Comments on: Diabetic VistA – The First Amputation http://blog.crossoverhealth.com/2007/11/07/diabetic-vista-the-first-amputation/ The Next Generation of Health Care Fri, 26 Feb 2010 06:55:13 +0000 http://wordpress.com/ hourly 1 By: The Future of VistA: Community versus Congressionally Mandated Leadership « Crossover Healthcare http://blog.crossoverhealth.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-411 The Future of VistA: Community versus Congressionally Mandated Leadership « Crossover Healthcare Thu, 31 Jul 2008 03:39:12 +0000 http://crossoverhealth.wordpress.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-411 [...] I have already mentioned in my Diabetic VistA post, there are certainly parts of the system that need radical updates, enhancements, and a freaking [...] [...] I have already mentioned in my Diabetic VistA post, there are certainly parts of the system that need radical updates, enhancements, and a freaking [...]

]]> By: Act III: VistA Will Find a Way « Crossover Healthcare http://blog.crossoverhealth.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-405 Act III: VistA Will Find a Way « Crossover Healthcare Wed, 30 Jul 2008 08:32:53 +0000 http://crossoverhealth.wordpress.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-405 [...] more ironic, despite all this success, the VA continues to try to get rid of it and the DoD continues to do everything they can to avoid admitting failure and embrace the obvious. [...] [...] more ironic, despite all this success, the VA continues to try to get rid of it and the DoD continues to do everything they can to avoid admitting failure and embrace the obvious. [...]

]]> By: PACSFerret http://blog.crossoverhealth.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-79 PACSFerret Sat, 17 Nov 2007 08:03:07 +0000 http://crossoverhealth.wordpress.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-79 You strike a negative note which is understandable in the context of Vista and the VA but lets remember open source apps (as opposed to infrastructure) are only recently gaining mainstream traction and healthcare is probably THE most conservative industry around. Rome wasn't built in a day & neither was Cerner. @Greg: When I first toyed with the idea of breaking into the imaging market 4 or 5 years ago I was told with absolute certainty that no-one could challenge "the big 4". Well, on this side of the pond at least, Sectra have done just that. It can be done, and will be again. Note on blog theme: Might be me being dim ut I can't find RSS feed? You strike a negative note which is understandable in the context of Vista and the VA but lets remember open source apps (as opposed to infrastructure) are only recently gaining mainstream traction and healthcare is probably THE most conservative industry around. Rome wasn’t built in a day & neither was Cerner.
@Greg: When I first toyed with the idea of breaking into the imaging market 4 or 5 years ago I was told with absolute certainty that no-one could challenge “the big 4″. Well, on this side of the pond at least, Sectra have done just that. It can be done, and will be again.
Note on blog theme: Might be me being dim ut I can’t find RSS feed?

]]> By: Greg Caulton http://blog.crossoverhealth.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-75 Greg Caulton Wed, 14 Nov 2007 01:45:53 +0000 http://crossoverhealth.wordpress.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-75 Cerner rewrote their leading Classic product with a modern architecture - Millennium - multi-tiered, rich C++ and VB clients, middleware and services portable across VMS or AIX, backed by Oracle. I would propose that we (the open source community) need to do the same to not only gain productivity from modern languages and development processes, but also to attract developers to healthcare. The next generation 'gain development experience' through open source projects. I do not believe MUMPS and VISTA is going to attract as many developers as an HIS using Oracle/PostgreSQL, JBoss, and rich clients - whether AJAX (www.tolven.org) or Swing with my own project (www.patientos.org). What is unknown to me is if I or any other projects will gain enough momentum to catch up with Cerner and others. Most people I speak with say it cannot be done (or at least not in the next 10 years). But I will damned if I give up trying :-) Cerner rewrote their leading Classic product with a modern architecture – Millennium – multi-tiered, rich C++ and VB clients, middleware and services portable across VMS or AIX, backed by Oracle.

I would propose that we (the open source community) need to do the same to not only gain productivity from modern languages and development processes, but also to attract developers to healthcare.

The next generation ‘gain development experience’ through open source projects. I do not believe MUMPS and VISTA is going to attract as many developers as an HIS using Oracle/PostgreSQL, JBoss, and rich clients – whether AJAX (www.tolven.org) or Swing with my own project (www.patientos.org).

What is unknown to me is if I or any other projects will gain enough momentum to catch up with Cerner and others. Most people I speak with say it cannot be done (or at least not in the next 10 years).

But I will damned if I give up trying :-)

]]> By: Gordon Moreshead http://blog.crossoverhealth.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-72 Gordon Moreshead Wed, 07 Nov 2007 21:18:46 +0000 http://crossoverhealth.wordpress.com/2007/11/07/diabetic-vista-the-first-amputation/#comment-72 They currently have a lab system that was built in the ‘80’s by internal developers in the development center in SLC which I managed at the time. For a little history, Cameron Schlehuber and Wally Fort were the primary developers with contributions from Ron Guinsburg for AP and Blood Bank. Though totally untrue, VA was at one time accused by Sunquest of copying their lab system. The two were very much alike in the early days because the same design methods were used and design decisions were made at virtually the same time with the same architecture in mind and with the same limitations on disk space costs, etc. It has needed modernization for the last ten years or so. This was especially true in the areas of file structures and user interfaces. General overall functionality was always quite good although VA minimized its efforts to maintain it with the changing needs of modern laboratories. It must not be too bad in that it has served the VA for nearly 25 years with minimal updating for the last 10 to 15 years or so. It would be a major project to modernize it, but it would have cost far less to do so than to do what they are doing now. In terms of life cycle costs, I suspect that a re-write would have been less costly to do and maintain than to go commercial. Back in the late ‘80’s, after implementation nationally, I estimated sunk costs at less than 10 million for the development and implementation across the entire VA. Not too bad for the taxpayer bang for the buck. Disclaimer: Since I have been gone from the VA for over ten years, some of my knowledge is dated, based on what was happening in the mid ‘90’s when I left. They currently have a lab system that was built in the ‘80’s by internal
developers in the development center in SLC which I managed at the time. For
a little history, Cameron Schlehuber and Wally Fort were the primary
developers with contributions from Ron Guinsburg for AP and Blood Bank.
Though totally untrue, VA was at one time accused by Sunquest of copying
their lab system. The two were very much alike in the early days because the
same design methods were used and design decisions were made at virtually the
same time with the same architecture in mind and with the same limitations on
disk space costs, etc. It has needed modernization for the last ten years or
so. This was especially true in the areas of file structures and user
interfaces. General overall functionality was always quite good although VA
minimized its efforts to maintain it with the changing needs of modern
laboratories. It must not be too bad in that it has served the VA for
nearly 25 years with minimal updating for the last 10 to 15 years or so.

It would be a major project to modernize it, but it would have cost far less
to do so than to do what they are doing now. In terms of life cycle costs, I
suspect that a re-write would have been less costly to do and maintain than
to go commercial. Back in the late ‘80’s, after implementation nationally, I
estimated sunk costs at less than 10 million for the development and
implementation across the entire VA. Not too bad for the taxpayer bang for
the buck.

Disclaimer: Since I have been gone from the VA for over ten years, some of my
knowledge is dated, based on what was happening in the mid ‘90’s when I left.

]]>