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Archive for the 'Underground Railroad' Category

Oct 08 2013

Underground Railroad Banquet Oct 24 at VistA Expo in Seattle.

Published by under Underground Railroad

I’ll be holding the next Underground Railroad Banquet at the the VistA Expo in Seattle on Oct 24. This is a continuation of the banquets I’ve been holding over the years, starting with in 1982 with an award to Chuck Hagel for his support in the early roll-out of VA’s VistA. 

Here is some more information about the history of this group.

And here are some YouTube videos from previous banquets.

 

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Oct 03 2013

A Brief History of the Underground Railroad.

Published by under Underground Railroad,VistA

I was part of a small group of programmers (called Hardhats) recruited to the VA in the late 1970’s to work on what would eventually become the VistA Electronic Health Record system.  Ted O’Neill, who had supported the funding of the development of ANS MUMPS from NIH and later National Bureau of Standards (now NIST), moved to the VA to develop an open, public domain version of a modular, decentralized hospital information system that was dedicated towards improving the clinical care in the VA.

This was in an era dominated by mainframe computers, managed by centralized data processing staffs doing largely batch processing of punched cards.  The notion of a network of interactive terminals connected to decentralized minicomputers was a radical notion at the time, and was threatening to the centralized data processing department.

This lead to a fierce bureaucratic battle between the decentralists and the centralists.  Ted O’Neil and Marty Johnson hired MUMPS programmers under local hospital management, both to insure that they worked closely with the actual end users, and to shield them from the conflicts that raged in Washington.  Eventually, Ted O’Neill was fired, several of the hardhats were fired, and central office tried to shut down the MUMPS effort.  I was demoted, and $500,000 worth computers were locked up in my hospital basement, unused.  The central data processing department told upper VA management that minicomputers could not possibly be used for large scale computing, and that only a centrally managed mainframe approach could provide the necessary functionality.

The hardhats continued to develop the software, cooperating on a peer-to-peer basis, and working closely with hundreds of doctors, nurses, and other clinical personnel. By 1981, we had developed a toolkit (the File Manager, Kernel) that supported a core system that could handle packages for ADT (Admissions, Discharges, and Transfers), Pharmacy, Scheduling, and Laboratory.

In 1981, VA Chief Medical Director Donald Custis visited the Washington VA medical center to see our software in operation. He was surprised to find a working system, enthusiastically used by clinical staff, based on very economical minicomputers.  He quipped, “It looks like we have an underground railroad here.”   I grabbed the name, and started passing out 500 VA Underground Railroad business cards.

In 1982, I organized the first Underground Railroad banquet in Washington, DC, and presented then-Deputy VA Administrator Chuck Hagel with an “Unlimited Free Passage on the Underground Railroad” certificate.  I also started handing out certificates for “Outstanding Engineering Achievement” to programmers for their contributions to VistA, and special VIP membership cards, with a 1982-era Motorola CPU chip laminated to the engine of the logo.

I am planning the next banquet October 24, 2013 in conjunction with the VistA Expo meeting in Seattle.  I will be delivering a “State of the Underground Railroad” address, discussing how many of the original issues are still around, 31 years later.

For example, I had noted that in a bureaucracy, everyone wants things centralized below them and decentralized above them.  Given the technology of the day, we focused on the hospital as the “anchor point.”  Today, however, this has moved up to Capitol Hill.  Both  Senate and House committees have discussed what language to use in EHR systems.  The $1b disastrous Integrated Electronic Health Record effort is an effort in mega-centralization.  DoD continues it’s Humpty Dumpty systems development approach, breaking systems into pieces and then trying to integrate them back together again, even after a 40 year track record of failure.

VistA’s approach to a patient- and provider- centric model has repeatedly proven it’s merit.  Our approach of involving thousands of clinical users – not just a few IT “experts” – has also proven itself.  Open source software, agile development, use of online fora, metadata-driven architectures, and email-based messaging are all innovations of VistA that are more current than ever.

