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RE: [Hardhats-members] == VistaWeb Missing Apps ==
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From: Gordon M. <gmo...@in...> - 2005-06-10 00:52:54
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Oh!? That is a data/terminology standardization issue and not particularly
relevant to "replacing Vista". This can be an issue in any system
implemented in multiple sites.
_____
From: har...@li...
[mailto:har...@li...] On Behalf Of Gillon,
Joseph
Sent: Thursday, June 09, 2005 6:24 PM
To: 'har...@li...'
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
Yep. One of the many, very valid reasons the VA is replacing VistA, and one
not mentioned, I believe, in the St. Pete Times article.
_____
From: har...@li...
[mailto:har...@li...] On Behalf Of Cameron
Schlehuber
Sent: Thursday, June 09, 2005 5:53 PM
To: har...@li...
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
Regarding the nonstandard note titles and the difficulties that poses ...
there have actually been some significant peer-reviewed journal articles by
some VA folks on that very issue. In fact, standardization of note titles
is one of the things currently in the queue to be accomplished in VistA (I'm
not sure but I believe it's also part of the CPRS-R work coming out very
soon). A fair amount of automated matching to standard titles will be
performed (no doubt with some manual intervention and checking). Once in
place, new note titles would be quickly built up from a compound set of
expressions from the Enterprise Reference Terminology which would cover
virtually all of the useful note titles (excepting the odd and uninformative
ones such as "Dr Soandso's notes"). That means that both old and new titles
can be sorted and searched in computationally meaningful ways for quick and
easy use.
-----Original Message-----
From: har...@li...
[mailto:har...@li...] On Behalf Of Gillon,
Joseph
Sent: Thursday, June 09, 2005 1:06 PM
To: har...@li...
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
That's an interesting problem you pose. Did you ever see Euclid? It had a
problem-centric UI that apparently providers loved. I guess you would click
on, say, diabetes, and it would tell you what you should know about diabetes
for patients of a certain age, gender, ethnicity, whatever. It would offer
recommendations for meds and also check prescriptions for possible problems.
It was written by a doc who's now in Reno. He just sent me the latest which
is now web-based and uses MDO, the middleware techonology that VW uses.
A sort of related but not quite the same feature is something VW will use
soon, and that's Up-to-Date and medical dictionary searches. User
highlights text, right clicks, picks the search engine and gets info.
I'm saying all this just to indicate there are efforts to get some AI into
our EMRs. In fact, the CPRS-R folks are going to use a lot of the old
Euclid functionality. Oh, it has a thing called Assist that helps write
notes. Sorry I don't know exactly how...
_____
From: har...@li...
[mailto:har...@li...] On Behalf Of Sowinski,
Richard J.
Sent: Thursday, June 09, 2005 3:51 PM
To: 'har...@li...'
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
Joe,
It's good to see you on Hardhats. What took you so long ?
Sorry about "hunt and peck" analogy it's just the most apt description of
what I see users doing when they use these products.
It's just my bias, I think remote data viewers fill an interim niche. But I
have had busy docs tell me that they don't have the time to sift through
this data on most patients, unless they are really, really curious about
something. I think the same thing can be said for Docs sifting through reams
of CPRS data from their own site! Just no time to do that: they see their
patient, write their note, write their prescription and any other orders,
and get on to the next patient.
This is no reflection on your VistaWeb product. I think it's a great tool,
faster than RDV's, and an accomplishment on your part. It certainly helps
alot when Docs really want to see that data.
I also think it is good that there is such great interest outside of VA in
some of the things VA has developed over the past few years, including
VistaWeb.
It's all good.
Joe, you are on the right track, I think your VistaWeb product could be
separated pretty simply from some of the "complexities" underneath.
We can talk off-line if you want. I don't want to burn anymore Hardhats
bandwidth on this topic, especially considering who is listening.
I have all the respect in the world for the St Peterburg Times and their
affiliation with the Poynter Institute, one of the most respected journalism
schools in the country, but I wish we could "talk tech" here without
worrying about being monitored or quoted.
After all, that's really what this forum is for.
- Rich
-----Original Message-----
From: har...@li...
[mailto:har...@li...]On Behalf Of Gillon,
Joseph
Sent: Thursday, June 09, 2005 1:06 PM
To: har...@li...
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
First, I should mention that if you are a VA employee be careful what you
say to this guy. He's a biased, sensationalist reporter looking to make
copy and not, IMHO, particulary interested in veracity. More interested in
uncovering another CoreFLS than anything else.
On to Rich. And hi BTW, been a while. Thinking just of implementing VW or
RDV outside the VA, you hit on one extremely important item, namely
standardization of data. I disagree with the "hunt and peck" label you're
sticking VW with since it shows all the data, collated, in seconds.
However, due to the non-standard note titles and stuff of that ilk, when you
sort the titles you don't necessarily get, say, all the cariology notes, in
one place. Were I starting a new multi-site VistA system I would really,
really, really give some time and effort to implementing standard
note/report titles, lab panel titles, team names, etc. All this stuff is a
totally squirrelly mess in the VA after years of each site doing whatever it
pleased.
