Open Source version of VistA, the US Department of Veterans Affairs healthcare information system
Open Source, health information system, Computerized Patient Record System, electronic medical records, enterprise, medical terminologies, ICD-9, CPT, DSM-III, LOINC
Multiple [Enterprise EMR]
OpenVistA is the Open Source version of VistA (Veterans health Information Systems and Technology Architecture),
the healthcare information system developed by and for the
U.S. Department of Veterans Affairs - the United States' largest integrated health system.
VistA was introduced (under this name) in 1996.
(The software making up the system was partly developed,
as the Decentralized Hospital Computer Program (DHCP), in
VistA is an "integrated outpatient and inpatient information system".
OpenVista uses the VA's VistA at its core.
The overall platform includes patient information systems, scheduling, A/D/T/Registration,
HL7 interface infrastructure, clinical documentation, vitals, medication management, order management,
computerized physician order entry, chart reporting, pharmacy, barcode medication administration, laboratory,
radiology, nutrition and much more.
"WorldVistA was formed to extend and collaboratively improve the VistA electronic health record and
health information system for use outside of its original [VA] setting. ...
WorldVistA has a number of development efforts aimed at adding new software modules such as pediatrics,
obstetrics, and other functions not used in the veterans' healthcare setting."
"WorldVistA EHR VOE/ 1.0, the only open source EHR that [met] Certification Commission for Healthcare Information Technology
(CCHITSM) ambulatory ... EHR criteria for 2006", was released in early 2008.
The VistA Monograph (see references below), "provides an overview and a list of the features of each VistA application" (updated annually).
Timothy Fletcher, Open VistA MUMPS to Java convertion Blueprint.
In: William M. Ulrich and Philip H. Newcomb (Eds), Information Systems Transformation: Architecture-Driven Modernization Case Studies
Morgan Kaufmann, 2010.
This case study documents technologies, processes, and methods of a 100% automated conversion of the Veterans Health Administration (VHA) Veterans Information System Technical Architecture (VistA) system, written in 2.1 million lines of MUMPS, into Java compatible with the J2EE framework. VistA is the core Electronic Healthcare Recordkeeping (EHR) system for the VHA hospital system, which provides EHR record keeping for more than 4.5 million veterans. A pilot project, conducted in 2005 under VHA auspices as a sole source contract, converted: (1) the Voluntary Timekeeping System (VTS), a module of VistA into Java; (2) FileMan, the VistA file management system into Java Database Connectivity (JDBC) interfacing with an Oracle 9i Relational Database; and (3) the VistA user interface into a Java Server Pages (JSP) browser user interface using the Microsoft IIS Web server. The pilot conclusively demonstrated the feasibility of a fully automated conversion of MUMPS into Java, achieving a transformation that encompassed nearly all of MUMPS language features. The technical strategy achieved a clear separation between application logic business rules, data handling presentation elements, and Web-enabled front-end/user screens. The project was prematurely ended in 2006 due to funding restrictions associated with the Iraq war after the successful completion of a small pilot for the VHA. In 2009 all 2.1 MLOC of MUMPS in OpenVistA, the open source variation of VistA, was converted into Java as a scalability demonstration.
The VA advantage: the gold standard in clinical informatics.
Healthc Pap. 2005;5(4):26-9.
"How does a healthcare organization undergo such transformation as described in the lead paper in eight short years? Just imagine being part of an organization that achieved the following transformations: (1) reduction in hospital and long-term-care beds from 92,000 to 53,000 and an increase in outpatient clinics from 200 to 850 (2) a 75% increase in the number of patients treated on an annual basis (from 2.8 million to 4.9 million) with only a 32% cumulative increase in budget (from $19 billion to $25 billion) (3) clinicians who have access to complete medical records for almost all patient visits and all care settings (4) clinicians who willingly enter medication orders 94% of the time (5) patients who are increasingly satisfied with their care, ranking the service consistently higher than the competition (6) improved patient outcomes, achieved at costs 25% less than the competition. Such transformation is impossible to achieve without vision, leadership, talent, teamwork and tools. I will restrict my comments to a discussion of the tools, specifically the VA's clinical information system (VistA, HealtheVet, My HealtheVet. However, it is important to note that the results described in this paper would not be possible without the VA's transformational leadership and dedicated teams of professionals capable of executing the vision. "
Brown SH, Lincoln MJ, Groen PJ, Kolodner RM.
VistA - U.S. Department of Veterans Affairs national-scale HIS.
Int J Med Inform. 2003 Mar;69(2-3):135-56.
The Veterans Health Administration of the U.S. Department of Veterans Affairs has a long, successful, and interesting history of using information technology to meet its mission. Each medical center is computerized to a degree that surprises the uninitiated. For example, medical documentation and ordering are computerized at every facility. A sophisticated national infrastructure has been developed to replicate, support, and evolve single-center successes. With advances in inter-facility networking, data sharing, and specialized central support and technical tools, VistA is becoming a single, highly scalable national health information system (HIS) solution. In this paper, we present an historical overview of VistA's development, describe its current functionality, and discuss its emergence as a national-scale hospital information system.
Kizer KW, Fonseca ML, Long LM.
The veterans healthcare system: preparing for the twenty-first century.
Hosp Health Serv Adm. 1997 Fall;42(3):283-98.
"Since its establishment in 1946, the veterans healthcare system has greatly expanded in both size and responsibility. It is now the largest integrated healthcare system in the United States, the nation's largest provider of graduate medical and other health professionals training, and one of the largest research enterprises in America. It is also the nation's largest provider of services to homeless persons, an essential provider in the public healthcare safety net, and an increasingly important element in the federal response to disasters and national emergencies. Patterned after what was considered the best in American healthcare, for most of the past 50 years the Department of Veterans Affairs (VA) healthcare has focused primarily on acute inpatient care, high technology, and medical specialization. Now, in response to societal and industrywide forces, the Veterans Health Administration (VHA) is reengineering the veterans healthcare system, changing the operational and management structure from individual hospitals to 22 integrated service networks and transitioning the system to one that is grounded in ambulatory and primary care. This article briefly describes the history and functions of the veterans healthcare system, its service population, and key aspects of its restructuring. "