VA plans new VistA medical scheduling system

VA plans new VistA medical scheduling systemDecember 23, 2011 | Mary Mosquera  http://www.govhealthit.com/news/va-plans-new-vista-medical-scheduling-system

The Veterans Affairs Department intends to replace its legacy medical scheduling application for its VistA electronic health record system and wants industry feedback about requirements for functionality, system interface and risk reduction.

A modernized system could manage appointments, patient information and coordinate associate services across all VA facilities for a single view of veterans.

[Editor's Desk: This Week in Government Health IT.]

The medical scheduling application has been an essential component of the Veterans Health Information Systems and Technology Architecture (VistA) and performs multiple interrelated functions to bring patients, clinicians and other resources together. But each facility has its own VistA version. The scheduling package also captures data which enables VA to measure, manage and improve access, quality and efficiency of care, and operating and capital resources.

However, VA’s existing scheduling application is more than 25 years old, “highly inefficient and no longer effectively supports the multiple linkages needed to engage patients, clinicians and ancillary services and support new models of clinical care delivery,” according to a Dec. 21 VA announcement in Federal Business Opportunities. Industry responses to the request for information are due by Jan. 31, 2012.

VA plans the new scheduling system to be standards-based, extensible and scalable and interoperable with the version of VistA held by the Open Source Electronic Health Record Agent (OSEHRA). VA launched OSEHRA in August to modernize VistA in open, modular architecture that uses standard open interfaces and allows for plug-and-play substitutes with competing products, VA said in the announcement.

The new medical scheduling system will rely on web- and mobile-device services for quick and secure communications with veterans, support for resource allocation decisions based on data, such as adjusting capacity dynamically to meet changing needs.

[Q&A: VA CIO Roger Baker on VLER momentum in 2011.]

The new scheduling package will be a highly complex and expensive process. “We expect that process will present significant risks, not just in adding a replacement software package to VistA, but also in affected business processes,” VA said in the request for information. So it anticipates establishing it incrementally to reduce some risks.

For example, in phase 1, a software layer that delivers scheduling system functional enhancement would be installed on top of the current VistA scheduling application. It could provide resource management, automation of business rules, and linkage of appointments within a facility and across facilities. VA may deploy a new scheduling application in phase 2.

VA attempted unsuccessfully to develop a scheduling replacement previously but pulled the plug on the project in 2009 after spending $127 million because the vendor had not delivered planned capabilities, the notice said.

 

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VA plans new VistA medical scheduling system

Roy Gaber's picture

My guess is the same fate will meet most any attempt to do this as did the VA’s $127 million attempt. CoreFLS was another disaster which should have raised some flags to avoid costly future mistakes.

In my opinion, VA is attempting to tear apart the fabric of VistA instead of enhancing its backend and developing UI’s appealing to the end users.

If it ain’t broke don’t fix it, just because it is old does not mean it is not state-of-the-art.

Seems to me that the world outside of the VA is embracing VistA.

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Stephen.Hufnagel
Sent: Tuesday, December 27, 2011 11:51 AM
To: Architecture
Subject: [architecture] VA plans new VistA medical scheduling system

VA plans new VistA medical scheduling system

December 23, 2011 | Mary Mosquera http://www.govhealthit.com/news/va-plans-new-vista-medical-scheduling-sy...

The Veterans Affairs Department intends to replace its legacy medical scheduling application for its VistA electronic health record system and wants industry feedback about requirements for functionality, system interface and risk reduction.

A modernized system could manage appointments, patient information and coordinate associate services across all VA facilities for a single view of veterans.

[Editor's Desk: This Week in Government Health IT <http://www.osehra.org/blog/editors-desk-week-government-health-it-11> .]

The medical scheduling application has been an essential component of the Veterans Health Information Systems and Technology Architecture (VistA) and performs multiple interrelated functions to bring patients, clinicians and other resources together. But each facility has its own VistA version. The scheduling package also captures data which enables VA to measure, manage and improve access, quality and efficiency of care, and operating and capital resources.

However, VA’s existing scheduling application is more than 25 years old, “highly inefficient and no longer effectively supports the multiple linkages needed to engage patients, clinicians and ancillary services and support new models of clinical care delivery,” according to a Dec. 21 VA announcement in Federal Business Opportunities <https://www.fbo.gov/?s=opportunity&mode=form&id=0ff8b0e488cacc30749b2b1e... . Industry responses to the request for information are due by Jan. 31, 2012.