VistA was much more than just a collection of programs.  It was a community of users, a framework for collaborative development, and a toolset for “meta” level programming that is rarely understood by outsiders who stare at the source code.  Just as one cannot understand Wikipedia and the Wikipedian community by staring at the source code driving the underlying wiki, we cannot understand VistA simply by looking at the source code.

I hope that the Underground Railroad Banquet can help communicate some of these broader implications of the VistA framework, as well as look forward to the next generation of VistA software.

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Jul 25 2013

1993 GAO Report: Increased Information Sharing Could Improve Service…

Here’s an interesting link to a GAO report analysing VA’S DHCP (now called VistA), DoD’s CHCS system, and Indian Health Services’ RPMS systems.

Seems that barriers to sharing were organizational issues, not technical.

Not much has changed in the intervening 20 years, except that the systems have become 100x to 1000x more expensive (i.e. profitable to systems integrators who revel in the complexity of having lots of incompatible pieces).

It’s like we are living in a time warp, doing the same thing, time after time, ignoring what has succeeded, and replicating what has failed.  And it just keeps getting more complicated.

Someone should ask, “What’s the simplest thing we can do?” rather than continually shoot for gold-plated perfection.

 

Tip of the Hat to Sam Habiel and Jim Garvie for digging this out…

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Jul 04 2013

Open Letter to Chuck Hagel: DoD still doesn’t know what the hell they are doing

Dear Chuck (I’m using this informal salutation in honor of your status as one of the fathers of VistA),

I was impressed with your concise and accurate assessment “I didn’t think we knew what the hell we were doing.” before a Congressional hearing Apr. 16. 2013.  I fear, however, that this is still the case.

I can only imagine the endless swirl of acronyms, PowerPoint presentations, and facile phrases being tossed at you.  I’m sure you’ve been told that DoD will have a “seamlessly integrated electronic health record” with VA, and that it will be built of “best of breed” components that will all snap together seamlessly because you have an “enterprise service bus.”  Doing this will improve health care for active duty and veteran population, eliminate the VA eligibility backlog, and be accomplished by the next election cycle for just a few billions of dollars.

These are all very good intentions.  But I fear that you are paving a road to a hellish destination.  Rather than lifting up the VA eligibility problem to a shiny new common information system, you are on the verge of dragging health IT into the same bureaucratic vortex that has already done so much damage in the past.  AHLTA was declared “intolerable” in a Congressional hearing 4 years ago.  Yet, not only is it still around (and absorbing $600m/yr operations and maintenance costs), but it is also serving as a template for the next generation of the IEHR – a top down, mega-centralized administrative system far removed from the clinical needs of health care professionals and patients.  DoD continues to focus on the organization chart, not the patient, closely coupling their software designs to their bureaucratic stovepipes.  Indeed, it is rare for me to even find the word “patient” in any DoD health IT documents.

DoD is taking a “We chew, you swallow” approach to dealing with doctors and other health care providers.  Vice Adm (ret) Harold Koenig, MD, Deputy Assistant Secretary of Defense, Health Care Operations, 1990-1994, recently told me of his disgust with the current trends at MHS:

“DoD Health IT is now designed for the administrators with the patients as the data source and the clinicians as data entry clerks.”

Here is another email message from a military physician:

AHLTA is far worse that you even alluded. It has virtually sucked the life out of our Providers and our MTFs. Yes, there may be some benefits but the pain is worse than the gain. I can’t believe that there will ever be a system that could successfully create a bi-directional interface with AHLTA. Any discussions that CHCS Ancillary functions will be replaced by the AHTLA as an architecture are just smoke screens for the embarrassment that AHLTA really is.   The worst part of AHLTA is when you actually have to read some of the documentation it generates…. there is rarely a coherent statement in a 3 page clinical note.

And here is a 1984 letter from Sonny Montgomery to Secretary of Defense Casper Weinberger re DoD use of VA software:

“Mr. Secretary, I cannot understand the DOD reluctance to try the VA system, which will provide on a timely basis the mandatory system compatibility between the two agencies.”

