Introduction to Open Source VistA and the

VistA Community

GMU 9/8/06Nancy Anthracite, MD

HOW IT ALL STARTED

It all started with MUMPSin the 1960s.

Massachusetts General Hospital Utility

Multi-Programming System

http:///en.wikipedia.org/wiki/MUMPS

Octo Barnett is a cardiologist and was the head of the lab where the language and computer

system for MGH was developed.

(He is a bit older now.)

Neil Pappalardo is credited with actually developing the language. He later founded the

company Meditech.

Jane and Niel

MUMPS became an ANSI Standard language in 1977.

That is when the story of what is now known as VistA began in the Department of Veterans Affairs.

Is programmed in the M[UMPS] language.

The story of the beginnings of VistA better than a good adventure novel – conspiracy, covert action, “Underground Railroad”, arson...

You can find a synopsis of the story here.

http://www.Hardhats.org/history/hardhats.html

The original group that struggled to create what is now called VistA called themselves the “Hardhats”, hence the name of the web site where there is a

lot of information about VistA, http://www.Hardhats.org and the

mailing list where a few hundered folks interested in VistA exchange

information, Hardhats@googlegroups.com

VistA, from its inception, was been developed by an open,

closely knit, cooperative effort between the users and the

programmers.

You will hear what is now called VistA referred to as DHCP in some

older references.

Decentralized Hospital Computer Program.

VERSIONSand

OPEN SOURCE

has a Trademark and is spelled with an upper case A an the

beginning and an upper case A at the end.

is in the Public Domain.

http://en.wikipedia.org/siki/Public_domain

United States Government works are

excluded from copyright protection and are in the

public domain.

Because there is no copyright for original US Government works,

those portions of VistA created by US Government employees can be

used by anyone any way they choose including using it as part of

a commerical product.

There portions of VistA that are protected by copyright or to

maintain security and are not released to the public.

Those portions are listed in a document maintained on the VA ftp

site. VistA can be downloaded from this site.

ftp://ftp.va.gov/vista/Software/Readme.html

is Free and Open SourceSoftware

http://en.wikipedia.org/wiki/Open_source_(disambiguation)

Open Source software is Free as in Freedom software. You are free to use, modify and redistribute the code.

Outside of the VA, the VistA server is generally run on one of two

“stacks” of software:

VistA, Caché and Windows

or

VistA, GT.M and Linux

The program that the user uses to interact with VistA called CPRS Chart is written in a language

called Delphi and currently runs only on Windows. A company

called Codeweavers is working to make this run on Linux.

Caché is a proprietary program from Intersystems that runs the M

code that in VistA. It is the program used by the VA now to run

VistA. A single user version of Caché can be downloaded from the

Intersystems web site.

http://www.Intersystems.com

You will hear various versions of VistA called by different names.

“FOIA VistA”, or Freedom Of Information Act VistA, is what can

be downloaded from the VA FTP site.

ftp://ftp.va.gov/vista

VistA was modified under a contract from the Pacific Telehealth & Technology Hui, a joint Veterans Affairs - DOD project promoted by Hawaii Senator Daniel Inouye, to

create Hui OpenVista.

Hui OpenVista runs on the open source stack of the operating system, Linux, with the Open Source program from Fidelity

Information Systems that runs the M code, GT.M, all of which can be downloaded free of charge from

the Internet.

http://www.PacificHui.orghttp://SourceForge.net/projects/sanchez-gtm

Other versions of VistA can also be run on Linux and GT.M. FOIA VistA

is one of them.

Linux and GT.M are released under the GNU General Public License or

GPL that requires modifications that are distributed to be donated

back to the open source community.

http;//www.gnu.org/copyleft//gpl.htm

Many of the programmers that “ported” VistA to GT.M and Linux

are members of WorldVistA, a 501(c)(3) nonprofit organization that promotes the use of VistA

outside of the VA.

http://www.WorldVistA.org

Most versions that run with Linux and GTM are found on the

WorldVistA download site on Sourceforge. Sourceforge is THE

site for many open source projects.

http://Sourceforge.net/projects/worldvista

The Center for Medicare and Medicaid Services (CMS), decided to modify FOIA VistA to create an affordable EHR that could help physicians improve patient care and report their performance if they chose. This version of VistA is called VistA-Office EHR.

The modifications are minor but necessary to remove the veterans'

hospital specific elements in registration and to allow the writing

and sending of prescriptions. Pediatrics and OB-GYN also

needed to be added.

The Iowa Foundation for Medical Care manages the project. Daou

Systems did the initial programming. WorldVistA was

awarded a contact to be the VVSO, VistA Vendor Support

Organization, to train new VOE vendors.

http://www.ifmc.org http://www.cms.govhttp://www.WorldVistA.org/vvso

WorldVistA, under a new contract with IFMC, is now helping to

prepare VOE to obtain Certification Commission for Healthcare

Information Technology (CCHIT) certification for Ambulatory Care

Electronic Health Records.

