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| − | From: "Matthew King" <mking@clinicaadelante.com> | + | From: [[Matthew King]] <mking@clinicaadelante.com> |
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| | The Community Health Centers in AZ are forming the Arizona Integrated | | The Community Health Centers in AZ are forming the Arizona Integrated |
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| | VistA Office in our EHR evaluation. | | VistA Office in our EHR evaluation. |
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| − | From: "John Leo Zimmer" <jlzimmer@cbchc.com> | + | From: [[John Leo Zimmer]] <jlzimmer@cbchc.com> |
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| | The Council Bluffs Community Health Center is assembling the hardware | | The Council Bluffs Community Health Center is assembling the hardware |
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| | VistA to community health centers' special needs. | | VistA to community health centers' special needs. |
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| − | '''From: Hardhats Listserve:'''
| + | ==From Hardhats Listserve:== |
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| | Here are some recurrent questions us nontechies have about VistA: | | Here are some recurrent questions us nontechies have about VistA: |
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| − | '''1) Is Mumps a serious limitation to complete EHR functionality, code maintainence, HL7, or PMS interfacing?'''
| + | [[1) Is Mumps a serious limitation to complete EHR functionality, code maintainence, HL7, or PMS interfacing?]] |
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| − | There are several major commercial EHRs that use MUMPS. In fact,
| + | [[2) What is the fundamental difference between a relational database and a hierarchical database and how does that effect the end-user? (Should we even care? If so why?)]] |
| − | the language was developed expressly FOR the health care
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| − | environment. There are far more limitations (and serious ones at
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| − | that) in most other languages and especially strict SQL
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| − | Absolutely not. I will go one step further than Cameron.
| + | [[3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?]] |
| − | I have heard that M is the #1 language used for EHR's.
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| − | Epicare, which just contracted for EHR for Kaiser, is based
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| − | on M, for example.
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| − | '''2) What is the fundamental difference between a relational database and a hierarchical database and how does that effect the end-user? (Should we even care? If so why?)'''
| + | [[4) What other concerns should we have regarding adopting VistA?]] |
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| − | While MUMPS has been characterized as "hierarchical", the
| + | [[5) Are any Community Health Centers currently utilizing VistA?]] |
| − | DBMS that VistA uses, VA FileMan, provides what is more accurately
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| − | characterized as a polymorphic view of the database. One can
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| − | readily use relational projections (indeed there are commercial
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| − | add-ons that give a strict SQL view of the database). The more
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| − | advantageous view through VA FileMan is more like an object view
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| − | of the data with abstract data types being highly specialized for
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| − | optimal use and performance. End users usually need not care
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| − | (except that performance of VA FileMan is demonstrably superior
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| − | (there are published reports) to SQL on the same hardware and
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| − | configuration.)
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| − | Another difference is the way the data is stored. M data is stored
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| − | in b-trees, as compared to flat tables (I believe). This leads to
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| − | faster data acess, and less CPU power needed.
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| − | Also, the database in M is called by some a "sparce array." This
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| − | means that there are no "blank spaces" left for data to be later
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| − | filled into. So with M, if there is no data present, then no space
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| − | is wasted. I find this to lead to many many fields being defined
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| − | for a given file. With a traditional database, having all these
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| − | fields with empty/wasted space, would lead to huge database files.
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| − | But with M, one can can store years of patient information on a
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| − | relatively small disk.
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| − | '''3) How hard is it for non-Mumps IT personnel to learn Mumps/VistA and are there enough experienced VistA programmers (or former VistA programmers) to consult or be hired to non-VA projects?'''
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| − | Learning MUMPS is as simple as learning BASIC. Learning about all
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| − | the utilities and capabilities of the common services in VistA is
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| − | a years long process. And learning the functionality and setup
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| − | for the clinical and administrative functions in VistA would
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| − | probably take several life-times. Are there enough experienced
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| − | programmers and application consultants? So far I believe you'll
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| − | currently pay more for a Java programmer.
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| − | I am a physician and have taught myself M. It is a very simple
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| − | language. I consider it to be a scripting language. But it gets
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| − | the job done, and has run hospitals safely for decades.
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| − | There are many people on the list that would like work as
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| − | programmers, so I don't think there will be any limitation there.
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| − | And when CMS releases VistAOffice, there should be even more
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| − | interest and consultants available.
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| − | '''
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| − | 4) What other concerns should we have regarding adopting VistA?'''
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| − | Expect a long learning curve. Get help.
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| − | I think a factor here is how much you want to put into the system.
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| − | It is not turn key at this point, although there are installers
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| − | who can do the work for you. It is not going to have all the
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| − | bells and whistles that commercial EMR's want you to pay for.
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| − | It is not currently integrated with a billing system or a system
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| − | for appointments.
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| − | matthew king adds:
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| − | On the other hand, a lot of the bell and whistles that seem to
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| − | exist in many commercial products are actually rudimentary or even
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| − | vaporware. VistA isn't as pretty, but is very functional, with
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| − | easily modified clinical and preventive care reminders,support for
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| − | disease management, advanced drug interaction checks and lexion
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| − | support. The CPRS module supports drag and drop template building.
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| − | This makes custom templates a snap, something you pay dearly for
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| − | in many commerical products. The experts say 1/3 of medical errors
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| − | can be reduced by intelligent software design. Since the VA
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| − | product exists for patients, not profits, it is designed for
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| − | clinical functionality and patient safety, so that is where it
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| − | shines. Most commercial products have recently added EHRs as an
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| − | afterthought in an emerging market. The bells and whistles look
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| − | slick, but don't necessarily add to patient safety.
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