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  • 12/03/09
  • 12/03/09
  • 12/03/09
  • 12/03/09
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  • 12/03/09 Several areas of VistA are antiquated. There is a legitimate reason VA is attempting to modernize VistA. The perceived need to scrap VistA is questionable, however, many areas have been neglected for years and need to be overhauled. Prioritizing the necessary enhancements will be based upon immediate need. The U.S. health care market is rapidly changing in order to emulate the success of the VA in improving patient quality and holding down cost. Changes will include governmental compliance with yet to be approved standards which we will have no input.
  • 12/03/09 Keeping the cost low enough to allow less affluent medical facilities to implement vxVistA, yet high enough to allow DSS to afford to begin further modernization of VistA. VOE has brought forth the perception that VistA is “free”. It may be less expensive than Cerner or NextGen, however, it isn’t free. Performing the development needed to commercialize VistA is expensive. Supporting commercial VistA customers is expensive. Keeping VistA customer’s database current with FOIA patches and with our own changes is expensive. Product liability insurance is expensive. This same “free” perception has also put downward pressure on implementation and support fees. The successful commercial HIS and practice vendors charge a license fee for a reason. They need the money in order to survive in a highly competitive market. Without a licensing fee for FOIA VistA VSA members are forced to generate their revenue from implementation and support services, and add on product licensing. The market needs to understand that VSA members have to produce revenue in order to survive in this market. This is a marketing challenge for the members and for VSA as a whole. VistA is affordable, however, it isn’t free.
  • 12/03/09 DSS supports Hui OpenVista because Hui is more neutral than any other viable entity. DSS and MedSphere are not neutral. Hui is a joint venture between DoD and VA and has had a long-term cooperative relationship with the VHA hierarchy. Hui OpenVista will allow other vendors to take advantage of an updated and improved commercial version of FOIA VistA. Over time, several VSA members and other parties will provide enhancements to a common open source code base. Hui OpenVista is protected with an open source license, Berkeley, which will allow other parties (Blue Cliff, DSS, MedSphere, Sea Island Systems, etc…) to bring to the market their own commercialized version of VistA. It will give them the latitude to decide what they want to offer to the world as an improvement to core open source VistA.
  • The VSA is a value marketing tool for its members. The major HIS and practice system vendors spend millions of dollars annually marketing their products to U.S. health care market. The majority of VSA’s members are not capable of matching the marketing efforts of our competitors. VSA has the ability to become a public voice for its members. Many of our competitors are billion dollar companies who lobby the federal and state governments. The next 3 years will become foundation years for all of us. In some ways we are already late from the starting blocks. I don’t believe VSA or any its members are currently members of CCHIT. Federal and state laws are being enacted which will greatly affect many VSA members. The VSA’s trade association status should help give us a greater voice in the ground work legislation being considered today. As it is today, we are definitely along for the ride. Hopefully it will not be a ride over a cliff.
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    1. 1. vxVistA V0.9 Mark Byers, President DSS, Inc., The VistA Experts April 20, 2006
    2. 2. Overview of Organization <ul><li>Software Development and System Integration company since 1990. Corporate offices in Juno Beach, Florida. Satellite development offices in Atlanta, Georgia and Tampa, Florida. Over 100 full-time, part-time, and contracted employees. </li></ul><ul><li>Original focus was on document imaging. Entered commercial health care market in 1993 and VA market in 1994. </li></ul><ul><li>Awarded 5 national VA contracts and co-awarded a sixth </li></ul><ul><li>More VistA integrated applications than any other vendor. Was the test vendor for the Bay Pines OI class 1 system test facility in 2000. </li></ul><ul><li>Over a dozen VistA integrated DSS applications. Over a dozen 3 rd party vendors’ applications integrated to VistA. </li></ul>
