veterans Administration and outside the Veterans Administration to get together to talk about VistA. It has grown into much more than that since then to include the group that is creating a completely free/open-source stack of the Veterans Administration VistA healthcare software collectively called OpenVistA. More developments as they occur.

More information on the March 11-14 VistA community meeting is available here on the WorldVistA web site. The Houston rodeo is in town during that time so it is wise to book a hotel room early. Here is a list.

*Updated 1/26/04: That’s version 0.1 not 1.0, folks.* Recipient of the 2002 Linux Medical News Award, K.S. Bhaskar has announced that VistA VivA 0.1 is now available. It is a bootable CD which runs VistA. *’…A klunky first release of OpenVistA VivA, the OpenVistA Linux live CD is
available for download from the WorldVistA project at Source Forge
(http://sourceforge.net/projects/worldvista). This live CD is based on
remastering Morphix (http://morphix.org) and is a combination of Morphix
and OpenVistA SemiVivA…* Read on for the full text of the announcement.

“Release early, release often,” is a mantra of the open source movement,
I believe attributed to Eric S. Raymond.

A klunky first release of OpenVistA VivA, the OpenVistA Linux live CD is
available for download from the WorldVistA project at Source Forge
(http://sourceforge.net/projects/worldvista). This live CD is based on
remastering Morphix (http://morphix.org) and is a combination of Morphix
and OpenVistA SemiVivA.

To use it, download and burn the ISO CD image from Source Forge, and
boot an x86 PC (probably at least 128MB RAM and a Pentium processor — I
don’t know what the minimum requirements really are, but I have tried it
on a 256MB 700MHz Athlon PC and a 1GB 1.8GHz Pentium IV PC) from it.
This will put you in a Linux desktop. Caveat: a PC running off a CD-ROM
based compressed file system will run more slowly than a PC running off
uncompressed files on a hard disk.

To run VistA, the operating system (if any!) on the hard drive will not
be touched. However, since I haven’t yet figured out how to operate a
database on a CD-ROM (and don’t expect to any time soon!), the database
will need to be installed on the hard drive. Open a terminal window by
clicking on the terminal icon at the bottom of the screen.

Morphix does not mount hard drive partitions by default, so you will
need to mount the partition on which you wish the database to reside,
e.g. “sudo mount -o rw /mnt/hda1” (if you are not sure what partitions
you have, type “cat /etc/fstab” and look for names that look like
/mnt/xdy or /mnt/xdy# where x is one of the letters h or s, and # is a
number).

To install the database and run it, to run a previously installed
database, or to erase a previously installed database, run “sudo
/usr/local/OpenVistA/vista” (UNIX/Linux users note: there is no
ampersand at the end of that command!). You will be prompted for
required input (and taken to a GT.M shell prompt for the initial
install, from where you will be able to type D ^XUP, D P^DI, etc.). On
an install, the dialog box telling you the database is being copied may
go away before the copy is complete. You should wait for the GT.M
prompt.

When completed, logout of Morphix. You will be taken to a shell prompt
from where you can type “halt” or “reboot”. Since the CD-ROM drive
won’t open at that point (since the CD is still mounted), I find that I
need to type reboot, and then eject the CD as the PC reboots, and then
power it down. Awkward, but it works. If you type halt, you will be
able to open the CD-ROM drive only on the next boot, as the BIOS does
comes to life.

This first release is klunky and primarily aimed at friendly users. If
you are uncomfortable with a GTM> command mode prompt from where you
have a roll and scroll VistA interface, this is not for you. Remember
that from “GTM>” you can type “Halt” to exit to a Linux shell.

I have created a forum (http://sourceforge.net/forum/?group_id=60087)
for discussion of any issues at the WorldVistA project at Source Forge.
You can also submit Bugs
(http://sourceforge.net/tracker/?group_id=60087&atid=493021) and Patches
(http://sourceforge.net/tracker/?group_id=60087&atid=493023) and ask for
Support (http://sourceforge.net/tracker/?group_id=60087&atid=493022) at
the WorldVistA project at Source Forge.

Networking is supported by Morphix. So you should be able to configure
your network interfaces and run a CPRS GUI on a Windows machine against
OpenVistA VivA.

FAQ

If your PC can’t boot from a CD-ROM, you can make a bootable floppy
(http://morphix.sourceforge.net/modules/mydownloads/visit.php?lid=27 is
a 1.4M floppy; I believe there is a 2.8M floppy image on the CD). Use
the Linux dd command or the DOS/Windows RAWRITE.EXE (available on the CD
if you just mount it) to write the floppy images.

KNOWN LIMITATIONS

Only hard drives with FAT16/32 (Windows 95/98/ME and some Windows NT
PCs) and common Linux partitions are supported. Hard drives with NTFS
partitions (some Windows NT, and most Windows XP and Windows 2000) are
known to be not supported. I don’t know about partitions with Linux
file systems such as jfs and xfs, since I don’t have access to PCs with
them.

The GT.M database is not configured here with journaling turned on. So,
if you power down the PC without shutting down GT.M cleanly (Halt from
the command prompt — unlike other M implementations GT.M doesn’t use a
daemon), you will get database errors (likely to be benign, but you
should repair them). Refer to the Administration and Operations manual,
available at Source Forge
(http://sourceforge.net/projects/sanchez-gtm). You will need to enable
and turn on journaling if you want more operational robustness.

OpenVistA VivA is set up as a demo. It comes with no warranty express
or implied. Use it at your own risk.

OpenVistA VivA was done by me as a personal project and Sanchez was not
involved in any way.

Never trust technical work done by a manager.

OpenVistA VivA is untested by anyone except me, and my testing too has
been cursory.

D ^XUP from the GT.M prompt results in a VistA application complaint
about a terminal device not being configured in the database. I have no
idea what to do about it.

The time reported by Morphix seems to be one hour behind the actual
time. I have no idea why.

— Bhaskar

The BBC has an article about VistA and WorldVistA with quotes from FOSS in medicine advocate Joseph Dalmolin: ‘…The appeal of having a unified computer system that can provide quick and easy access to patient records is obvious.

“It doesn’t cost you $10m for something as complex as this. It wouldn’t cost a lot of money to do an entire country,” he said…’

The good news is that PocketMD allows you to access the Veterans Administration VistA data on a PDA. The bad news is that it requires numerous proprietary Microsoft products to access the public domain VistA system such as PocketPC, IIS web server and SQL server.