VistA-Office EHR is not yet released. It should be released next year after passing CCHIT

certification. An old Beta Version of VOE is available for download

along with a vendor test. The Vendor Test can be requested

here.

http://WorldVistA.org/vvso

There is also a mailing list for information and questions about VistA-Office EHR on the same site.

http://WorldVistA.org/vvso

The server portion of the VA Demo can be installed on your own

machine. It has been configured for Cache on Windows or GT.M on

Linux.

http://opensourcevista.net:8888/NancysVistAServer/VADemo12-5-06 (and others for Cache)

http://sourceforge.net/projects/worldvista for Linux

ADDITIONAL VISTA

RESOURCES

There are a lot of information resources available to you should you be interested in learning more

about VistA.

WorldVistA holds meetings that are open to anyone at least twice a

year. Anyone is welcome to join.

http://www.WorldVistA.org

WorldVistA members, Hardhats and anyone who wishes to sign up frequently post messages on the Hardhats mailing list. This list is

technically oriented.

http://groups.google.com/group/Hardhats

WorldVistA has a WIKI where there is a lot of information about

installing and configuring VistA. Anyone can read the wiki but you must sign up to post to the wiki to

prevent spamming.

http://openforum.worldvista.org/~forum

WorldVistA member Kevin Toppenberg maintains a site with

additional resources for installation and configuration.

http://www.geocities.com/ktop3/

This site contains the VistA software as released by the VA. It also has additional software that connects to the VistA server, like the GUI Vitals package, “patches”

which keep VistA up to date, improve it and fix problems.

ftp://ftp.va.gov/vista

This site provides information about new uploads to the VA FTP

site and patch descriptions.

http://www.mcenter.com/vns/

The famous VistA Monograph can be found on this ftp site. It describes the

over 100 “packages” included in VistA. The packages are the

functional elements of VistA such as the “Lab Package” and the “Pharmacy

Package”.

http://ftp.va.gov/VistAdocs/Monograph

This site showcases the GUI clincian's interface, CPRS (Clinical Patient Record System) Chart. You can download the “Client” program

to your Windows machine and connect to a VA Demo VistA server

on the Internet.

http://www.va.gov/vista

This is the site used both inside and outside of the VA to maintain the documentation for VistA. It is

extensive but often difficult for new users to understand.

http://www.va.gov/vdl

This is a site maintained by the VA for the VistA eHealth University. It

contains extensive training material for users and trainers. It is EXCELLENT. For instance, class

113H for learning how to make Templates for CPRS.

http://www.va.gov/vehu

VistA eHealth University or Camp CPRS is a huge training meeting held by the DVA every year. For the first time this year, attendees

from outside of the VA were allowed to sign up to attend on a

space available basis.

VEHU or Camp CPRS

The Pacific Hui in cooperation with the University of Hawaii has

prepared training materials for VistA that can be downloaded here.

The University of Hawaii is continuing to develop more VistA

related training.

http://www.PacificHui.org

VistA Outreach uses EsiObjects to make it easier to program

additional interfaces for users and other programs for VistA.

EsiObjects is also used with the DOD CHCS I.

http://EsiObjects.comhttp://VistAOutreach.org

A presentation about what has been done with CHCS I with

EsiObjects can be found here. CHCS I is derived from VistA.

EsiObjects can be used with CHCS I or VistA.

http://downloads.opensourcevista.net

The VVSO will has online training as well as training meetings. This training site will be expanding over

time.

http://WorldVistA.org/moodle

There are a number of companies that sell their services for installing and maintaining VistA and that may

also have their own versions of VistA. Some of those companies

are members of the VistA Software Alliance.

http://www.VistASoftware.org

The VistA Software Alliance is a not for profit 501(c)(6) organization. The members are allowed to lobby on behalf of VistA. There is more

information about the 501 nonprofit designation here:

http://en.wikipedia.org/wiki/501(c)(3)

These for profit companies provide training as well. There may be

others.

http://EsiTechnology.comhttp://HITS-Inc.com

http://PioneerDataSys.com

Nancy Anthracite maintains a file server with a large assortment of file downloads including Cache versions of the VA CPRS Demo that can be used on your own

machine.

http://OpenSourceVistA.net:8888/NancysVistAServerhttp://downloads.opensourcevista.net

Every Friday Hewlett Packard hosts a VistA Community Conference

Call from 12-1 PM EST. These are toll free calls. The call in numbers and codes are announced on the

Hardhats Mailing List shortly before the call.

VistA Community Conference Calls