VETERANS HEALTH INFORMATION SYSTEMS AND TECHNOLOGY ARCHITECTURE

The 'Veterans Health Information Systems and Technology Architecture (VistA)' is an enterprise-wide information system built around an electronic health record, used throughout the United States Department of Veterans Affairs (VA) medical system, known as the Veterans Health Administration (VHA).^[1] By 2001, the VHA was the largest single medical system in the United States, providing care to 4 million veterans, employing 180,000 medical personnel and operating 163 hospitals, over 800 clinics and 135 nursing homes.^[2] By providing electronic health records capability, VistA is thereby one of the most widely used EHRs in the world.

Contents

Features

VistA Imaging

Role in development of a national healthcare network

Usage in non-governmental hospitals

Supporters of VistA

See also

References

External links

Features

The Department of Veterans Affairs (VA) has had automated data processing systems within its medical facilities since before 1985,^[3] beginning with the Decentralized Hospital Computer Program (DHCP) information system, including extensive clinical and administrative capabilities. In 1995, DHCP was enshrined as a recipient of the Computerworld Smithsonian Award for best use of Information Technology in Medicine.
VistA supports both ambulatory and inpatient care, and includes several significant enhancements to the original DHCP system. The most significant is a graphical user interface known as the Computerized Patient Record System (CPRS) for clinicians released in 1997. In addition, VistA now includes computerized order entry, bar code medication administration, electronic prescribing and clinical guidelines.
CPRS provides a client-server interface for health care providers to review and update a patient’s electronic medical record. This includes the ability to place orders, including medications, special procedures, x-rays, patient care nursing orders, diets, and laboratory tests. CPRS is flexible enough to be implemented in a wide variety of settings for a broad spectrum of health care workers and provides a consistent, event-driven, Windows-style interface.
For its development of VistA, the Department of Veterans Affairs (VA) / Veterans Health Administration (VHA) was named the recipient of the prestigious Innovations in American Government Award presented by the Ash Institute of the John F. Kennedy School of Government at Harvard University in July, 2006.
The adoption of VistA has allowed the VA to achieve a pharmacy prescription accuracy rate of 99.997%, and the VA outperforms most public sector hospitals on a variety of criteria, enabled by the implementation of VistA.^[4]
The VistA system is public domain software, available through the Freedom Of Information Act directly from the VA website,^[5] or through a growing network of distributors. The VistA Software Alliance is a non-profit organization that both promotes the widespread adoption and helps customize and distribute VistA nationally to non-VA healthcare facilities.^[6]
VistA was developed using the M or MUMPS language/database. Currently available releases can utilize both GT.M, an open source database engine for Linux and Unix computers, and InterSystems Caché, a commercial database with backwards compatibility for Mumps applications that has also been used on MS-Windows platforms. Although initially separate releases, publicly available VistA distributions are now often bundled with the database in an integrated package. This has considerably eased installation.

VistA Imaging

The Veterans Administration has also developed VistA Imaging, a coordinated system for communicating with PACS (radiology imaging) systems and for integrating others types of image-based information, such as EKGs, pathology slides, and scanned documents, into the VistA electronic medical records system. This type of integration of information into a medical record is critical to efficient utilization.^[7]
VistA Imaging has been made freely available in the public domain for private/public hospital use through the Freedom of Information Act. It is available through the Department of Veteran's Affairs software request office.
It can be used independently or integrated into the VistA electronic health record system (as is done in VA health facilities).

Role in development of a national healthcare network

The VistA electronic healthcare record has been widely credited for reforming the VA healthcare system, improving safety and efficiency substantially. The remarkable results have spurred a national impetus to adopt electronic medical records similar to VistA nationwide.
BHIE collectively describes a set of protocols that in 2007 was being developed and used by the VHA to transfer data (from VistA) between hospitals and clinics nationwide. It also allows transfer of data between VA hospitals and Department of Defense hospitals. This became a priority during the Second Iraq War, when a concern for the transition of healthcare for soldiers as they transferred from active military status to veteran status became a national focus of attention.^[8]
BHIE allows peer-to-peer transmission of large amounts of co-ordinated healthcare information.
The combination of VistA and BHIE in the VA system with the Department of Defense will continue to enlarge one of the largest networks of healthcare data in the world.
The VHA has also started a pilot project, known as HealtheVet, that allows veterans to access, and create a copy of, their health records online. A national release of the project is underway. This will allow veterans to port their health records to institutions outside the VA health system or keep a personal copy of their health records, a Personal Health Record (PHR).
Because of the success of these programs, a national move to standardize healthcare data transmission across the country was started. Text based information exchange is standardized using a protocol called HL7 (Health Level 7), which is approved by the American National Standards Institute. DICOM is an international image communications protocol standard. VistA is compliant with both.
Although VistA usually is run as a stand-alone application, it has evolved interfaces to be able to communicate with commercial off-the-shelf products. It can also communicate with other applications using HL7, DICOM, and other protocols.
The stages of development of a healthcare data network have been compared to the stages of the development of the Internet, which also involved standardization of data exchange using TCP/IP, a set of protocols developed by the Department of Defense.

