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VistA Expertise Network Key Takeaways

From November 17th through November 20th, OSEHRA representatives including myself and Luis Ibanez attended the VistA Expertise Network meeting in Redmond, Washington.  Following an extensive and informative meeting with key community members, Luis and I took the following notes back to the OSEHRA management group, and have been actively discussing these with OSEHRA team members, and the community as a whole.  I have published these publicly, as to enable the community to comment on the various thoughts as we move the discussion along.

Key Takeaways:

  1. Let’s get back to user-driven development.

The reason that innovation was exponential in the early years of VistA is due to providers, many of whom were also coders, and a direct method of communication between staff and developers.  The feedback loop between the end-user community and the development community must be closed for the rate of innovation to increase.

Considerations

  • Collaboration – How do we engage and expand our end user community, both inside and outside of the VA?
  • Incentive – How do we inspire the community to participate, both to end-user suggestions and enhancements?
  • Utilities – How do we stay engaged to ensure that our current and future tools are appropriate to drive these considerations?
  1. The VistA community wants to operate from a unified code-base.

All VistA vendors have variations.  Operating from a unified ‘gold’ version of VistA would expeditiously improve the ability for all community members to share and implement code improvements.

Considerations

  • Product Definition – How do we define the core version of VistA which represents the unified code-base?  Which community participant contributes what, and how will all mesh together. 
  • Licensing – There is a dispute over appropriate licensing, particularly as it relates to the ‘copyleft’ provision.  The community has justified concerns over code-hijacking, which must be balanced with the needs for transparency and innovation.  This discussion will continue as we further define product definition, and its relevance to Meaningful Use.
  • Meaningful Use – The community views it as essential for adoption outside of the VA that OSEHRA be able to furnish a Meaningful Use compliant version of VistA.

Community Concerns:

Concern:  Can the VA employees contribute outside of their VA employment role?  OSEHRA has been informed that VA employees may contribute outside of their employment role.

Concern:  The trademark clause of the membership agreement is still in place.  It is preventing individuals from enrolling in the website.  This must be addressed.  OSEHRA is currently looking into this.

Concern:  JIRA is not an open source bug tracker.  Though it is supportive of open-source, there is concern about it.  OSEHRA will examine and weight the benefits of possible alternatives.

Community Suggestions:

Documentation:  VistA Document Library (VDL).  Should be taken and logically restructured utilizing modern tools, made available to the community.

Educational Engagement:  Junior College Educational Training Initiative; excellent opportunity to utilize VistA in next generation training.  Educational builds already exist in community.

Educational Suggestion:  OSEHRA should be engaging in VEHU (VistA e-Health University).

Educational Suggestion:  Define how OSEHRA can interact appropriately with Vistapedia.

 Transparency Suggestion:  The community would like visibility to all of the Class 3 in-flite projects, in order to prevent duplication of effort and provide situational awareness.

Medsphere’s Fileman:  This would be an excellent first step to working from a unified code base.

VistACOM:  Excellent first project to leverage certification process against public contribution using GPL license (non-core VistA component).

 

Comments

Tom Munnecke

Users and more...

Thanks for the great summary, Matt.  I enjoyed meeting you and Luis in Seattle.  I think that "where are the users?" is a common sentiment from VistA folks when they see the new architectures.

I also suggested that folks take a tour of a VA hospital some time.  Seeing the role our software plays life-critical situations in sometimes chaotic situations is quite a different perspective than looking at the internals of the software through computer screens.  Dr. Ross Fletcher, Chief of Staff of the Washington VAMC, would be an excellent tour guide.

But I think that the issue is deeper than just user-driven development, or user interface experience design.  The basic VistA design point of view was from the perspective of the User (file #3) interacting with Patients (file #2).  This provided an extremely tight feedback loop - one that allowed users to form what today might be called "learning communities" or "communities of practice," which it gave developers critical feedback for what today might be called agile development or extreme programming.

In scanning the OSEHRA architecture, (it would be nice to have a search function, by the way), I did't find either users or patients listed.  The point of view of this approach is essentially the central office organization chart, focusing on departments and functions, rather than patients and users.

Striking the balance between the bottom-up and the top-down is critical.  I noticed early in my tenure that no matter where I went in the organization chart, people wanted things decentralized above them and centralized below them.  

This is similar to Conway's Law:  "organizations which design systems ... are constrained to produce designs which are copies of the communication structures of these organizations."  OSEHRA, coming from central office, sees the system as a centralized structure.  VistA, coming from the hands-on direct user experience, sees the system as an integrated interplay between users and patients.

There is a huge chasm between these two approaches.  This is a baby step in the right direction, but I think it needs a much deeper consideration.