The VA and VistA: A Role Model for Radical Improvement of Health Systems Everywhere

Phillip LongmanSenior Research FellowNew America FoundationSenior FellowWashington MonthlyLongman@newamerica.net

Tom Cruise’s depiction of life in a Bronx VA Hospital, 1989

Sample dialogue: This place is a f***ing slum!

Articles About VA’s Quality Revolution

“ . . . Overall, VHA patients receive better care than patients in other settings”

Elements of VA Quality Revolution

Fully integrated, patient-centered, evidence-based care. Focus on wellness, prevention, and effective disease

management. Low rates of medical error. Realized economies of scale (drugs, medical supplies and

devices) Low cost per patient. High rates of patient of satisfaction.

The History of the Hard Hats

Deviant Secretive Insubordinate Persecuted Persevering Triumphant Unsung

“There is no reason for any person to have a computer in their home”

~Ken Olson, President, Digital Equipment Corporation, at the Convention of the World Future Society, 1977.

Wally Fort

George Timson - 1980

Got MUMPS?

MUMPS (Massachusetts General Hospital Utility Multi-Programming System), or alternatively M, is a programming language created in the late 1960s, originally for use in the healthcare industry.

It was designed for the production of multi-user database-driven applications. It predates C and most other popular languages in current usage, and has very different syntax and terminology.

Appeared in 1966 Designed by Neil Pappalardo

“Hard Hat” Greg Kreis

A Two-User Wang 3300 System, circa 1970

The Origins of VistA

To overcome a Central Office ban on personal computers, “Hard Hats” ordered and then modified word processors designed for secretaries.

Open Source before Open Source

VistA today

The Proprietary Threat

Code Red:How software companies could screw up Obama’s health care reform.

Washington MonthlyJuly/August 2009

VistA 2.0?

“VistA is not a program; it’s a process”

Rick Marshall

Executive Director

VistaExpertise Network

VistA 2.0?

Question: Should VistA be established as a nationalstandard? What are the implications of this action?

Answer: Given the resources that VA has expended todate and can bring to bear in the future, VistA 2.0 couldbecome the international standard for medical centerinformation systems. This could result in huge financialsavings in the healthcare community, but VistA 2.0 couldresult in huge advances in evidence based medicine,medical research and data standardization andportability.

American Council on Technology, VistA Modernization, “Legacy to Leadership” Report, May 2010

Phillip LongmanSenior Research FellowNew America FoundationSenior FellowWashington MonthlyLongman@newamerica.net