VA plans the new scheduling system to be standards-based, extensible and scalable and interoperable with the version of VistA held by the Open Source Electronic Health Record Agent (OSEHRA). VA launched OSEHRA in August to modernize VistA in open, modular architecture <http://govhealthit.com/news/vista-open-source-will-morph-va-dod-joint-eh... that uses standard open interfaces and allows for plug-and-play substitutes with competing products, VA said in the announcement.

The new medical scheduling system will rely on web- and mobile-device services for quick and secure communications with veterans, support for resource allocation decisions based on data, such as adjusting capacity dynamically to meet changing needs.

[Q&A: VA CIO Roger Baker on VLER momentum in 2011 <http://www.osehra.org/news/4-questions-with-va-cio-roger-baker> .]

The new scheduling package will be a highly complex and expensive process. “We expect that process will present significant risks, not just in adding a replacement software package to VistA, but also in affected business processes,” VA said in the request for information. So it anticipates establishing it incrementally to reduce some risks.

For example, in phase 1, a software layer that delivers scheduling system functional enhancement would be installed on top of the current VistA scheduling application. It could provide resource management, automation of business rules, and linkage of appointments within a facility and across facilities. VA may deploy a new scheduling application in phase 2.

VA attempted unsuccessfully to develop a scheduling replacement previously but pulled the plug on the project in 2009 after spending $127 million because the vendor had not delivered planned capabilities, the notice said.

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There does seem to be a disconnect.

Carol Monahan's picture

We've been seeing a lot of things that emphasize the notion of "plug and play", which has not been shown to be an effective paradigm. Large enterprise systems are all-inclusive for a reason. You won't find companies running their A/R from Peoplesoft and then using A/P from SAP - instead they choose the system that best fits what their company does overall, and then they implement the parts of that system that they need, only bridging to external systems as absolutely necessary, and sometimes only as a step along the path to replacing those external systems with fully-integrated components from their main system. And this is in the general business market, where there are a great variety of "off the shelf" solutions readily available for purchase. 

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VA plans new VistA medical scheduling system

Stephen Hufnagel's picture

Actually, the VA is starting with the backend as you recommend below. The Interoperable EHR (iEHR) will start as a data store, Enterprise Service Bus and Graphical User Interface. The open question is: Will the VA refactor existing VistA applications or purchase commercial applications. As I posted separately, Roger Baker has not provided a consistent future-state vision.

Steve

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Gaber, Roy G.
Sent: Tuesday, December 27, 2011 12:05 PM
To: architecture@groups.osehra.org
Subject: RE: [architecture] VA plans new VistA medical scheduling system

My guess is the same fate will meet most any attempt to do this as did the VA’s $127 million attempt. CoreFLS was another disaster which should have raised some flags to avoid costly future mistakes.

In my opinion, VA is attempting to tear apart the fabric of VistA instead of enhancing its backend and developing UI’s appealing to the end users.

If it ain’t broke don’t fix it, just because it is old does not mean it is not state-of-the-art.

Seems to me that the world outside of the VA is embracing VistA.

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Stephen.Hufnagel
Sent: Tuesday, December 27, 2011 11:51 AM
To: Architecture
Subject: [architecture] VA plans new VistA medical scheduling system

VA plans new VistA medical scheduling system

December 23, 2011 | Mary Mosquera http://www.govhealthit.com/news/va-plans-new-vista-medical-scheduling-sy...

The Veterans Affairs Department intends to replace its legacy medical scheduling application for its VistA electronic health record system and wants industry feedback about requirements for functionality, system interface and risk reduction.

A modernized system could manage appointments, patient information and coordinate associate services across all VA facilities for a single view of veterans.

[Editor's Desk: <http://www.osehra.org/blog/editors-desk-week-government-health-it-11> This Week in Government Health IT.]

The medical scheduling application has been an essential component of the Veterans Health Information Systems and Technology Architecture (VistA) and performs multiple interrelated functions to bring patients, clinicians and other resources together. But each facility has its own VistA version. The scheduling package also captures data which enables VA to measure, manage and improve access, quality and efficiency of care, and operating and capital resources.

