Is the VA killing VistA? Say it ain't so

VistA works due to the history and culture of its development and developers. Corporate-style IT, on the other hand, has a rather abysmal track record (e.g., do a google search on "IT failure rates").

Does the VA have any experience with corporate-style software projects? How about CoreFLS, where an investment of $400 million plus lost?

Those who do not learn from history are doomed to repeat its mistakes. It seems that applying the culture of CoreFLS to VistA will have quite predictable results.

First of all, you're confusing DoD with VA. Two separate, independant Agencies. Second of all, you're confusing VistA with CoreFLS, two unrelated application packages. Third of all, while many people tout the performance and open "sourceness" of VistA and coporate IT maintenance, no one seems willing to mention the cost of maintaining VistA apps at VA. $440,000,000.00 a year. Let me state that again in case it hasn't sunk in: $440 MILLION per year. That's your tax dollars. Yes, VistA is nifty, but sustainable? Hardly. SOA apps are the future. It's the only viable long term solution. Get used to it.

Hogwash!!!

This is a reply to the second posting. Mr. Anonymous (any real name by any chance?) is either very confused or a liar. He is mixing up the cost of supporting and maintaining the VA medical system (163 hospitals and close to 2,000 other facilities - the largest medical system in the United States) with the cost of supporting VistA itself.

Dr. Silverstein is absolutely correct in what he states in his post. CoreFLS was a radical departure from the traditional way that the VA developed software (an open source development model). CoreFLS was the first attempt at "oursourcing" the development of software to a commercial vendor. It followed DoD's model. It was a colossal failure.

Why would the VA be now implementing this "oursourcing" model to the rest of their development efforts? Well, I wrote an extensive report in the Jan/Feb 2008 issue of my newsletter, VistA & Open Healthcare News, detailing what is taking place at the VA.

I am glad that Ms. Zieger has raised this issue. VistA is head and shoulders the best system for hospitals to adopt.

Roger A. Maduro

440 million hmmm? Sounds like a lot of money to support 155 hospitals and 1400 clinics world wide. Sounds like a lot of money to support 216,000+ employees. Sounds like a lot of money if you are an uninformed tax payer just to keep a mission critical system running. Sounds like a lot of money unless you are a patient, then it sounds more like a bargain if you are one of the 5.5 million unique patients or one of the 60,000,000 visits, who at the cost of $7.13 per visit, get all of their clinical data presented to their provider with sub-second response time. Do that in some hypothetical unproven SOA that has yet to see the light of day in a mission critical environment by anyone! Get a grip, know a good deal when you see one. Numbers referenced from: www1.va.gov/opa/fact/vafacts.asp

I went to my doctor not too long ago and in the process of discussing issues I mentioned to her that I had recently been to the VA for other issues and they did some blood work on me (among other things). "Really now?" she said "I'll be right back". In less than five minutes she returned and remarked that they DID do quite a bit of bloodwork on you, didn't they. It happens this teaching hospital partners with the VA here and she works in both. I can't say for sure, but I would also guess that it was thanks to Vista she could get this information (without having to rerun the tests, redraw the blood, and me (or my insurance company) getting billed again.

Sounds like a case to keep Vista to me.

On the other hand what is the DoD's shining record for health care? I think that answer pretty much speaks for itself. I waited 23 years to be able to have the ability to locate a Doctor that wanted to practice medicine. I won't be going back to ANY DoD medical people for anything at all.

I hope the VA manages to win the fight and keep their good system going.

I've worked in IT for 25 years as a programmer. On most projects I've been involved with system/software selection was determined by the whims of those in power who typically have little hands-on IT experience. Technical merits typically take a back seat. Sounds like the Vista story reinforces my experience. Ignorant managers will once again triumph over the technically competent who have no interest in managing but who have solid credentials in delivering high performance systems.

The problem with VISTA is that it works and works too well. No one in Washington wants something that works too well. If it does, that means there are no jobs and contracts to spread around to re-invent the "VISTA Wheel". The beauty of VISTA is in its tools that enable users to develop the packages further. Any nurse or physician can take a VISTA package and through their creativity; create ways that would make their jobs easier and better because they have the perspective from a clinician or user. Not to mention some of the many programmers who have put much time in development to make VISTA and its tools simple enough for users to take it and mold it in the many ways and share these ideas with all the other VISTA sites. It's stability and efficiency is also second to none with its use of MUMPS. If it ain't broke why fix it? Because it takes multi-million dollar government contracts to fix it. I use VISTA and hope the VA continues to use it and continue on the creativity and innovation that has made it what it is today.

VISTA has gone South of the Equator and is doing well.

This is just another example of high ranking military types looking for an exit strategy. Push through a high dollar project. Get a well paying job with the vendor later. There is no retirement money to had, by these types, from the FOSS world.

With the planned spring release of My HealthEVet which includes access to scheduled appointments, secure Dr. Patient email and online patient access to medical records directly or by delegation, The VA continues to be far and away ahead of anyone else of any size in reducing the cost of medical care and increasing the quality of patient practitioner interaction and the quality of care.

I am at a loss for words at the thought that the software that conforms to the needs of the VA, and the men and women it serves, would be set aside for the software that the VA would need to conform to. Has AHLTA at least gotten beyond the problems reported back in April 2006 with the reduction in the number of patients-per-day doctors were able to see? ("Patient Access Drop" by Tom Philpott on military.com)

Been working in IT at a hospital for 10 years, while the owning company and all its hospitals was acquired by another company, and later when that other company hatched its own new application plan, and then when that company was acquired by yet another company.

I can't tell you how many times we had to implement new applications that were less functional than the old ones. We had managed to get some processes completely electronic, and then had to go backwards to a paper-based system that was far less capable.

Why? The Golden Rule: those who have the gold make the rules. They managed based on the reports they had, which came from their old systems, and they expected all newly acquired systems to produce exactly the same reports. It wasn't the needs of the people using an application that mattered, but the needs of the people paying for it.

So I have no trouble believing that VistA could be dropped in favor of a new system that wasn't nearly as good. The push of the government for years has been COTS, Commercial Off-The-Shelf applications, and VistA isn't that.

It would still be a great shame, though.