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| | * [[Bhaskars_Opinion_on_Vendors|Bhaskar's Opinion Regarding VistA Vendors]] | | * [[Bhaskars_Opinion_on_Vendors|Bhaskar's Opinion Regarding VistA Vendors]] |
| | The following discussion was excerpted from a thread on Hardhats. | | The following discussion was excerpted from a thread on Hardhats. |
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| − | * [http://groups.google.com/group/Hardhats/browse_thread/thread/6b5fb65257abe677?hl=en "Front End over VA VistA"]
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| − | ==Bhaskar's Vision for WorldVistA Vendors==
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| − | K.S. Bhaskar Date: Fri, 15 May 2009 16:21:57 -0400
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| − | For what it's worth, I don't think most doctors should be
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| − | installing VistA on a PC; or even installing an operating system on a
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| − | PC; or, come to think of it, managing VistA on a PC.
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| − | [That's not to say that some set of doctors are not capable of doing it. I am just saying that majority should not be doing it any more than I
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| − | should be practicing medicine. Doctors don't even treat themselves - my
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| − | uncle, a nephrologist, says, "A doctor who treats himself has a fool for
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| − | a patient."]
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| − | IMHO*, the best way to deploy VistA at the primary care level is to
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| − | package it as an appliance, with a service contract (maybe like a
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| − | sterilizer, EKG machine, fire extinguisher, or photo copier). Practices
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| − | are accustomed to dealing with appliances and service contracts. A
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| − | practice signs up for VistA, a vendor configures it on an inexpensive PC
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| − | (set up with encrypted file systems or encrypted databases, in case it
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| − | gets stolen) and ships it to the practice. They plug it in, connect it
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| − | to the LAN, and turn it on - it's ready for use (since it comes
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| − | preconfigured with user ids, access codes, etc.). Maybe someone from
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| − | the vendor goes out for half a day to set up and hold the hand of anyone
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| − | that needs a hand held.
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| − | The VistA appliance calls home via a secure connection over the
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| − | Internet. The vendor has an environment to which the practice's
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| − | database is streamed so it is current to within millibleems of the
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| − | database at the practice. All administration of VistA at the practice
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| − | is done remotely by the vendor.% There is excellent response because
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| − | VistA is being accessed on the LAN.
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| − | In the event the appliance dies, the practices switches to VistA in the
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| − | vendor's environment in seconds to minutes (there are multiple ways to
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| − | do this). Now, they have exactly the same VistA environment and
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| − | database that they had a few moments before, but it is just slightly
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| − | less responsive because the connection is over the Internet rather than
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| − | on the LAN. The vendor sends a replacement (PCs are cheap enough) with
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| − | a copy of the practice's environment from the vendor's data center. The
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| − | practice plugs it in and it catches up. At a mutually convenient time,
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| − | the roles are switched so that the appliance at the practice is once
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| − | more the primary and that in the vendor's data center is once more a
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| − | secondary.
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| − | The vendor charges a fee for the service (whether it is $10/month,
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| − | $100/month or $1000/month - that will be determined by the market). The
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| − | practice has a predictable monthly cost and the vendor has predictable
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| − | revenue.
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| − | The practice never sees the roll and scroll interface unless it breaks
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| − | the glass. The vendor does, of course, but that's OK. That's what the
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| − | vendor does.
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| − | All of this can be done today. Comments are welcome.
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| − | Regards
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| − | -- Bhaskar
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| − | <pre>
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| − | * Isn't it interesting that In My Humble Opinion and In My Hubristic Opinion have the same acronym?
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| − | % It's trivial to implement an electronic "break the glass" to give the
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| − | practice access to the data without the cooperation of the vendor if &
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| − | when they need it (vendor goes out of business, contract dispute,
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| − | whatever), but to also record that the glass was broken.
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| − | </pre>
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| − | Vipen Mahajan Date: Sat, 16 May 2009 22:06:24 +0530
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| − | Hi Bhaskar,
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| − | Good overview concept. Some questions, :
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| − | # How does the doctor get trained to use VistA, or CPRS? Can we put this training into say Moodle, with screen shots, and a narrative to explain
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| − | # How about the reservations of providers, to touching the keyboard even. Esp for the the older ones.
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| − | # How reliable is the virtual machine/appliance, the file system etc for a production environment, now?
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| − | # Is the Vendors' server on the cloud? EC2?
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| − | # How about the conversion of the older charts etc.
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| − | Regards,
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| − | Vipen
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| − | --
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| − | Vipen Mahajan
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| − | Principal
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| − | Leo Systems
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| − | Chicago/Boston/Munich/New Delhi.
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| − | K.S. Bhaskar Date: Sat, 16 May 2009 18:34:29 -0400
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| − | > 1. Training
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| − | [KSB] This could go into Moodle. Or it could be part of the marketing /
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| − | selling additional services that the vendor provides.
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| − |
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| − | > 2. How about the reservations of providers, to touching the keyboard even. Esp for the the older ones.
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| − | [KSB] Maybe dictation / transcription / electronic signature (they will
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| − | at least have to touch the PC for that last).
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| − | > 3. How reliable is the virtual machine/appliance, the file system etc for a production environment, now?
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| − | [KSB] I am not talking about a virtual machine at the practice - I am
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| − | talking about an appliance which is a real Linux PC on which VistA runs. They can see it, touch it and feel it, just as they can a sterilizer,
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| − | photo copier, EKG machine, etc.
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| − | But I have become more comfortable with virtual machines for production
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| − | use. For example, with QEMU/kvm, you can create a virtual disk with
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| − | something like "-drive file=myVistA.qcow,index=0,media=disk,cache=none"
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| − | or cache=writethrough. So, while it is the business of the universe to
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| − | be imperfect, I think using one of these options is fine for production,
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| − | especially in a logical multi-site configuration.
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| − | > 4. Is the Vendors' server on the cloud? EC2?
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| − | [KSB] It can be. But I don't think a cloudy machine is economical if
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| − | you run it 24x7. It would be better to get a hosted virtual machine
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| − | from an ISP such as linode.com.
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| − | As a practical matter, since a vendor will make money not on a single
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| − | practice, but on volume, I suspect it will be most cost effective for
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| − | vendors to have their own servers (probably hosted at an ISP).
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| − | In any case, the economics of hosting servers is not VistA specific. I
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| − | was only focusing on that part of the business that was specific to VistA.
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| − | > 5. How about the conversion of the older charts etc.
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| − | [KSB] Whatever solution works for VistA works for my proposed packaging
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| − | and deployment. There are scanning solutions for documents that have
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| − | been connected with VistA.
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| − | Regards
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| − | -- Bhaskar
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NOTE: THIS PAGE AT THIS TIME MERELY PRESENTS INDIVIDUAL OPINIONS THAT ARE IN NO WAY THE CONSENSUS OF THE VISTA COMMUNITY AT LARGE. READ IT WITH A GRAIN OF SALT.
