WorldVistA, VistA-Office EHR, and MUMPS - Get "Back-to-the-Future"

There's been numerous discussions about therealistic given the complexity and magnitude of
health information system in use by the U.S.HealtheVet”.
Department of Veterans Affairs ("VA") and howThe main points the VA would like to address in
widespread adoption of such a system canreplacing VistA are as follows:
improve our health care delivery system as it has• HealtheVet will be less expensive to maintain
for the VAi. In this article, I'll expand on thesethan VistA
highly subjective debates by providing a• HealtheVet will have more ability to
comprehensive, high-level overview of VistA andinterface with other applications
its variants, such as HealtheVet, Vista-Office EHR• The cost to keep the 20-year old VistA
and WorldVistA, and its pros and cons as itsystem afloat is very high
relates to small and mid-sized physician practices.• VistA is written in M, an old medical
I’m sure we’ve all heard of VistA,computer programming language
but please allow me to reintroduce the well-known• At some point, M programmers will
system. Drumroll…disappear
The Veteran’s Health Information SystemsWhy then, would Wired Magazine award
and Technology Architecture, more commonlyWorldVistA on the basis of being “the most
known as VistA, is an electronic health recordsintriguing breakthrough” in medicine?
system developed by the VA in the late 1970s.As a technology platform primarily based on the
Highly efficient in its design methodology, VistAlegacy VistA, WorldVistA is far from being an
system engineers worked side-by-side with“intriguing breakthrough”. This award
clinicians in order to build the system to closelywas nothing more than a publicity stunt aimed to
reflect the practice of medicine. With over 100+lure physicians towards an efficient, yet highly
modules covering virtually every aspect of healthcomplex and slowly aging platform and playing on
care delivery, it is a highly complex yet fullysweet spots with words such as
fledged electronic health records system. VistA“free” and “no-cost”.
has proven to lower the VA’s cost ofAs mentioned above, even the VA recognizes
care and improving the efficiency of its 1000+the need for modernization of VistA, why
medical facilities.doesn’t the Board for WorldVistA?
Vista-Office EHR, or VOE, is a light-weight versionIt’s very simple - because there’s
of VistA aimed at providing EHR functionality forno such thing as a free lunch.
smaller medical practices. Conceived by theIn researching the costs of VOE, implementation
Center for Medicare and Medicaid Servicesfees can be equivalent to or even surpass that of
(“CMS”), VOE was taken over andcommercialized EHR software in training,
additionally enhanced by WorldVistA, according toimplementation, and maintenance costs (check out
their website. WorldVistA is the official vendor[ Additionally, the basis on which VistA was
support organization for this technology, asdesigned is slowly becoming extinct in the world
indicated by CMS. Recently, the 2007 Raveof software engineering. MUMPS lack the attention
Awards from Wired Magazine claimed to haveand mainstream support of more common
chosen winners by “looking for the mostprogramming languages, including Java, C#, and
intriguing breakthroughs in the world today”C++. Support for modern technologies such as
and announced WorldVistA as the 2007 RaveXML for heterogeneous interoperability; SQL for
Award winner for the most intriguingrelational database management; and others is not
breakthrough in medicine. Hummm…veryinherently supported in this platform. Unlike
interesting indeed.MUMPS, the plethora of programmers available for
Finally, there’s HealtheVet – thethese common languages is unlikely to decline in
VA’s attempt to modernize its well-knownthe foreseeable future.
VistA health information system. Recognizing theLet’s face it – in order for any EHR
need to take advantage of today’ssystem to be a viable solution for physicians, it
technology, the VA has reported its desire tomust be simple, requiring very minimal training;
upgrade VistA to help provide modern supportaffordable, as most commodity software
for records accessibility, information collaboration,applications; and agile, adapting to physician work
and ease-of-conformance to the ever changingflows and dynamic regulatory demands.
HIPAA regulations. The VA received failing gradesWorldVistA and other implementations based on
from Carnegie Mellon University’s SoftwareVistA will not suffice as mainstream electronic
Engineering Institute, who was hired by the VA tomedical record solutions for physician practices.
perform a technical analysis on HealtheVet. TheOrganizations supporting such ideologies must get
results of this report concluded that theback to the future, or get left behind.
“current plans to replace VistA are not