And here is a letter that Rep. Montgomery sent to the to the Underground Railroad skunkworks in 1985:

“As you know, the Committee and I fully supported Chuck Hagel’s decentralized ADP plan when he announced it in March of 1982 during his tenure as the VA Deputy Administrator. After Chuck left the VA, the plan, which relied heavily on the resources of the Underground Railroad, was derailed and appeared to be approaching its demise.

In order to get it back on track, I wrote a strong letter to the Administrator, and solicited the help of Chairman Boland of the HUD-Independent Agencies Subcommittee of the Committee on Appropriations. Subsequently, the Congress provided the funds and the VA, with the outstanding assistance of the Underground Railroad, performed a near miracle in bringing the largest health care system in the western world into the present day ADP world!”

We have seen VistA thrive within the VA and in the Indian Health Service (as RPMS).  Ironically, UK National Health Service has just announced that it will spend some of its £260m Technology Fund on further exploring the creation of an NHS version of the US Veterans Health Association’s open source electronic medical record, VistA.

This is ironic because the NHS has recently cancelled a massive Health IT project that was almost a clone of what IEHR is attempting to do.  Here’s my Hello to NHS.

In short, DoD is trying to get out of a hole by digging it deeper.  The current path will exacerbate the VA Claims eligibility problem.  It will further damage the ability of DoD physicians to deliver quality health care.  But will generate enormous profits to systems integrators who will benefit by the system not working, as they see an continuous stream of expensive change orders. This will come at the expense of further suffering of active duty and veteran patients.

I think that the way out of this problem is to rethink the architecture and the ethos of the VA/DoD health care efforts:

  1. Shift to a Patient-Centric ethos.  The current trend is towards a single, mega-centralized, standardized, enterprise-centric “federated” data base environment, supposedly the only way to achieve a “seamlessly integrated” system.  The VistA that you green-lighted 31 years ago was based on a design ethos of a parallel, decentralized, patient-centric system.  Given the computing power (much less than an iPhone’s computing power to run a whole hospital), and communications speeds (1/40,000th of an iPhone’s) we focused on the hospital as the “anchor point.” With the coming effects of the revolution in translational/personalized/genomic/telemedicine/social network medicine, it is imperative to put the patient at the center of the health care universe, not the organization charts of the bureaucracies who run the hospitals.
  2. Accept that a hospital is different from an aircraft carrier.   Adopting health IT, dealing with the complex interplay between providers, patients, and information is a fundamentally different thing than acquiring an aircraft carrier.  Just because they cost the same order of magnitude does not mean that their acquisition can be managed the same way.  Even within a hospital, the administrative information (logistics, billing, accounting, etc) is a fundamentally different problem than dealing with clinical information such as lab, pharmacy, and radiology.  This ignorance has been a fatal flaw in any number of failed systems over the decades.
  3. Decouple the IT architecture from the Organization Chart.  The designs that I’ve seen coming from the DoD are enterprise-focused, “baking in” all of the stovepipes, organizational turf wars, and protecting rice-bowls of the many political, economic, and professional constituencies hoping to influence the architecture.  Instead of patching together an “integrated system” of point-to-point connections, we need to move to a broader vision of creating a common information space.  Note the words of Tim Berners-Lee in his design of the World Wide Web:
    What was often difficult for people to understand about the design of the web was that there was nothing else beyond URLs, HTTP, and HTML.  There was no central computer “controlling” the web, no single network on which these protocols worked, not even an organization anywhere that “ran” the Web. The web was not a physical “thing” that existed in a certain “place.” It was a “space” in which information could exist.”
  4. Uplift the current systems into a higher level of metadata management.  This is equivalent to building a ladder, rather than trying to get out of a hole by digging deeper.  The current approach throws away the conceptual integrity that made VistA such a success, replacing it with an “aircraft carrier” mentality that obliterates the ethos that drove VistA’s success.  The President’s Council of Advisors on Science and Technology published a health IT study that a great job of describing some of the foundations of this metadata approach, and treating Health IT as a “language” problem, not an “interface.”  This is a very nuanced difference, but think of how easy it is to link an Amazon.com book reference to a Twitter post:  you simply drag the URL of the book to Twitter, and press send.  You do not need to interface Twitter to Amazon, or use the “Book reference nomenclature standard,” etc.  It is simply an intrinsic property of the information space.  Similarly, we could build a health information space that that allowed this kind of sharing ( with enhanced patient privacy and security), as an intrinsic of being part of the common information space.  This move to a higher level of abstraction is a bit like thinking of things in terms of algebra, instead of arithmetic.  Algebra gives us computational abilities far beyond what we can do with arithmetic.  Yet, those who are entrenched in grinding through arithmetic problems have a disdain for the abstract facilities of algebra.  The DoD is rejecting the Uplift model, instead succumbing to the “Humpty Dumpty Syndrome” – breaking things into pieces, and then trying to integrate them again.  This is great work for “all the Kings men” as long as the King has the resources to pay them to try to put Humpty together again.  But sooner or later (and I had hoped you would have chosen the “sooner” option) the King needs to cut off this funding.
  5. We need a Skunkworks to develop and prototype a new vision.  The VistA that you greenlighted was designed by a very small group of dedicated, talented people working directly with VA clinical staff.  We were building a community of users, co-evolving the software and the community.  Ward Cunningham, inventor of the Wiki technology, and I talked a bit about the origins of VistA and of Wikipedia.  I’ve already begun collecting the people and ideas to make this a reality.   Just a tiny fraction of the IEHR budget would deliver spectacular results.