However, VA’s existing scheduling application is more than 25 years old, “highly inefficient and no longer effectively supports the multiple linkages needed to engage patients, clinicians and ancillary services and support new models of clinical care delivery,” according to <https://www.fbo.gov/?s=opportunity&mode=form&id=0ff8b0e488cacc30749b2b1e... a Dec. 21 VA announcement in Federal Business Opportunities. Industry responses to the request for information are due by Jan. 31, 2012.

VA plans the new scheduling system to be standards-based, extensible and scalable and interoperable with the version of VistA held by the Open Source Electronic Health Record Agent (OSEHRA). VA launched OSEHRA in August <http://govhealthit.com/news/vista-open-source-will-morph-va-dod-joint-eh... to modernize VistA in open, modular architecture that uses standard open interfaces and allows for plug-and-play substitutes with competing products, VA said in the announcement.

The new medical scheduling system will rely on web- and mobile-device services for quick and secure communications with veterans, support for resource allocation decisions based on data, such as adjusting capacity dynamically to meet changing needs.

[Q&A: VA CIO Roger Baker on VLER momentum in 2011 <http://www.osehra.org/news/4-questions-with-va-cio-roger-baker> .]

The new scheduling package will be a highly complex and expensive process. “We expect that process will present significant risks, not just in adding a replacement software package to VistA, but also in affected business processes,” VA said in the request for information. So it anticipates establishing it incrementally to reduce some risks.

For example, in phase 1, a software layer that delivers scheduling system functional enhancement would be installed on top of the current VistA scheduling application. It could provide resource management, automation of business rules, and linkage of appointments within a facility and across facilities. VA may deploy a new scheduling application in phase 2.

VA attempted unsuccessfully to develop a scheduling replacement previously but pulled the plug on the project in 2009 after spending $127 million because the vendor had not delivered planned capabilities, the notice said.

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VA plans new VistA medical scheduling system

Stephen Hufnagel's picture

You are correct for core functionality; but, clinicians always want different presentation GUIs, depending on their context and similarly there are many domain specific applications which are applicable in limited arenas (e.g., emergency care). I would predict that the core iEHR will be the data store, Enterprise Service bus, GUI and ancillary services; then, applications will be added.

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of VISTACarol
Sent: Wednesday, December 28, 2011 1:27 PM
To: Architecture
Subject: Re: [architecture] VA plans new VistA medical scheduling system

We've been seeing a lot of things that emphasize the notion of "plug and play", which has not been shown to be an effective paradigm. Large enterprise systems are all-inclusive for a reason. You won't find companies running their A/R from Peoplesoft and then using A/P from SAP - instead they choose the system that best fits what their company does overall, and then they implement the parts of that system that they need, only bridging to external systems as absolutely necessary, and sometimes only as a step along the path to replacing those external systems with full-integrated components from their main system. And this is in the general business market, where there are a great variety of "off the shelf" solutions readily available for purchase.

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VA plans new VistA medical scheduling system

Roy Gaber's picture

With the framework in place for as long as VistA has been, I would assume the logical course of action would be to leverage its existing application base, add any desired functionality on the M side, and then develop either a unified interface by class of user, or individual apps which could be combined by user preference/availability to the user, thus allowing each user the ability to reate their own custom interface to the back-end.

Given VistA’s scope, encompassing both clinical and administrative functionality, it would be, in my opinion, a waste of taxpayers’ dollars to try to rip it apart and then rebuild it.

What is the attraction in these endeavors? The VA has built the most comprehensive, all encompassing computing environment for all aspects of operation.

I fail to see the need to purchase COTS apps given the complexity of trying to interface them into the VistA framework, contracting to a group of developers who have no idea how to leverage the back-end, leave that to in-house development and of course the open source community too; they have already taken into account some of the disciplines which do not exist in VistA, given its predisposition towards veterans, pediatrics to name one.

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Stephen Hufnagel
Sent: Friday, December 30, 2011 9:00 AM
To: architecture@groups.osehra.org
Subject: RE: [architecture] VA plans new VistA medical scheduling system

Actually, the VA is starting with the backend as you recommend below. The Interoperable EHR (iEHR) will start as a data store, Enterprise Service Bus and Graphical User Interface. The open question is: Will the VA refactor existing VistA applications or purchase commercial applications. As I posted separately, Roger Baker has not provided a consistent future-state vision.

Steve

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Gaber, Roy G.
Sent: Tuesday, December 27, 2011 12:05 PM
To: architecture@groups.osehra.org
Subject: RE: [architecture] VA plans new VistA medical scheduling system

My guess is the same fate will meet most any attempt to do this as did the VA’s $127 million attempt. CoreFLS was another disaster which should have raised some flags to avoid costly future mistakes.

