The Veterans Health Information Systems and Technology Architecture (VistA) is an enterprise-wide information system built around an electronic health record, used throughout the United States Department of Veterans Affairs (VA) medical system, known as the Veterans Health Administration (VHA).
By 2003, the VHA was the largest single medical system in the United States, providing care to over 4 million veterans, employing 180,000 medical personnel and operating 163 hospitals, over 800 clinics, and 135 nursing homes. About a quarter of the nation's population is potentially eligible for VA benefits and services because they are veterans, family members, or survivors of veterans.
By providing electronic health records capability, VistA is thereby one of the most widely used EHRs in the world. Nearly half of all US hospitals that have a full implementation of an EMR are VA hospitals using VistA.
Features
The Department of Veterans Affairs (VA) has had automated data processing systems, including extensive clinical and administrative capabilities, within its medical facilities since before 1985. Initially called the Decentralized Hospital Computer Program (DHCP) information system, DHCP was enshrined as a recipient of the Computerworld Smithsonian Award for best use of Information Technology in Medicine in 1995.
VistA supports both ambulatory and inpatient care, and includes several significant enhancements to the original DHCP system. The most significant is a graphical user interface for clinicians known as the Computerized Patient Record System (CPRS), which was released in 1997. In addition, VistA includes computerized order entry, bar code medication administration, electronic prescribing and clinical guidelines.
CPRS provides a client-server interface that allows health care providers to review and update a patient's electronic medical record. This includes the ability to place orders, including those for medications, special procedures, X-rays, nursing interventions, diets, and laboratory tests. CPRS provides flexibility in a wide variety of settings so that a consistent, event-driven, Windows-style interface is presented to a broad spectrum of health care workers.
For its development of VistA, the Department of Veterans Affairs (VA) / Veterans Health Administration (VHA) was named the recipient of the prestigious 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 VistA electronic medical records system is estimated to improve efficiency by 6% per year, and the monthly cost of the EMR is offset by eliminating the cost of even a few unnecessary tests or admissions.
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 a variety of criteria, enabled by the implementation of VistA.
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. The VistA Software Alliance is a non-profit trade organization that both promotes the widespread adoption of versions of VistA for a variety of provider environments.
VistA is a collection of about 100 integrated software modules.
VistA was developed using the M or MUMPS language/database. The VA currently runs a majority of VistA systems on the proprietary InterSystems Caché version of MUMPS, but an open source MUMPS database engine, called GT.M, for Linux and Unix computers has also been developed. Although initially separate releases, publicly available VistA distributions are now often bundled with the GT.M database in an integrated package. This has considerably eased installation. In addition, the free and open source nature of GT.M allows redundant and cost-effective failsafe database implementations, increasing reliability for complex installations of VistA.
An open source project called EsiObjects has also allowed the (ANSI- Standard) MUMPS language and database technology to evolve into a modern object-oriented language (and persistent-object store) that can be integrated into mainstream, state-of-the-art technologies. For the Caché MUMPS database, a similar object-oriented extension to MUMPS called Caché ObjectScript has been developed. Both of these have allowed development of the MUMPS database environment (by programmers) using modern object-oriented tools.
M2Web is an open source web gateway to MUMPS for use with VistA.
A free open source module from M/Gateway called MGWSI has been developed to act as a gateway between GT.M, Cache, or M21 MUMPS databases and programming tools such as PHP, ASP.NET, or Java, in order to create a web-based interface.
The VHA has an ongoing pilot project, known as HealtheVet (HeV) that envisions the next generation of VistA, with further modernization of database capabilities and interfaces.
MyHealtheVet is another initiative that allows veterans to access, and create a copy of, their health records online. This 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 (PHR).
VA hospitals using VistA are one of only three hospital systems that have achieved the qualifications for HIMSS stage 7, the highest level of electronic health record integration, while a non-VA hospital using VistA is one of only 42 US hospitals that has achieved HIMSS stage 6.
