Roger Baker receiving VIP Underground Railroad card

Roger Baker, Assistant Secretary for Information and Technology for the Department of Veterans Affairs receives his upgraded VIP Underground Railroad Card from Tom Munnecke. Peter L. Levin, Senior Advisor and Chief Technical Officer for the VA, looks on. The VIP card has a 1981-era Motorola 6800 CPU chip laminated over the engine of the railroad. The VIP card is in recognition of his efforts to build on the success of the VIstA tradition, towards the new generation of open source health Information technology.

Off camera was Philip Longman, author of Best Care Anywhere: Why VA Health Care is Better Than Yours describing the organizational transformation that VistA helped trigger.

We discussed the importance of understanding VistA as a community and a broad approach to organizational transformation far beyond just the source code employed in the computer programs, akin to the way that the success of Wikipedia is due to the user community - the underlying programs had only to be "good enough" to build a robust community.

 Roger Baker receiving VIP Underground Railroad Card from Tom Munnecke; Peter Levin looks on...

The Underground Railroad celebrates the user-focused, pioneering, grass roots energy and enthusiasm of the thousands of developers, clinical specialists, and users that have contributed so much to the success of VistA.  At its peak, VistA had over 50,000 users networked together on FORUM to develop software, exchange tips and tricks, coordinate clinical and subject matter expertise, distribute software, and build the community that transformed the VA's health care system.

The underground railroad holds celebratory banquets; some videos from previous ones can be seen here.  Dr. Ross Fletcher, Chief of Staff at the Washington VA, presents his observations on the success of VistA.  And here is US Medicine Editor Nancy Tomich describing her insights as a journalist covering the development of VistA.



More on the VistA and the Underground Railroad

Peter Groen's picture

Take a look at this series of You Tube video presentations about the public domain VA VistA comprehensive health information system. The speakers were attending the latest gathering of the original developers who were members of a clandestine group of forward thinkers within the Veterans Administration (VA) known as the Underground Railroad. VistA is now one of the most well known of the open source Electronic Health Record (EHR) systems. See the video presentations on You Tube.  

Back in the 1980’s, the VA implemented their first enterprise-wide hospital information systems known as the Decentralized Hospital Computer Program (DHCP). These systems were installed on new, low-cost mini-computers placed in each hospital. Over the decade personal computers (PC), local area networks (LAN), wide area networks (WAN), and office automation systems (OAS) were also deployed.

In the 1990’s, the VA DHCP system was renamed Veterans Health Information Systems and Technology Architecture (VistA). The VA moved to a client/server architecture and implemented the Computerized Patient Record System (CPRS) within VistA using a Windows-based graphical user interface (GUI).  Laptops, interactive voice response (IVR), high speed LAN/WANs, the Internet, and web-based applications were also widely deployed.

In the first decade of this 21st century, VistA continued to be enhanced with the addition of a Master Patient Index (MPI), a Health Data Repository, the My HealtheVet Personal Health Record (PHR), and the Federal Health Information Exchange (FHIE) system.  Wireless technology and mobile systems were also widely deployed. OSEHRA will only accelerate continued innovation and enhancements.

One of the keys to success for both the VA and DoD has been the commitment to standards – technical standards, data standards, messaging standards, imaging standards, telecommunications standards, terminology standards and standard code sets, e.g. ICD, CPT, SNOMED.  Collaboration, open solutions, and innovation have been strategies that have contributed to the success of VistA over time.

VistA has been adopted by the global ‘open source’ health IT community and has now been widely deployed outside the VA – both across the U.S. and around the world.  VistA has  been adopted  and enhanced by the Indian Health Service. It has been deployed in numerous hospitals and clinics in West Virginia, Hawaii, Texas, Florida, Oklahoma,  and other states. VistA has also been implemented in hospitals and clinics in Mexico, Egypt, Germany, Finland, Nigeria, Jordan, Iraq, India, and other countries.  It has been embraced by health care provider organizations and health IT vendors in both the public and private sector spawning many new companies and jobs, even as it also positively impacts the quality of care provided to millions of patients.

To learn even more about the VA and their renowned VistA system, you might want to read the "A History of Health Information Technology (HIT) in the VA - 1955 to 2005". You might also want to read a history of VistA and the Hardhats published on the Hardhats.Org web site.



Peter, Thank you for linking

Conrad Clyburn's picture


Thank you for linking to the excellent video series.

Conrad Clyburn