We are at a turning point in health IT in the United States and the world, but I fear that you are on the wrong path.  I hope you reconsider the direction you are going.

P.S. The next Underground Railroad Banquet is scheduled to happen in October at the VistA Expo in Seattle, if you or any of your staff who are appreciative of the VistA ethos would like to join us.

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May 03 2013

Military Health System loses control of its IT spending

Here’s the latest event in the saga of VA/DoD health information sharing from Bob Brewin: Military Health System and TRICARE Lose Control Over IT Budget

One official said the move reflects frustration among senior Pentagon leaders with MHS efforts to procure new health IT systems, both independently and in partnership with the Veterans Affairs Department to develop the integrated electronic heath record. The departments have spent at least $1 billion over the past five years pursuing an integrated system.

This follows Chuck Hagel’s testimony to Congress that We Don’t Know What the Hell We Are Doing and former DoD Undersecretary for Health Affairs Ward Cascell’s that 2009 revelation that AHLTA is Intolerable.   I got private emails from DoD docs that were even more explicit:

AHLTA is far worse that you even alluded. It has virtually sucked the life out of our Providers and our MTFs. Yes, there may be some benefits but the pain is worse than the gain. I can’t believe that there will ever be a system that could successfully create a bi-directional interface with AHLTA. Any discussions that CHCS Ancillary functions will be replaced by the AHTLA as an architecture are just smoke screens for the embarrassment that AHLTA really is.

The worst part of AHLTA is when you actually have to read some of the documentation it generates…. there is rarely a coherent statement in a 3 page clinical note.

AHLTA is more than Intolerable…It’s the 3rd highest reason listed by the Army at the June 08 AUSA Conference Providers are leaving the military…

The first time I saw the AHLTA design, I thought that this was a reversal of all the successes the federal government had seen in health IT.  I remember thinking, “This is just one giant single-point-of-failure.”

30 years ago, we had two operational VA/DoD sharing sites.Tom Munnecke, Ingeborg Kuhn, George Boyden, Beth Teeple showing off the first VA/DoD Health IT interface Here is March AFB’s Beth  Teeple’s oral history of the March AFB/Loma Linda test.

Thanks in part to Chuck Hagel’s early support of VistA, Rep. Sonny Montgomery, chair of the House Veterans Affairs Committee, noted that while VA had deployed a Core VistA system in all 172 hospitals for $82m, DoD had only produced prototypes of 4 stand-alone modules – for $250m (prices in 1985 dollars).  DoD called this IOCs – Interim Operating Capabilities, but we called them “Incompatible Operating Capabilities.” Each was  completely independent of the others, using incompatible coding systems, hardware, user interfaces, and communications protocols.  “Integration” was intended to come later.