    3. 3. Overview of Organization, continued <ul><li>Began exploring the commercialization of VistA in 2002 </li></ul><ul><li>Began development of vxVistA in 2004 </li></ul><ul><li>Certified beta test vendor for VOE in 2005 </li></ul><ul><li>Established subsidiary company in Mexico in 2006 </li></ul><ul><li>vxVistA will be released in 2006 </li></ul>
    4. 4. <ul><ul><ul><li>vxVistA is being developed as a full-featured HIS, which will be sold domestically and internationally. </li></ul></ul></ul><ul><ul><ul><li>The current development focus is on commercializing the EHR portions of VistA. </li></ul></ul></ul><ul><ul><ul><li>vxVistA will stay aligned with FOIA VistA as long as possible. DSS has selected Hui OpenVista as vxVistA open source core. DSS will support keeping Hui OpenVista current with FOIA VistA. </li></ul></ul></ul><ul><ul><ul><li>DSS believes vxVistA will be implemented in a variety of clinical practice settings. These include small group and large group practices, both private and government owned. </li></ul></ul></ul><ul><ul><ul><li>vxVistA will be used in institutional settings, such as medical schools, prisons, mental health facilities. </li></ul></ul></ul><ul><ul><ul><li>vxVistA will also be used in hospitals, both rural and urban. </li></ul></ul></ul>Vision
    5. 5. Overview of EHR Today <ul><ul><ul><li>vxVistA is a commercialized version of FOIA VistA. All enhancements are compatible with FOIA VistA. </li></ul></ul></ul><ul><ul><ul><li>Patient and User Registration System (PURS) GUI </li></ul></ul></ul><ul><ul><ul><li>SSN or multiple medical record numbers </li></ul></ul></ul><ul><ul><ul><li>Pharmacy script creation </li></ul></ul></ul><ul><ul><ul><li>Multi-formulary pharmacy </li></ul></ul></ul><ul><ul><ul><li>Provider Assistive Templates (PAT) </li></ul></ul></ul><ul><ul><ul><li>Templates and reminders for gynecology </li></ul></ul></ul><ul><ul><ul><li>Pediatric vitals </li></ul></ul></ul><ul><ul><ul><li>vxDocManager </li></ul></ul></ul><ul><ul><ul><li>vxMHTP </li></ul></ul></ul><ul><ul><ul><li>vxROI </li></ul></ul></ul><ul><ul><ul><li>vxDRM </li></ul></ul></ul><ul><ul><ul><li>vxCodingCompliance </li></ul></ul></ul>
    6. 6. <ul><ul><ul><li>ADT/Registration </li></ul></ul></ul><ul><ul><ul><li>Adverse Reaction Tracking </li></ul></ul></ul><ul><ul><ul><li>Allergy </li></ul></ul></ul><ul><ul><ul><li>Bed Control </li></ul></ul></ul><ul><ul><ul><li>Chart Deficiency </li></ul></ul></ul><ul><ul><ul><li>CPRS </li></ul></ul></ul><ul><ul><ul><li>Clinical Procedures </li></ul></ul></ul><ul><ul><ul><li>Clinical Reminders </li></ul></ul></ul><ul><ul><ul><li>Consults </li></ul></ul></ul><ul><ul><ul><li>DRG/ICD/CPT/Lexicon </li></ul></ul></ul><ul><ul><ul><li>HL7 </li></ul></ul></ul><ul><ul><ul><li>Kernel </li></ul></ul></ul><ul><ul><ul><li>Laboratory </li></ul></ul></ul>Modules in Current Use
    7. 7. <ul><ul><ul><li>Mental Health </li></ul></ul></ul><ul><ul><ul><li>Notifications </li></ul></ul></ul><ul><ul><ul><li>Oncology </li></ul></ul></ul><ul><ul><ul><li>Pathology </li></ul></ul></ul><ul><ul><ul><li>Patient Care Encounter (PCE) </li></ul></ul></ul><ul><ul><ul><li>Patient Treatment File (PTF) </li></ul></ul></ul><ul><ul><ul><li>Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Problem List </li></ul></ul></ul><ul><ul><ul><li>Radiology </li></ul></ul></ul><ul><ul><ul><li>Scheduling </li></ul></ul></ul><ul><ul><ul><li>Text Integration Utility (TIU) </li></ul></ul></ul>Modules in Current Use (continued)
    8. 8. Overview of EHR in Future <ul><ul><ul><li>Continued modernization of VistA application modules </li></ul></ul></ul><ul><ul><ul><ul><li>VHA modernization of VistA has become stalled. DSS will use VA enhancements whenever possible. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>DSS will not continue to wait for upgrades to major modules to occur </li></ul></ul></ul></ul><ul><ul><ul><ul><li>DSS will continue supporting current VistA architecture. M database using Delphi GUI via RPC Broker. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Will use SQL where needed </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Will use HL7 where needed </li></ul></ul></ul></ul><ul><ul><ul><ul><li>GUI’s for major modules </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Will develop web applications where needed </li></ul></ul></ul></ul><ul><ul><ul><ul><li>DSS will work with Pacific Hui in order to contribute some code into Hui OpenVista in the hope it will become part of the VistA code base </li></ul></ul></ul></ul>
