What follows is a travelogue by WorldVistA director Chris Richardson from San Francisco, California to the recent World Summit on the Information Society (WSIS) meeting in Tunis, the capital city of Tunisia located in northwest Africa. WorldVistA is a group ‘focused on further developing and supporting the growing global VistA [electronic medical record] community.’

(Editor’s note: dates are in VistA format � 305 is the year 2005.)

Tunis Journal � 3051113 � The Pre-Board

Gentle readers;

This is a journey which holds a lot of exploration and discovery about the differences and similarities between various peoples. Having run the gauntlet of the Bay Area Rapid Transit system to find the my way to the San Francisco Airport, I found a large contingent on BART heading toward football game (49ers vs. somebody). Sitting there listening to them discuss the various players casually and making comment about the players in a familiar way as if the players were an extended family. The fans got off and the Opera Ladies got onto BART as we made our way to the San Francisco Airport.

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WorldVistA president Rick Marshall has an article on page 9 (you may have to search on ‘Marshall’) of Health IT Strategist about VistA: ‘…The secret to its success does not lie in specific features or the technology used. It is a dynamic, hyperactive life cycle that engages the creativity of tens of thousands of users…’

VistA provider Medsphere has a press release announcing its new CEO Ken Kizer, MD, MPH replacing Larry Augustin of VA Linux and Sourceforge fame: ‘…Kizer has long been an advocate of information technology as an enabler for improving healthcare safety and quality. He recognized the critical importance of healthcare IT when he was Under Secretary for Health in the U.S. Department of Veterans Affairs (VA) and pioneered the system-wide implementation of an electronic health record, bar code medication administration, and other IT innovations years before the healthcare industry embraced the importance of IT.

“In my new role as CEO, I will be able to focus on broadly disseminating a proven healthcare IT solution that has been adapted and improved for commercial healthcare use,” said Kizer. “I believe that Medsphere’s approach to healthcare IT represents a disruptive technology that has the potential to fundamentally change the healthcare IT paradigm and revolutionize the whole industry.”

The Veterans Affairs (VA) VistA Electronic Medical Record is based on MUMPS, a programming language designed specifically for healthcare in the 1960’s. People and organizations are rarely neutral on both public domain VistA-the-software, and MUMPS the language. VistA the software is almost universally liked by the doctors and nurses of the VA doing clinical work. VistA and MUMPS is also loathed by programmers, competitors and outsiders to the VA. VistA is big, the language it is written in is ugly, they say. Yet there is a jarring contradiction. By most accounts and measures the software, works and works well. The MUMPS language also seems to work for private sector EMR companies such as Epic. In a field that is littered with the corpses of companies that have tried and failed to create useful, commercially viable EMR software, this success counts for a lot. Why is it so successful?

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September 19th, 2005 CMS released an ‘evaluation version’ of the highly anticipated Vista Office EHR (VOE) according to this CMS website press release. Highlights of the press release are that apparently CMS is going to evaluate how implementations are working at a limited number of beta test sites, then consider standards for ‘certification criteria and process’ through WorldVistA. More information, including system requirements and what makes a beta test site can be found at www.vista-office.org. There does not appear to be a place in which anyone can download the software and I read this to mean there probably won’t be one unless you qualify as a beta test site or qualified vendor. Click Read More for the full text of the CMS announcement.

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Delay of the widely anticipated release of VistA Office EHR that was expected to happen August 1st continues. Modern physician (intrusive registration required) has an article on the subject: ‘…The CMS, in partnership with the Veterans Affairs Department, announced in the summer of 2004 that it would adapt for use in physician offices the Veterans Health Information Systems and Technology Architecture, a clinical information system that runs in nearly all 1,300 healthcare sites in the Veterans Health Administration.

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iHealthBeat has an article: that states: ‘Rep. Steve Buyer (R-Ind.), chair of the House Veterans’ Affairs Committee, at a hearing on Wednesday said he will introduce legislation that would give the VA’s CIO control of resources, budget and personnel, Government Health IT reports. The move to reform the VA’s IT operations and centralize it within the CIO’s office will affect the VA’s entire IT budget, including HealtheVet and the VA’s electronic health records system (Hasson, Government Health IT, 9/14)…’

The highly-anticipated VistA Office EHR release by the Centers for Medicare and Medicaid Services (CMS) is ‘on hold..undergoing review’ according to this Government Health IT News article: ‘…The release of free electronic health record (EHR) software that physicians could download from the Department of Health and Human Services has been delayed indefinitely, a department official said yesterday.

Dr. Karen Bell, division director of the Quality Improvement Group at HHS� Centers for Medicare and Medicaid Services, told a conference audience that VistA-Office �is undergoing a review right now by the secretary�s office.� You can�t download anything� now…’

There is an interesting interview with Scott Shreeve, MD a Co-founder of Medsphere a company which installs and supports VistA EHR: ‘…Since Medsphere was first, we had the opportunity to gather an incredible team of ex-VA and VistA luminaries. George Timson, our Senior Architect, is viewed as the rock star of the Underground Railroad, as they called it back then. He was one of the original Hardhats, the programmers who started working on VistA in 1979. There are great stories of the intrigue and political wrangling that forced this renegade group of programmers to go underground to collaborate before the VA cried uncle in 1982 and agreed to adapt VistA as their platform of choice. George created Fileman, an incredible file management tool that�s been running 20 years and still runs great today. He wants to get this incredible legacy he created out there and loves working with us to bring it to the broader market. Lots of people want to work with him. He�s one of the most intelligent and witty people I�ve every met in my life…’

Although it does not directly mention VistA, this Washington Post article describes the transformation of the VA healthcare system from worst to best: ‘…the system has undergone a dramatic transformation and now is considered by some to be a model. Researchers laud the VA for its use of electronic medical records, its focus on preventive care and its outstanding results…’