And I think Rich hits another nail on the head with the MPI thing. If you
are going to have distributed databases you definitely need something
central to figure out what sites to query. Well, maybe if you only had half
a dozen sites... Still. Rich, I know that VistA kicks out an HL7 message
on inpatient events (admit, discharge, transfer). Does it do anything on
outpatient visits? If it did you could just set up an HL7 listener to catch
these messages and put the relevant data into an SQL database. Then, since
VW can talk to SQL databases as well as VistA databases, you could just
replace the MPI RPC with a select statement.
_____
From: har...@li...
[mailto:har...@li...] On Behalf Of
Noh...@sp...
Sent: Thursday, June 09, 2005 1:45 PM
To: har...@li...
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
----- Forwarded by Steve Nohlgren/News/Sptimes on 06/09/2005 01:43 PM -----
Ric...@me...
Sent by: har...@li...
06/09/2005 10:18 AM
Please respond to hardhats-members
To: har...@li...
cc:
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
Mr. Sowinski's comments about the value of a central data repository or
repositories speaks to an issue we are wondering about at the St. Petersburg
Times--whether or not HealtheVet plans inject some unnecessary complexities
while upgrading VistA. As I understand it, the national HDR will be an
Oracle database that will merge clinical data real time and avoid this
hunting and pecking for remote info. It will also to allow for report
writing and queries to get a better handle on trends. Kaiser Permanente is
splitting those two functions in their Epic System. The clinical data is
stored in a Cache warehouse so everything pops up automatically no matter
where the patient goes for treatment, but that data also become input to an
Oracle warehouse for report writing and analysis. As I understand it, they
figured that keeping both functions in a relational database would require
more CPU and slow down the clinical side. Would such a divided s ystem make
more sense for the VA's centralized database. If anyone feels like
responding to me directly, you can use your home e-mail.
Thanks, Steve Nohlgren
When I speak of the "complexities" of the infrastructure I am speaking of
the MPI,
the updating of data across sites, etc. Initializing all patients with ICN's
etc.
Actually, I think that particular infrastructure could be simplified, and
probably should be
simplified, if one wanted to implement remote data viewing capability
outside of
VHA.
When you think about it, you really only need a list of sites a patient has
been
"registered at", and a good identifying scheme, to "assemble" a patient's
record
from multiple sites.
But actually, the model I prefer is a centralized repository or
repositories.
The problem with apps like Remote Data Views and VistaWeb is, the physician
has
to "hunt an peck" for data. Physicians are expected to do 20-minute
appointments,
write their computerized notes and orders, and maintain 2000-patient panels.
Many Docs
simply do not have the time to look through this remote data.
Other issues are, you cannot run research-type queries across sites, to
identify cohorts
of patients meeting certain research criteria. Data is not standardized.
Your lab test name,
or lab test panel, may be different from mine.
With a data repository: reminders, alerts, etc can be run against a
standardized database,
and and data from many sites can be viewed via a common interface. A Doctor
can even be
paged automatically, if a patient's test data is outside normal ranges. Or
for any other
reason, specified.
But apps like RDV's and VistaWeb certainly fill a niche, for some Docs who
have smaller panels
or, who take the extra time, for now.
- Rich
-----Original Message-----
From: har...@li...
[mailto:har...@li...]On Behalf Of Jim
Self
Sent: Wednesday, June 08, 2005 5:55 PM
To: har...@li...
Subject: RE: [Hardhats-members] == VistaWeb Missing Apps ==
Richard Sowinski wrote:
>The reason I have asked people on this list if they have VistaWeb up and
>running, is because I suspect
>they underestimate the infrastructure required "under the hood", to make
it,
>or RDV run.
>
>I also suspect, some have misconstrued what VistaWeb is. I think some of
>them think it is a Web-based front-end
>to Vista, instead of a remote view-only application, used to view patient
>data at other sites.
I haven't tried to get VistaWeb running because of a lack of free time for
playing with
things dependent on M$ proprietary technology, but I have thought that the
source files in
VistaWeb might be helpful in defining some aspects of what a Web-based
front-end to VistA
should include.
>From reviewing the VistaWeb documentation a while back, it seemed to me
that
it would be
quite easy using M2Web to improve upon the views of VistA data provided by
VistaWeb if
someone could take a little time just to specify what views are needed and
what data
fields should be included. I had the same impression from a health-e-vet
demo earlier, but
I haven't had the free time to pursue either very much so far. I have a good
understanding
of the underlying technology (MUMPS, Fileman, Web, etc.) but not of the
VistA EMR, so
someone with that knowledge and/or the time to gather it could help greatly
to move such a
project along.
---------------------------------------
Jim Self
Systems Architect, Lead Developer
VMTH Computer Services, UC Davis
(http://www.vmth.ucdavis.edu/us/jaself)
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