This was classic DoD “Humpty Dumpty” development.  Break the system into pieces, then hire systems integrators to put it all back together again.  This is a wonderful business opportunity for the beltway systems integrators, but after 30 years of broken systems, its time to reevaluate the whole approach.

VistA never broke into pieces, but was based on common metadata and a shared set of tools.  It was “integrated” by virtue of never having been “disintegrated.”  Over the years, I learned that when someone speaks of “integrating” a system, we have to ask, “what disintegrated it in the first place?”  Until those forces are addressed, there is little chance of success.

Here is an excerpt of a letter  Sonny Montgomery sent me in 1984 Sonny Montgomery sent me in 1984:

As you know, the Committee and I fully supported Chuck Hagel’s decentralized ADP plan when he announced it in March of 1982 during his tenure as the VA Deputy Administrator. After Chuck left the VA, the plan, which relied heavily on the resources of the Underground Railroad, was derailed and appeared to be approaching its demise.

In order to get it back on track, I wrote a strong letter to the Administrator, and solicited the help of Chairman Boland of the HUD-Independent Agencies Subcommittee of the Committee on Appropriations. Subsequently, the Congress provided the funds and the VA, with the outstanding assistance of the Underground Railroad, performed a near miracle in bringing the largest health care system in the western world into the present day ADP world!

The VA and DoD forked into two paths: DCHP became VistA, and has won many awards and distinctions.  DoD reluctantly accepted CHCS, but under its management, has spiraled down into the mess we see today.

Here is 1984 Oct 10 Congressional Record authorizing DHCP as competitor in CHCS, my 1985 overview of DHCP to TRIMIS Program Office, 

And here is a 1984 oct 4 montgomery letter to Sec Def Casper Weinberger re DoD use of VA software:

Mr. Secretary, I cannot understand the DOD reluctance to try the VA system, which will provide on a timely basis the mandatory system compatibility between the two agencies.

It’s amazing that we are having the same conversation 29 years later.  Not a whole lot has changed, except that we’ve spent billions of dollars and decades delivering “intolerable” health care to those who most deserve it.

I’m getting tired of rehashing 30 year old events, but it seems necessary.  DoD has been relentlessly trying to do the same thing – and failing.  It’s time we break out of the “More Expensive Failure” mode and move to an approach that works.

In my next post, I’ll present a proposal for some solutions.

 

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Apr 11 2013

Jon Stewart offered Prestigious Unlimited Free Passage on Underground Railroad award

640px-Jon_Stewart_and_Michael_Mullen_on_The_Daily_Show

After reading Bob Brewin’s piece Did Jon Stewart Foil the Pentagon’s Health Records Plan? I have decided that Jon Stewart is a worthy recipient of the Unlimited Free Passage on the Underground Railroad certificate.  He understands the problems that the hardhats have been facing in the development of VistA over the years, and also seems to understand the success that it has enjoyed despite the hardships over the years.   I hope that this recognition will help him see some opportunities for improving government, health care, and service to our Veterans.  It is also an amazing story of how a bottom-up, decentralized approach to innovation can work, even in the most hardened bureaucracy.

The VA MUMPS Underground Railroad was formed in the early days of the VistA development in response to the attempts of the centralists to shut down a field-based decentralized approach.  The Hardhats were the technical folk who wrote the code to make it happen, but VistA was always more than just source code, so we needed recognize the many others who were involved in making it a success as described in Phillip Longman’s book Best Care Anywhere and this video. US Medicine editor Nancy Tomich describes the situation.  Nancy and I are now working on the New Health Project to carry things to the next generation.

The Underground Railroad has been struggling to build a common vision of VA/DoD health sharing for decades,   and not without its casualties,  so it is good to finally see some media attention to the issue.

