VistA
The Veterans Health Information Systems and Technology Architecture is the system of record for the clinical, administrative and financial operations of the Veterans Health Administration VistA consists of over 180 clinical, financial, and administrative applications integrated within a single shared lifelong database.
The Veterans Health Administration is the largest integrated national healthcare delivery system in the United States, providing care for nearly 9 million veterans by 180,000 medical professionals.
VistA received the Computerworld Smithsonian Award for best use of Information Technology in Medicine, and more recently received the highest overall satisfaction rating by physician users of EHRs in the U.S.
In May, 2018, the VA awarded a contract to modernize VistA by implementing a commercial EHR. The projected completion for implementing the commercial EHR was by 2028. By March 2023 – halfway through the program – only 5 the total of 150 VA medical centers had piloted the new system. Numerous reports of safety and reliability had emerged at the commercial EHR sites, and four veterans had suffered premature death. As a result, in April 2023 the House Veterans Affairs Committee for Health IT issued a bill to terminate the commercial EHR contract
Clinical Functions
Financial-Administrative Functions
Infrastructure Functions
Patient Web Portal Functions
Achievements
For its development of VistA, the United States Department of Veterans Affairs / Veterans Health Administration was named the recipient of the Innovations in American Government Award presented by the Ash Institute of the John F. Kennedy School of Government at Harvard University in July, 2006.The adoption of VistA has allowed the VA to achieve a pharmacy prescription accuracy rate of 99.997%, and the VA outperforms most public sector hospitals on many other quality metrics, all attributable to VistA.
Hospitals using VistA are one of only a few healthcare systems in the U.S. that have achieved the highest level of electronic health record integration HIMSS Stage 7, while a non-VA hospital using VistA is one of only 42 US hospitals that has achieved HIMSS stage 6.
Licensing and dissemination
The VistA system is public domain software, available through the Freedom Of Information Act directly from the VA website or through a growing network of distributors, such as .VistA modules and projects
Database backend
VistA was developed using the M or MUMPS integrated application database. The VA currently runs its VistA systems on a proprietary version of MUMPS called Caché, but an open source MUMPS database engine, called GT.M, for Linux and Unix systems has also been developed.Patient Web Portal
is a web portal that allows veterans to access and update their personal health record, refill prescriptions, and schedule appointments. This also allows veterans to port their health records to institutions outside the VA health system or keep a personal copy of their health records, a Personal Health Record.VistA Imaging
The Veterans Administration developed VistA Imaging, which is a PACS systems and for integrating image-based information, such as X-Rays, CAT-scans, EKGs, pathology slides, and scanned documents into the VistA electronic medical records system. Integration of images into a medical record is critical to efficient high-quality patient care.Deployments and uses
Role in development of a national healthcare network
The VistA electronic healthcare record has been widely credited for reforming the VA healthcare system, improving safety and efficiency substantially. The results have spurred a national impetus to adopt electronic medical records similar to VistA nationwide.A Clinical Data Repository /Health Data Repository allows interoperability between the DoD's Clinical Data Repository & the VA's Health Data Repository. This is accomplished through the Bidirectonal Health Information Exchange. Bidirectional real time exchange of pharmacy, allergy, demographic and laboratory data occurred in phase 1. Phase 2 involved additional drug–drug interaction and allergy checking. Initial deployment of the system was completed in March 2007 at the El Paso, Augusta, Pensacola, Puget Sound, Chicago, San Diego, and Las Vegas facilities.
VistA has been interfaced with commercial off-the-shelf products. Standards and protocols used by VA are consistent with current industry standards and include HL7, DICOM, and other protocols.
Tools for CCR/CCD support have been developed for VistA, allowing VistA to communicate with other EHRs using these standardized information exchange protocols. This includes the Mirth open source cross platform HL7 interface and NHIN Connect, the open source health information exchange adaptor.
The VistA EHR has been used by the VA in combination with Telemedicine to provide surgical care to rural areas in Nebraska and Western Iowa over a area.
Usage in non-governmental hospitals
Under the Freedom of Information Act, the VistA system, the CPRS graphical interface, and unlimited ongoing updates are provided as public domain software.This was done by the U.S. government in an effort to make VistA available as a low cost Electronic Health Record for non-governmental hospitals and other healthcare entities.
The VA has produced a version of VistA that runs on GT.M in a Linux operating system, and which was suitable for use in private settings. VistA has since been adapted by companies such as to hundreds of hospitals and clinics in the private sector. VistA has been deployed internationally, running the healthcare information system of entire national healthcare systems, such as the Kingdom of Jordan. Some United States universities, such as UC Davis and Texas Tech, have implemented VistA. The non-profit organization, WorldVistA, was established to extend and collaboratively improve the VistA electronic health record and health information system for use outside in the private and public sector throughout the U.S. and internationally.