Usage in non-governmental hospitals

Under the Freedom of Information Act, the VistA system, the CPRS interface, and unlimited ongoing updates are provided as public domain (but not free and open source) software.
This was done by the US government in an effort to make VistA available as a low cost electronic medical record system (EMR / EHR) for non-governmental hospitals and other healthcare entities.
It has been adopted by companies such as Blue Cliff and Medsphere, with US government grant assistance, to a variety of environments, from individual practices to clinics to hospitals, to regional healthcare co-ordination between far-flung islands. In addition, VistA has been adopted worldwide and is now used in other countries. Universities, such as UC Davis, have even adapted it for other uses such as in a veterinary hospital.
Companies have evolved to provide integration with other healthcare databases not initially used by the VA system, including billing software, lab databases, and images databases (radiology, for example).

Supporters of VistA

There have been many champions of VistA as the electronic healthcare record system for a universal healthcare plan. VistA can act as a standalone system, allowing self-contained management and retention of healthcare data within an insitution. Combined with BHIE (or other data exchange protocol) is can be part of a peer-to-peer model of universal healthcare. It is also scalable to be used as a centralized system (allowing regional or even national centralization of healthcare records). It is, therefore, the electronic records system most adapatable to a variety of healthcare models.
In addition to the unwavering support of congressional representatives such as Congressman Sonny Montgomery of Mississippi, numerous IT specialists, physicians, and other healthcare professionals have donated significant amounts of time in adapting the VistA system for use in non-governmental healthcare settings.
The ranking member of the House Veterans Affairs Committee’s Oversight and Investigation Subcommittee, Rep. Ginny Brown-Waite of Florida, recommended that the Department of Defense (DOD) adopt VA’s VistA system following accusations of inefficiencies in the DOD healthcare system. The DOD hospitals use Armed Forces Health Longitudinal Technology Application (AHLTA) which has not been as successful as VistA and has not been widely adapted to non-military environments, as VistA has.
In November 2005, the U.S. Senate passed the Wired for Health Care Quality Act, introduced by Sen. Enzi of Wyoming with 38 co-sponsors, that would require the government to use the VA’s technology standards as a basis for national standards allowing all health care providers to communicate with each other as part of a nationwide health information exchange. The legislation would also authorize $280 million in grants, which would help persuade reluctant providers to invest in the new technology.^[9] There has been no action on the bill since December 2005. Two similar House bills were introduced in late 2005 and early 2006; no action has been taken on either of them, either.^[10]
Hewlett Packard (HP) was awarded a $784 million service and maintenance contract to provide ongoing service and support for VistA. This partnership helps to ensure that the most up-to-date technology is available to VistA.^[11]

See also

★ Electronic health record

★ Health informatics

★ MUMPS

★ Veterans Health Administration

★ United States Department of Veterans Affairs

References

1. Department of Veterans Affairs: Veterans Health Administration
2. Department of Veterans Affairs: List of Medical facilities
3. VistA, U.S. Department of Veterans Affairs national scale HIS, , Stephen H., Brown, International Journal of Medical Informatics 69: 135-156, Bethesda, MD (USA),
4. The Best Medical Care In The U.S. How Veterans Affairs transformed itself -- and what it means for the rest of us, , , , BusinessWeek, Red Oak, IA (USA),
5. Department of Veterans Affairs: VistA website
6. VistA Software Alliance: website
7. PACS Lessons Learned at the Baltimore VA, , , , Imaging Economics, Skokie, IL (USA),
8. Full VA/DOD e-health sharing several years off, Mosquera, Mary, , , Government Health IT, Falls Church, VA (USA),
9. Senator Endorses VistA for EHR Standard
10. Library of Congress: Thomas: Bills, resolutions: S.1418
11. Ten year deal to support and maintain VistA Health Information Systems builds on 20 year relationship between HP and the VA

External links

★ VISTA Monograph

★ VistA / CPRS Demo site (Department of Veterans Affairs)

★ VA VistA software FTP site (Department of Veterans Affairs)

★ WorldVistA - Home of the OpenVistA project

★ WorldVistA Wiki

★ Hardhats - a VistA user community

★ Innovations Award - Ash Institute News Release

★ VistA Software Alliance

★ BlueCliff -- provides a VistA-based EMR package and customization of VistA applications throughout the US, as an outgrowth of a governmentally sponsored project

★ Sequence Managers Software -- provides a VistA-based EMR package, based in Raleigh, North Carolina

★ VistA Imaging overview

★ BHIE Bidirectional Health Information Exchange protocols of the Department of Veterans Affairs