VA's VistA, with modifications, goes big in Mexico

jing.wang · 发表于 2006-3-29 03:18:01

Beyond the Headlines >> Written by <a href="mailto:jconn@crain.com">By Joseph Conn / HITS staff writer</a> VA's VistA, with modifications, goes big in MexicoStory originally published March 28, 2006Mexico has installed in 21 government-owned hospitals the core VistA information system developed by the U.S. Veterans Affairs Department, along with several key applications, and the technology could be in place at up to 100 Mexico-owned hospitals by year-end, according to a health service official there. In fact, Mexico is likely to be the largest VistA implementation in the world within three years, with several hundred hospitals running at least the basic system, said Peter Groen, a technology specialist who recently retired from the VA, having last served as its liaison for outside-the-agency VistA installations. VistA (short for Veterans Health Information Systems and Technology Architecture) and its predecessors were developed largely through an in-house collaboration between VA programmers and clinicians over the past three decades. The software code and documentation are publicly available, essentially free of charge, under the Freedom of Information Act. With the development of a Spanish-language version, several Mexican companies specializing in VistA likely will emerge to team up with the VistA Software Alliance, a U.S.-based vendor consortium, to sell the system across South America, Groen said. "Ten to 20 years down the road, I would see lots of countries in South America using VistA," he said. "Then it will raise the whole scenario, who really owns VistA?" A delegation from Mexica first met with Groen and other VA officials in 2004 to discuss installing VistA at the Instituto Mexicano del Seguro Social, or IMSS, a government agency that runs 263 hospitals and 4,000-plus clinics, providing care to some 45 million workers and their dependents and some 10.5 million uninsured. "When they first came to us and looked at VistA and decided it was a viable thing, I was really impressed with them," Groen said. "They had a lot of PhDs. We think we have great programmers; they have just as good down there. They took our software and disappeared. I'd send e-mails down there, and some they would answer and some they wouldn't. They really didn't ask for any help, and they didn't get any from the VA. They did speak with folks in the VistA alliance about getting help, but they have a tight budget; they decided they have to do it themselves." By May 2005, the IMSS had turned on two key VistA modules -- ADT (admission, discharge and transfer) and CPRS (computerized patient-record system) -- at 12 tertiary hospitals in Mexico City, Monterey and Guadalajara as part of a $100 million national IT expansion, said Mauricio Derbez del Pino, the IMSS' coordinator of technology for medical services and point man for the VistA installation. Since May 2005, the system as been installed at nine more hospitals. Staff members at an additional 79 hospitals have received VistA training, but further rollouts are on hold while the IMSS works to make the necessary hardware available, del Pino said. "In maybe two months, more or less, we'll be able to say we're working in 100 hospitals," he said. IMSS programmers, with assistance from the Universidad Nacional Autonoma de Mexico, or UNAM, translated VistA into Spanish and further adapted it to the agency's needs with new components, del Pino said. The university previously helped the IMSS develop an electronic medical record for ambulatory care, released in 2002 and now supporting 800 government clinics. More recently, the university helped train IMSS hospital staff on the new VistA system. A local contractor also aided IMSS programmers with some of the development work, del Pino said. "Our technical people made a first draft of the translation and sent it to the doctors to make a fine-tuning," he said. "The doctors work with the local server and afterwards send to a central data repository. We have our own (virtual private network) that joins all the medical units of IMSS." Among other new elements, developers built a custom program for operating rooms, interfaces with the ambulatory EMR and interfaces with in-hospital laboratories, which are run by contractors with their own computer systems, del Pino said. A computerized physician order-entry system will come later, and the agency hopes to have an obstetrics component ready by November. So far physician support had been good, del Pino said. "All the doctors are very keen for this," he said. "There is much more to be done for our hospitals, but it is really a great step forward, because they were basically working with paper. We had some small pieces of software that were not connected. The data was not consistent." The IMSS' version of VistA is running on GT.M, an open-source version of the MUMPS database and programming language offered by Fidelity National Information Services, Malvern, Pa. The not-for-profit WorldVistA organization maintains an open-source version of VistA. The VA doesn't promote or sell VistA, but the code is in the public domain. As a result, several countries in addition to Mexico, such as Egypt, Nigeria, Germany and Jordan, have deployed IT systems based on the product. The VA has no plans to take advantage of advances to VistA made in Mexico or other countries but may incorporate some outside work into the VistA replacement system, HealtheVet, now under development, said Robert Kolodner, chief health informatics officer at the Veterans Health Administration who has worked on VistA and predecessor systems since the 1980s. HealtheVet is intended to move VistA from Cache, a version of MUMPS, to a JAVA development platform and relational database. "We're moving to a very different system, which has a different architecture," Kolodner said. "We're not really focused on bringing in enhancements to the current state of VistA, because by the time we do that, we'd have moved on to the next platform." Kolodner wouldn't provide a timetable for the conversion to HealtheVet. Congress last year mandated a restructuring of the VA's IT administration after a development disaster involving a $372 million IT project in Bay Pines, Fla. As a result, much of the VA's IT development work is on hold. Earlier this month, the VA's chief information officer, former Dell Computer executive Robert McFarland, resigned, perhaps signaling further delay. Groen said he sees collaboration by the world's software programmers through an open-source development model as a good way to keep up with world's healthcare IT needs. Born in the Philippines to an American mother and a Dutch father, Groen grew up with an international perspective as his father, a banker, moved the family around the Pacific Rim. Groen came to the U.S. in 1968 to attend college and served in the Navy for six years, including in Vietnam, before joining the VA. He is a part-time faculty member at Shepherd University in Shepherdstown, W.V., and has written a book on collaboration in health informatics scheduled to be published this fall. While VistA is a public-domain software and not truly open-source, its development within the VA was "totally collaborative," Groen said. "It has all of the characteristics of the open-source community and that's what made it work. "The knowledge of healthcare and medicine is changing so rapidly that no one company can stay on top of it, and so it has to be a collaborative, community affair," he said. "Why not go with a solution in which everyone is contributing ideas and solutions? ... I think open-source is the key in the healthcare arena."

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VA&#39;s VistA, with modifications, goes big in Mexico

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VA's VistA, with modifications, goes big in Mexico