VistA can be interfaced with healthcare databases not initially used by the VA system, including billing software, lab databases, and image databases.
VistA implementations have been deployed in non-VA healthcare facilities in Texas, Arizona, Florida, Hawaii, New Jersey, Oklahoma, West Virginia, California, New York, and Washington, D.C.
In one state, the cost of a multiple hospital VistA-based EHR network was implemented for one tenth the price of a commercial EHR network in another hospital network in the same state..
VistA has even been adapted into a Health Information System at the veterinary medical teaching hospital at UC Davis.
International deployments
VistA software modules have been installed around the world, or are being considered for installation, in healthcare institutions such as the World Health Organization, and in countries such as Mexico, American Samoa, Kurdistan, Iraq, Finland, Jordan, Germany, Kenya, Nigeria, Egypt, Malaysia, India, Brazil, Pakistan, and Denmark.In September 2009, Dell Computer bought Perot Systems, the company installing VistA in Jordan.
History
The name "VistA" was adopted by VA in 1994, when the Under Secretary for Health of the U.S. Department of Veterans Affairs, Dr. Ken Kizer, renamed what was previously called the Decentralized Hospital Computer Program.Both Dr. Robert Kolodner and George Timson date VistA's actual architecture genesis, then, to 1977. The program was launched in 1978 with the deployment of the initial modules in about twenty VA Medical Centers. The program was named the Decentralized Hospital Computer Program in 1981.
In December 1981, Congressman Sonny Montgomery of Mississippi arranged for the Decentralized Hospital Computer Program to be written into law as the medical-information systems development program of the VA. VA Administrator Robert P. Nimmo signed an Executive Order in February 1982 describing how the DHCP was to be organized and managed within the VA's Department of Medicine and Surgery.
In conjunction with the VA's DHCP development, the Indian Health Service deployed a system built on and augmenting DHCP throughout its Federal and Tribal facilities as the Resource and Patient Management System. This implementation emphasized the integration of outpatient clinics into the system, and many of its elements were soon re-incorporated into the VA system. Subsequent VistA systems therefore included elements from both RPMS and DHCP. Health IT sharing between VA and IHS continues to the present day.
The U.S. Department of Defense then contracted with Science Applications International Corporation for a heavily modified and extended form of the DHCP system for use in DoD healthcare facilities, naming it the Composite Health Care System.
Meanwhile, in the early 1980s, major hospitals in Finland were the first institutions outside of the United States to adopt and adapt the VistA system to their language and institutional processes, creating a suite of applications called MUSTI and Multilab.
The four major adopters of VistA – VA, DoD, IHS, and the Finnish – each took VistA in a different direction, creating related but distinct "dialects" of VistA. VA VistA and RPMS exchanged ideas and software repeatedly over the years, and RPMS periodically folded back into its code base new versions of the VA VistA packages. These two dialects are therefore the most closely related. The Musti software drifted further away from these two but retained compatibility with the infrastructure of RPMS and VA VistA. Meanwhile, the CHCS code base diverged from that of the VA's VistA in the mid-eighties and has never been reintegrated. The VA and the DoD had been instructed for years to improve the sharing of medical information between the two systems, but for political reasons made little progress toward bringing the two dialects back together. More recently, CHCS's development was brought to a complete stop by continued political opposition within the DoD, and it has now been supplanted by a related, but different, system called AHLTA. While AHLTA is the new system for DoD, the core systems beneath AHLTA remain those of the underlying CHCS system. Thus, the VistA code base was split four ways.
Many VistA professionals then informally banded together as the "Hardhats" to promote that the FOIA release of VA VistA be standardized for universal usage.
WorldVistA was formed from this group and was incorporated in March 2003 as a non-profit corporation. This allowed the WorldVistA board of directors to pursue certain activities that they otherwise could not pursue as an informal organization. It is, however, an organization independent of the VA system and its version of VistA therefore differs from that of the VA's. Nevertheless, it maintains as an objective that its public version be compatible with the VA's official version. It has developed for multiple operating systems, including Linux -based and Microsoft Windows-based operating systems. Co-operation with the maintainers and vendors of , another widely deployed open source public version of VistA, helps maintain interoperability and a standardized framework.
In 2011 the Open Source Electronic Health Record Agent project was started to provide a common code repository for VistA software. On February 10, 2020, the Open Source Electronic Health Record Alliance announced that they would cease operations on February 14, 2020.
In summary, it was the joint collaboration of thousands of clinicians and systems experts from the United States and other nations, many of them volunteers, that the VistA system has developed.