In my opinion, VA is attempting to tear apart the fabric of VistA instead of enhancing its backend and developing UI’s appealing to the end users.

If it ain’t broke don’t fix it, just because it is old does not mean it is not state-of-the-art.

Seems to me that the world outside of the VA is embracing VistA.

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Stephen.Hufnagel
Sent: Tuesday, December 27, 2011 11:51 AM
To: Architecture
Subject: [architecture] VA plans new VistA medical scheduling system

VA plans new VistA medical scheduling system

December 23, 2011 | Mary Mosquera http://www.govhealthit.com/news/va-plans-new-vista-medical-scheduling-sy...

The Veterans Affairs Department intends to replace its legacy medical scheduling application for its VistA electronic health record system and wants industry feedback about requirements for functionality, system interface and risk reduction.

A modernized system could manage appointments, patient information and coordinate associate services across all VA facilities for a single view of veterans.

[Editor's Desk: This Week in Government Health IT <http://www.osehra.org/blog/editors-desk-week-government-health-it-11> .]

The medical scheduling application has been an essential component of the Veterans Health Information Systems and Technology Architecture (VistA) and performs multiple interrelated functions to bring patients, clinicians and other resources together. But each facility has its own VistA version. The scheduling package also captures data which enables VA to measure, manage and improve access, quality and efficiency of care, and operating and capital resources.

However, VA’s existing scheduling application is more than 25 years old, “highly inefficient and no longer effectively supports the multiple linkages needed to engage patients, clinicians and ancillary services and support new models of clinical care delivery,” according to a Dec. 21 VA announcement in Federal Business Opportunities <https://www.fbo.gov/?s=opportunity&mode=form&id=0ff8b0e488cacc30749b2b1e... . Industry responses to the request for information are due by Jan. 31, 2012.

VA plans the new scheduling system to be standards-based, extensible and scalable and interoperable with the version of VistA held by the Open Source Electronic Health Record Agent (OSEHRA). VA launched OSEHRA in August to modernize VistA in open, modular architecture <http://govhealthit.com/news/vista-open-source-will-morph-va-dod-joint-eh... that uses standard open interfaces and allows for plug-and-play substitutes with competing products, VA said in the announcement.

The new medical scheduling system will rely on web- and mobile-device services for quick and secure communications with veterans, support for resource allocation decisions based on data, such as adjusting capacity dynamically to meet changing needs.

[Q&A: VA CIO Roger Baker on VLER momentum in 2011 <http://www.osehra.org/news/4-questions-with-va-cio-roger-baker> .]

The new scheduling package will be a highly complex and expensive process. “We expect that process will present significant risks, not just in adding a replacement software package to VistA, but also in affected business processes,” VA said in the request for information. So it anticipates establishing it incrementally to reduce some risks.

For example, in phase 1, a software layer that delivers scheduling system functional enhancement would be installed on top of the current VistA scheduling application. It could provide resource management, automation of business rules, and linkage of appointments within a facility and across facilities. VA may deploy a new scheduling application in phase 2.

VA attempted unsuccessfully to develop a scheduling replacement previously but pulled the plug on the project in 2009 after spending $127 million because the vendor had not delivered planned capabilities, the notice said.

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VA plans new VistA medical scheduling system

Peter Groen's picture

I thought the message was very clear from VA senior management that tapping the growing open source community for open source solutions would be the preferred path, rather than purchasing COTS products. COTS would be the 2nd choice. Interfacing the many existing open source genomic systems, open source dental, open source behavioural health, open source public health, open source emergency management, etc. into OSEHRA/VistA is the way to move. Many other federal agencies that have tended to consistently go with COTS solutions have been good stewards of public funds. The goal should be to build an improved framework that accomodates this approach into the future.

-----Original Message-----
From: Gaber, Roy G. <Roy.Gaber@va.gov>
To: architecture <architecture@groups.osehra.org>
Sent: Fri, Dec 30, 2011 3:07 pm
Subject: RE: [architecture] VA plans new VistA medical scheduling system

With the framework in place for as long as VistA has been, I would assume the logical course of action would be to leverage its existing application base, add any desired functionality on the M side, and then develop either a unified interface by class of user, or individual apps which could be combined by user preference/availability to the user, thus allowing each user the ability to reate their own custom interface to the back-end.