    9. 9. Overview of EHR in Future, continued <ul><ul><ul><li>Will develop new vxVistA integrated applications </li></ul></ul></ul><ul><ul><ul><li>Will commercialize DSS’ VA integration with commercial products </li></ul></ul></ul><ul><ul><ul><ul><li>vxICB (insurance capture buffer) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>vxIntelliDose </li></ul></ul></ul></ul><ul><ul><ul><ul><li>vxRTV (Real-time Vitals) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>vxSavlink </li></ul></ul></ul></ul><ul><ul><ul><ul><li>vxTheraDoc </li></ul></ul></ul></ul><ul><ul><ul><ul><li>vxTRM </li></ul></ul></ul></ul><ul><ul><ul><ul><li>vxVistAGateway </li></ul></ul></ul></ul><ul><ul><ul><li>Expansion of number and type of integrated commercial products </li></ul></ul></ul><ul><ul><ul><li>vxVistA will become certified by CCHIT or other EHR standardization committees </li></ul></ul></ul>
    10. 10. <ul><ul><ul><li>Dietetics </li></ul></ul></ul><ul><ul><ul><li>Integrated Billing and Accounts Receivable </li></ul></ul></ul><ul><ul><ul><li>Laboratory </li></ul></ul></ul><ul><ul><ul><li>MPI </li></ul></ul></ul><ul><ul><ul><li>Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Scheduling </li></ul></ul></ul><ul><ul><ul><li>VistA Imaging and PACS </li></ul></ul></ul><ul><ul><ul><li>Women’s Health </li></ul></ul></ul>Enhancement of Modules for Future Use
    11. 11. <ul><ul><ul><li>Current vxVistA test sites are confidential </li></ul></ul></ul><ul><ul><ul><li>VOE is implemented in a gynecology clinic in Washington, D.C. </li></ul></ul></ul>Deployments
    12. 12. <ul><ul><ul><li>Keeping code base current with FOIA or with Hui OpenVista </li></ul></ul></ul><ul><ul><ul><li>Establishing support necessary to maintain FOIA code base and our internally developed software </li></ul></ul></ul><ul><ul><ul><ul><li>Development </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Documentation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>QA </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Installation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tech Support </li></ul></ul></ul></ul><ul><ul><ul><li>VistA needs to be upgraded </li></ul></ul></ul><ul><ul><ul><li>Prioritizing the necessary enhancements will be based upon immediate need </li></ul></ul></ul><ul><ul><ul><li>Rapidly changing U.S. health care market </li></ul></ul></ul>Major Issues or Challenges
    13. 13. <ul><ul><ul><li>Affordability </li></ul></ul></ul><ul><ul><ul><li>High cost of providing support </li></ul></ul></ul>Major Issues or Challenges, continued
    14. 14. <ul><ul><ul><li>VSA members should support a common open source commercialized version of VistA </li></ul></ul></ul><ul><ul><ul><ul><li>DSS supports Hui OpenVista </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hui OpenVista will become a repository of enhancements to a common open source code base </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hui OpenVista is protected with a Berkeley open source license which protects add-ons </li></ul></ul></ul></ul><ul><ul><ul><ul><li>If Hui becomes ineffective, the Berkeley license will allow others to find a new neutral controlling entity for commercialized open source VistA </li></ul></ul></ul></ul>Collaboration
    15. 15. Collaboration, continued <ul><ul><ul><li>VSA members should continue to support the VSA </li></ul></ul></ul><ul><ul><ul><ul><li>VSA is a valuable marketing tool </li></ul></ul></ul></ul><ul><ul><ul><ul><li>VSA has the ability to become a public voice for its members </li></ul></ul></ul></ul><ul><ul><ul><ul><li>I want to thank Claudine Beron and her support staff, and the VSA Board for their dedication and sacrifice </li></ul></ul></ul></ul>
    16. 16. Links for EHR <ul><ul><ul><li>www.VistAExperts.com </li></ul></ul></ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul>
    17. 17. Contacts <ul><li>Mark Byers, President </li></ul><ul><li>DSS, Inc. </li></ul><ul><li>(561) 227-0207 office </li></ul><ul><li>(561) 373-4116 cell </li></ul><ul><li>[email_address] </li></ul><ul><li>Mike Ginsburg, vxVistA Marketing Manager </li></ul><ul><li>DSS, Inc. </li></ul><ul><li>(561) 227-0207 office </li></ul><ul><li>(561) 472-5672 direct </li></ul><ul><li>[email_address] </li></ul><ul><li>Jeff Bechtel, vxVistA Sales Consultant </li></ul><ul><li>DSS, Inc. </li></ul><ul><li>(561) 227-0207 office </li></ul><ul><li>(561) 472-5544 direct </li></ul><ul><li>[email_address] </li></ul>