VistA Imaging
The Veterans Administration has also developed VistA Imaging, a coordinated system for communicating with PACS (radiology imaging) systems and for integrating others types of image-based information, such as EKGs, pathology slides, and scanned documents, into the VistA electronic medical records system. This type of integration of information into a medical record is critical to efficient utilization.
VistA Imaging has been made freely available in the public domain for private/public hospital use through the Freedom of Information Act. It is available through the Department of Veteran's Affairs software request office. (Licensing of several proprietary modules are required for it to function correctly.)
It can be used independently or integrated into the VistA electronic health record system (as is done in VA health facilities).
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 remarkable results have spurred a national impetus to adopt electronic medical records similar to VistA nationwide.
VistA Web collectively describes a set of protocols that in 2007 was being developed and used by the VHA to transfer data (from VistA) between hospitals and clinics within the pilot project. This is the first effort to view a single patient record so that VistA becomes truly interoperable among the more than 128 sites running VistA today.
BHIE enables real-time sharing of electronic health information between DoD and VA for shared patients of allergy, outpatient pharmacy, demographic, laboratory, and radiology data. This became a priority during the Second Iraq War, when a concern for the transition of healthcare for soldiers as they transferred from active military status to veteran status became a national focus of attention.
A Clinical Data Repository/ Health Data Repository (CHDR) allows interoperability between the DoD's Clinical Data Repository (CDR) & the VA's Health Data Repository (HDR). Bidirectional real time exchange of computable 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.
The combination of VistA and the interoperable projects listed above in the VA/DoD systems will continue to expand to meet the objectives that all citizens will have an electronic record by 2014.
Because of the success of these programs, a national move to standardize healthcare data transmission across the country was started. Text based information exchange is standardized using a protocol called HL7 (Health Level 7), which is approved by the American National Standards Institute. DICOM is an international image communications protocol standard. VistA is compliant with both.
VistA has been interfaced with commercial off-the-shelf products, as well. 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 EMRs 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.
In 2009, a project was undertaken to facilitate EHR communication between the VA (using VistA) and Kaiser Permanente (using Epic) using NHIN Connect. (Both VistA and the commercial EHR Epic use a derivative of the MUMPS database, thereby facilitating data exchange.) When completed, two of the largest medical record system
VistA Software Alliance - trusted electronic health ...
VistA is a trusted electronic health record system providing ... Developed by the Department of Veterans Affairs, the VistA healthcare information system supports the ...
VistA - Wikipedia, the free encyclopedia
The Veterans Health Information Systems and Technology Architecture (VistA) is an enterprise-wide information system built around an electronic health record, used throughout the ...
Veterans Affairs and Kaiser Permanente Share Electronic ...
The new pilot program connects VA's VistA (Veterans Affairs Health Information Systems and Technology Architecture) and ... from the U.S. Department of Defense's health care system ...
VistA Monograph Home
Veterans Health Information Systems and Technology Architecture (V IST A) In 1996, the Chief Information Office ... of DHCP's evolution and metamorphosis into a new, open system ...
GAO-08-805 Veterans Affairs: Health Information System ...
In 1996, the name of the system was changed to the Veterans Health Information Systems and Technology Architecture. Page 6 GAO-08-805 Veteran Affairs
VA VistA Innovations Award Home
Veterans Health Information Systems and Technology Architecture (VistA) is an integrated outpatient and inpatient information system. Key features of VistA include:
VistA - Description
Veterans Health Information Systems and Technology Architecture, VistA, is an integrated system of software applications that directly supports patient care at Veterans Health ...
Veterans Health Information Systems and Technology ...
Veterans Health Information Systems and Technology Architecture (VistA) ... Being a system implemented somewhat uniformly across 128 ...
VHA Dir 2007-006, Veterans health Information and ...
Veterans Health Information and Technology Architecture (VistA) capability allows authorized users to maintain system parameters thereby identifying whether a check should be turned ...
VHA Directive 2008-029, Maintaining Billable Provider ...
VHA Directive 2008-029, Maintaining Billable Provider Credential Information in the Veteran Health Informatioon System and Technology Architecture (VISTA) New Person File