Jon Stewart

This is the most prestigious award offered by the Underground Railroad, having previously been given in 1982 to Chuck Hagel:

Chuck Hagel UFP

In keeping with the Underground Railroad’s history, his certificate can only be given in person, with appropriate ceremonial presence.

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Feb 07 2013

Washington Post article on Chuck Hagel and the VA

I was delighted to see the recent  article Vets see promise in Hagel and his short VA tenure.  It talked about his support for the VistA EHR system which was my briar patch back in the 1980’s:

“Hagel met with the programmers. “He found out about it and liked it, so he pushed it at the right time,” [Harry] Walters [Former VA Administrator] said. “Now it’s the most effective electronic health-record system in the country.”

The programmers presented Hagel with a certificate of appreciation at a banquet in 1982. “He stuck his neck out,” Munnecke said. “It was a gutsy decision on his part.”

Stay tuned.

And I continue to be amazed at how powerful the Underground Railroad I designed on a lark 30 years ago remains today.

Here is my original post about him.

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Jan 21 2013

VistA Named one of top 10, oldest, most significant Open Source Projects

Published by under Underground Railroad,VistA

I just noticed that the VA VistA Electronic Health Record System was named as one of The 10 oldest, significant open-source programs in the company of Linux, Python, Perl, and other software.   Back in the early days of VistA, the term “Open Source” didn’t exist – we called it “public domain.”

What makes VistA unique in this list is that it is more than just code, it is a longitudinal data base extending back over 30 years across 172 hospitals and millions of patients.  This is an irreplaceable resource – VistA has petabytes of information about clinical conditions, activities, locations, and demographics from a period when most other hospitals were just dreaming about putting their records online.  This information is mapped by a “data dictionary” – a “road map” to the data base that defines the semantics (what it means) of the data, not just the syntax (how it is formatted).  It is also structured around a network model of information (the connectors between the dots), rather than just a hierarchical model (think of how the Dewey Decimal System tries to form a hierarchy of the books in a library).

This data is not complete, perfectly formatted, nor coordinated with precision.  Clinical data is not research-grade clinical trials data, and the patient population is that of (mostly male) veterans.  But it is a treasure trove of information, waiting for future data mining.  And what we consider “junk” information today (say, appointment schedules from 30 years ago), may hold great value in future research (say, how epidemics spread).

I hope the VA has the wisdom to retain this information in its original form.

At the 2012 OSEHRA summit meeting, I happened to be on a panel with medical researcher Leonard D’Avolio who commented on how easy it was to extract research data from VistA.  It was quite a touching moment for me, to have helped set in motion something that captured data that would be available 33 years later.

To quote my friend Doc Searls: “When young you think life is a sprint. When older you see it’s a marathon. And when mature you see it’s a relay race.”

The question, just who are we handing off the baton to?  Is the medical information we’re dealing with today going to be available 33 years from now?

I see a number of necessary conditions for this to happen:

1.  We need a curator.  Some organization needs to take on the role of “librarian” to maintain the archives.  The VA is a likely candidate for this, but even so, I think they might need a bit of prodding to keep them focused on their responsibility.  And maybe if Chuck Hagel (one of the Fathers of VistA) is confirmed as Secretary of Defense, he’ll recall his roots as one of the fathers of VistA and bring DoD medical information along, as well.  Roger Baker, Assistant Secretary for Information and Technology for the Department of Veterans Affairs, is moving things along so well that he earned a VIP membership card in the Underground Railroad.

2. We need to manage the data at a “meta” level.  The VistA Data Dictionary is being updated to more modern semantic web concepts, for example through Conor Dowling’s Semantic VistA.  The PCAST report called for greater use of Metadata, apparently unaware that they were recommending an approach already used by VistA for 1/3 century, which they cited as a case study in a successful large-scale system.  This is a bit like Monsieur Jourdain in Moliere’s play Bourgeois Gentleman, who suddenly realized that he had been speaking prose all his life, but didn’t know it.

3.  We need to continue the tradition of Open Source.  There is some movement in this direction with the OSEHRA effort, but it’s funding is but a tiny fraction of what it needs to be.

