Assignment 1

VistA Background
Clinical Systems INFO71750

By:
Karolina Olejarczyk, Roberto Ventura, Kate Pinsonneault
Professor Stefan V. Pantazi, MD, PhD
September 20, 2015

Instructions
Peruse the literature in the VistA literature folder in order to learn more about the Veterans
Affairs VistA system. Provide brief answers to the following questions.
1. Essay (5 points) Why do you think VistA is considered one of the most successful
systems of its kind?
The Veterans Health Information Systems and Technology Architecture (VistA) is a
comprehensive clinical information system and electronic health record used by the Veterans
Health Administration (VHA) of the Department of Veterans Affairs (VA) in the United
States. It is the largest and most rapidly developing form of EHR and considered one of the
utmost advanced systems of its kind for several reasons.
As a result of the adoption of VistA, the VHA has experienced dramatic improvements in
quality of patient care, overall cost per patient and patient accommodation. Many
independent surveys have demonstrated a high satisfaction rate amongst physicians using
VistA compared with other EHR systems as it allows them to practice higher quality
medicine. VistAs many features enable clinicians to easily keep track of patients and all
associated medical information, such as laboratory and medication orders, test results and
medical history. This and the fact that VistA is collaboratively developed as an open source
software, maximizes its clinical versatility. As a public domain software VistA is affordable
for any hospital or health system to implement. Its interoperable data sharing capabilities also
contribute to making it a significantly appealing choice of infrastructure.
In conclusion, VistA is a highly successful information system because of its usability,
affordability and interoperability.
(Edmund Billings, 2014)
2. Essay (2 points) Give an example of something you found interesting about VistA
(e.g., history, evolution).
Although there are many interesting facts surrounding the evolution and history of
the VistA system, it is the future of VistA that is truly fascinating. Currently, two long
range IT strategies are being pursued by the VA in order to improve VistA and create an
ideal health information system.
An internal strategy to move the existing system towards HealthVet VistA has
been developed. A Personal Health Record (PHR) module, Health Data Repository
(HDR), and web-enabled front end are just some of the planned enchantments that will
further improve the veterans health system.
An external strategy that involves collaborating with organizations outside the VA
in has also been initialized in order to develop HealthePeople VistA. Its goal is to

transform to person-centered, outcomes-driven health systems and to transfer the VistA

EHR software suite to a private physician office setting
These strategies will contribute to improving not only the VA healthcare system
but any clinical institutions that adopt VistA into their IT infrastructure, thus taking
healthcare as we know it to a new level.
(VA VistA System, 2005)

3. Essay (3 points) In your view, what is the point in studying a system such as VistA in
a health informatics course?
ThepointofstudyingasystemsuchasVistaAinahealthinformaticscourseisto
gainexperiencewitharealisticEHRsystem.Studentsareabletolearnhowtoextractand
analyzetheinformationquicklyandaccuratelyinordertoimprovepatientcareusing
VistaA.StudentsarealsoabletogetasenseofthecodingEHRsrequire.Lastlyhaving
experiencewithanEHRsystemwillhelpstudentsimplementsimilarEHRsystemsinthe
future.ManyEHRsystemsfailduetopoorimplementation.HIMstudentswillbebetter
preparedforthisbecausetheyhavehadtheopportunitytobecomefamiliaranEHR
systembeforehand.
(Health Information Management Education, 2015)

4. Essay (3 points) Now that you have some experience with the actual system, can you
look at it from the perspective of the material taught in class so far? What is the
VistA system modeling? What is it supposed to represent?
VistaAmodelsahealthinformationsystem.VistaAissupposedtorepresentan
EHRsystem.AftergainingexperiencewiththesystemitisapparentthatVistaAisa
greatexampleofmaterialtaughtin.VistaAdemonstratesthedifferenttypesofhealthcare
professionalsthatusethesystemandthelevelofaccessthattheyhave.VistaAalso
providesanexampleoftheprivacyandconfidentialityhealthinformationsystemshave.
Forexample,doctors,nurses,labworkerandradiologistsareallabletousethesystem
buttheamountofinformationtheycanenterandextractvaries.AdditionallyVistaA
exemplifiestheamountofdetailedinformationthatisrecordedinEHRs.This
informationrangesfromconditions,medications,surgeries,labs,personalinfoandmore.
Havingallthisinformationavailablewouldbeapowerfultool.
(Brown,H.,etal,2003)

5. Essay (2 points) Is VA VistA used exclusively in the US? Explain.

VistA is considered a state-of-the-art health information system worldwide since
its deployment in the 1990s and early 2000s (VA VistA System, 2005). VistA is being
used in numerous healthcare organizations and institutes in several nations around the
world. Countries like: Mexico, Finland, Egypt, Germany, and American Samoa have
implemented VistA software into their institutes (VA VistA System, 2005). The
emergence of WorldVistA was designed to further develop and support the growing
global VistA community in several countries such as: Panama, India and Jordan.
6. Essay (5 points) Do you agree with any of the opinions expressed in reference 7?
Explain.
Reference 7 focuses on the scandal involving VA VistAs CIO Robert Howard and
his controversial spending using the companys IT budget. The author says contracting,
by nature, offers many opportunities of corruption of all kinds (Blankenhorn, 2009). The
author also mentions that VistA has never been a school for scandal (Blankenhorn,
2009). Without question, Mr. Howards actions are inappropriate and unnecessary as it
has tainted ZDNet Healthcares reputation and closed source software in general.
However, to say that proprietary software corrupts by nature (Blankenhorn, 2009), may
be pushing the line. Both software models present multiple advantages and
disadvantages. Mr. Howards poor spending habits which benefitted himself and others
rather than the company, is more of a reflection of his character and not that of
proprietary software in general. VistA is used around the world and should remain in
government hands since its a more feasible and less costly alternative to smaller
healthcare organizations (VA VistA System, 2005).
Mr. Howards intentions may have been valid, however his decision to switch
from the companys homegrown software to a proprietary vendor, despite proven past
reliability, is questionable and unclear. In conclusion, it is easy to see why this incident
has sparked much controversy, however, it is not fair to claim that proprietary software
corrupts and should be avoided is a claim that pushes the line, since the technology itself
is not to blame.

References
Brown, H., Lincoln, M. J., & Groen, P. J. (2003). VistA * U . S . Department of Veterans Affairs
national-scale. International Journal of Medical Informatics, 69, 135156.
D. Blankenhorn., (2009). VA Scandal gives proprietary software a bad name. Retrieved from
www.smartplanet.com
Edmund Billings, M. (2014, June 10). How Does the VAs Technology Rate Against Other EMR
Vendors? Retrieved from The Health Care Blog:
http://thehealthcareblog.com/blog/2014/06/10/how-does-the-vas-technology-rate-againstother-emr-vendors/
N.A. (2005). VA VistA System: VistA and the M are still very much alive and well. Retrieved
from www.vista-office.org
N.A. (2015). Health Information Management Education. Retrieved from
http://neehrperfect.com