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How the VA VistA system is like a fighter jet

Comparing the Veterans Affairs Department’s evolution of health IT record systems to fighter jets got a little complicated at the Bethesda chapter of AFCEA’s Health IT Day today.

Dr. Steve Ondra, senior policy adviser for health affairs at the VA, was talking about the development and modernization of legacy electronic health record systems at the department, including VistA, and how those systems eventually will synchronize with new record programs, such as the VA/Defense Department Virtual Lifetime Electronic Record.

 He compared the evolution of VistA to the VLER, as being comparable to the evolution of World War II-era planes into modern fighter jets. The comparison became more complex as it went along.

To illustrate his point, Ondra said the VA started out with electronic record systems comparable to a P-51 Mustang, a World War II-era fighter plane, and to a Sabre Jet, which dates from the Korean War.

“The Sabre is a good jet, but a little dated,” Ondra said, apparently still talking about the VA's legacy systems such as VistA.

The next step, which includes creating the VLER, aims to be upgrade the legacy VA systems to make them comparable to an F-15 or F-22 modern fighter jet, Ondra added. He did not explain further.

Julie Boughn, chief information officer for the Centers for Medicare and Medicaid Services, talked about the need for health IT to support health care improvements while also preserving security of the data.

Boughn, who has been at CMS since 2000, said she has not always been impressed by government briefings on data security.

“I was driving here and heard a segment on National Public Radio on cybersecurity. It was better than some of the top secret briefings I’ve heard,” Boughn said.

Posted by Alice Lipowicz on Apr 06, 2010 at 7:20 PM


Reader Comments

Tue, Jul 13, 2010 Chris Califonia

This is another silly attack on a technology. Logic is still logic regardless of the language it is written in. Just some languages have capabilities that others do not. MUMPS is such a language that has capabilities that may be able to be aped by other languages, but not easily duplicated. Here is a sample of the characteristics that has made MUMPS so timeless. 1) It has a very small footprint. MUMPS was originally written for a 4K machine. With the onslaught of the technology, the new available hardware has been a great boon to the MUMPS community. It means that we can do more with less. Use smaller machines and make them look much bigger than they are. 2) The performance has done nothing but improve. Faster memory and faster processors have meant that we run circles around the traditional database world. 3) The VLER is already 30+ years in operation in the form of the VA VistA systems. Try really keeping all of that data without loss and we will see you guys in the next millennium, and we will still be collecting solid patient histories and outcomes. 4) Sparse Matrix Arrays. MUMPS has them and VistA uses them very well. 5) CHCS-I is a MUMPS engine and was able to make disparate third party systems talk to each other when they could not talk to each other directly. The same is true with VistA. The effort to replace CHCS-I has been very costly with lots of vendors doing their level best to duplicate the performance of CHCS-I and the result was CHCS-II, a system so bad that they had to change the name to AHLTA (which is pretty greatly hated by all in the DoD who are consigned to use it). 6) MUMPS and VistA are architectureless. They do not rely upon the limitations of the hardware to accomplish their tasks. Freezing the further development of VistA has made us have to live with some old technological decisions which used to be limitations. Newer additions to the ANSI Standard for MUMPS have not been fully put into practice. This could mean a decrease in actual code and improve performance, as well as allowing us to move farther forward with new technology. 7) Internationalization is another area which is rich for the further expansion once the VA unfreezes the development of VistA. VistA has been doing pretty well considering that the VA has frozen and further development for over 15 (almost twenty) years. 8) Be watching the further expansion of the VistA model outside the VA. It could be that in a few years when the VA is spending gobs of money and getting nothing, they may have to catch back up from the community hospitals that are not waiting for the VA to make a decision. Who knows, the latest enhanced VistA may be coming from the Middle East. Watch out for a VistA Gap.

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