Given VistA’s scope, encompassing both clinical and administrative functionality, it would be, in my opinion, a waste of taxpayers’ dollars to try to rip it apart and then rebuild it.

What is the attraction in these endeavors? The VA has built the most comprehensive, all encompassing computing environment for all aspects of operation.

I fail to see the need to purchase COTS apps given the complexity of trying to interface them into the VistA framework, contracting to a group of developers who have no idea how to leverage the back-end, leave that to in-house development and of course the open source community too; they have already taken into account some of the disciplines which do not exist in VistA, given its predisposition towards veterans, pediatrics to name one.

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Stephen Hufnagel
Sent: Friday, December 30, 2011 9:00 AM
To: architecture@groups.osehra.org
Subject: RE: [architecture] VA plans new VistA medical scheduling system

Actually, the VA is starting with the backend as you recommend below. The Interoperable EHR (iEHR) will start as a data store, Enterprise Service Bus and Graphical User Interface. The open question is: Will the VA refactor existing VistA applications or purchase commercial applications. As I posted separately, Roger Baker has not provided a consistent future-state vision.

Steve

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Gaber, Roy G.
Sent: Tuesday, December 27, 2011 12:05 PM
To: architecture@groups.osehra.org
Subject: RE: [architecture] VA plans new VistA medical scheduling system

My guess is the same fate will meet most any attempt to do this as did the VA’s $127 million attempt. CoreFLS was another disaster which should have raised some flags to avoid costly future mistakes.

In my opinion, VA is attempting to tear apart the fabric of VistA instead of enhancing its backend and developing UI’s appealing to the end users.

If it ain’t broke don’t fix it, just because it is old does not mean it is not state-of-the-art.

Seems to me that the world outside of the VA is embracing VistA.

From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Stephen.Hufnagel
Sent: Tuesday, December 27, 2011 11:51 AM
To: Architecture
Subject: [architecture] VA plans new VistA medical scheduling system

VA plans new VistA medical scheduling system
December 23, 2011 | Mary Mosquera http://www.govhealthit.com/news/va-plans-new-vista-medical-scheduling-sy...
The Veterans Affairs Department intends to replace its legacy medical scheduling application for its VistA electronic health record system and wants industry feedback about requirements for functionality, system interface and risk reduction.
A modernized system could manage appointments, patient information and coordinate associate services across all VA facilities for a single view of veterans.
[Editor's Desk: This Week in Government Health IT.]
The medical scheduling application has been an essential component of the Veterans Health Information Systems and Technology Architecture (VistA) and performs multiple interrelated functions to bring patients, clinicians and other resources together. But each facility has its own VistA version. The scheduling package also captures data which enables VA to measure, manage and improve access, quality and efficiency of care, and operating and capital resources.
However, VA’s existing scheduling application is more than 25 years old, “highly inefficient and no longer effectively supports the multiple linkages needed to engage patients, clinicians and ancillary services and support new models of clinical care delivery,” according to a Dec. 21 VA announcement in Federal Business Opportunities. Industry responses to the request for information are due by Jan. 31, 2012.
VA plans the new scheduling system to be standards-based, extensible and scalable and interoperable with the version of VistA held by the Open Source Electronic Health Record Agent (OSEHRA). VA launched OSEHRA in August to modernize VistA in open, modular architecture that uses standard open interfaces and allows for plug-and-play substitutes with competing products, VA said in the announcement.
The new medical scheduling system will rely on web- and mobile-device services for quick and secure communications with veterans, support for resource allocation decisions based on data, such as adjusting capacity dynamically to meet changing needs.
[Q&A: VA CIO Roger Baker on VLER momentum in 2011.]
The new scheduling package will be a highly complex and expensive process. “We expect that process will present significant risks, not just in adding a replacement software package to VistA, but also in affected business processes,” VA said in the request for information. So it anticipates establishing it incrementally to reduce some risks.
For example, in phase 1, a software layer that delivers scheduling system functional enhancement would be installed on top of the current VistA scheduling application. It could provide resource management, automation of business rules, and linkage of appointments within a facility and across facilities. VA may deploy a new scheduling application in phase 2.
VA attempted unsuccessfully to develop a scheduling replacement previously but pulled the plug on the project in 2009 after spending $127 million because the vendor had not delivered planned capabilities, the notice said.

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