4.  We need to fund the effort.  Some folks think that Open Source means “free labor” – that the VA can just declare VistA to be an open source system and programmers will flock to it, offering volunteer time to do the VA’s bidding.  This isn’t going to work.  VA needs to fund these efforts, and release the work as open source.

5.  We need to think of what we are building as an “information space” rather than just an “integrated electronic health record.”  If someone said that they were going to improve our legal system by systematically storing and arranging lawyer’s documents, most of us would be a little skeptical.  But there is a huge chasm between our goal of  improving our health care and the current task of automating the medical record.  As we’ve seen with Twitter, Facebook, Google, Linked In, and Wikipedia, there are huge benefits to focusing on “connecting the dots” in large scale systems, rather than just focusing on specific dots.  Here’s a webinar I gave at Kitware, a leading open-source company.

All in all, though, it’s pretty cool to see VistA placed in this company.

 

 

 

 

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Jun 13 2012

Videos from 2012 Underground Railroad Banquet

Ever since my early days in the VA, I’ve hosted VA MUMPS Underground Railroad banquets to recognize people who have participated in helping to make the VA VistA Electronic Health Record system work. Here are some videos from the June 5, 2012 banquet held at George Mason University.

The name comes from a meeting that Donald Custis, then Head of VA’s Department of Medicine and Surgery, first saw the VistA system work. He had been told by the centralists that it was impossible to put an health information system on minicomputers, but when he saw it, he quipped, “Looks like we have an underground railroad here.” I took this as the name of our group, and had membership cards printed up, and started passing out awards for “Unlimited Free Passage on the Underground Railroad” and “Outstanding Engineering Achievement on the Underground Railroad.”

Here are my opening comments:

Here are the comments of Dr. Ross Fletcher, Chief of Staff of the Washington VA Medical Center. Ross has been a poster boy for clinician/programmer interaction in software development, always happy to give a physician’s eye view on how software should work. Having such close interaction between doctors and programmers was a key factor for the success of VistA. In this presentation, he demonstrates iPad apps to access VistA databases:

Here are the comments of Joseph Dal Molin, one of the founders of the World VistA community:

And here is a copy of a 1984 letter from Rep Sonny Montgomery, reinforcing the importance of the Underground Railroad: 1984 nov 5 montgomery letter to Underground Railroad

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Jun 02 2012

Some historical VA/DoD papers

From the initial 1978 Oklahoma City VA/DoD/IHS meeting, we had envisioned a government-wide health information system, based on shared, open source software.  Things went well for the VA, and we deployed a nation-wide system starting in 1983.  Things looked bright for a while for DoD use, as we installed a shared system at March AFB in Riverside, CA. connected to Loma Linda VA hospital.  Congressman Sonny Montgomery got wind of the effort, and supported it to the hilt.  DoD didn’t like the idea – spending more money on consultants to make it look bad than they did to try out the system to see if it worked.

Here are some papers I’ve scanned in that relate to some of the early history of VA/DoD sharing.

Despite these being nearly 30 years old, the issues they talk about are pretty much current – just part of a never-ending story about VA-DoD integration efforts.

 

1985 munnecke overview of DHCP to TRIMIS Program Office

1984 Oct 10 Congressional Record authorizing DHCP as competitor in CHCS

1984 oct 4 montgomery letter to weinberger re DoD use of VA software

1984 nov 5 montgomery letter to Underground Railroad

1986 Anon letter to DOD Inspector General re alleged conflicts of interest in CHCS

1985 first VA DoD email message exchange at March AFB

1984 MITRE report on Utilization of VA software in the TRIMIS program

1984 Octo Barnett responds to MITRE report on DoD methodology

1985 munnecke email re ADL dirty tricks

1997 US Medicine article by tom From DHCP to Vision for Change

1978 Tom Munnecke’s Original DHCP FileMan and Kernel design notes at OK City kickoff meeting

1985 Munnecke Occams Razor alive and well into VA
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