Veterans Health Information Systems and Technology Architecture (VistA)
In the late 1970's, the Office of Data Management and Telecommunications (ODM&T) was given the job to computerize the VA nationwide [Brown, SH,2003]. It was developed using MUMPS (Massachusetts General Hospital Utility Multi-Programming System), or alternatively M, programming language.
Frustrated with slow systems development by the (ODM&T), which took 14 years to deploy a laboratory system to six sites, the Department of Medicine & Surgery created the Computer-Assisted System Staff (CASS) in 1977. Their Decentralized Hospital Computer Program (DHCP) included programs for administration, mental health, radiology and dietetics. The ODM&T tried to shut down development, but DHCP developers continued their work. Eventually VA Administrator Robert Nimmo approved a policy giving facility directors the power to choose computer applications in 1982. A first group of 25 sites and 11 applications was in place by 1983.
In 1995, DHCP was enshrined as a recipient of the Computerworld Smithsonian Award for best use of Information Technology in Medicine.
By 1999, multimedia online patient records were provided in VistA. Images from specialites such as cardiology, pulmonary and gastronintestinal medicne, pathlogy , radiology, hematology and nuclear medicine were supported.
As of 2001, it was the largest system in use in the US, with medical documentation and ordering available at every VA hospital in the country. In September 2002, 90.6% of all inpatient and outpatient pharmacy orders were entered by the provider. Today, the system is in use in hundreds of hospitals and clinics worldwide, not just in the VA Hospital System.
VistA consists of nearly 100 applications. Two relatively new applications include Computertized Patient Record System (CPRS) and Barcode Medication Administration (BCMA). A complete description and list of all applications can be found at the Vista website.
One important drawback of VistA is that site-specific data dictionaries prevents data summarization between sites, or on a system-wide level.
The VA currently runs a majority of VistA systems on InterSystems Caché. VistA can also run on GT.M, an open source database engine for Linux and Unix computers. 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 and and AHLTA of the DoD, were the first two largest US Government EHR built on standard based of interoperability of patient records. The project objective was to develop an interface between the DoD Clinical Data Repositiry (CDR), and the VA's Health Data Repository (HDR) that support a real time bi-directional exchange of computavle health data.
References
1. Brown, SH, Lincoln MJ et al. VistA - U.S. Department of Veterans Affairs national-scale HIS. International Journal of Medical Informatics. 2003; 69:135-156.
