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buy vs. build  Nohl-@sptimes.com
 Aug 19, 2004 08:45 PDT 

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Dear Hardhats:

On 8/2, we published a story about the strengths of VistA, including
e-mail quotes from VA
computer specialists who questioned the wisdom of top-down replacement of
homegrown modules. You can read it at www.sptimes.com by typing
""CoreFLS'' into the archives box.

We are now thinking of pursuing two other themes and would like your help.

One involves VistALite. It appears that one part of the government may be
promoting VistA as
a model for computerizing doctor offices and clinics, while the VA has a
long range plan to
alter or dismantle VistA as an M-language database and decentralized
computing community. Granted, a huge integrated system and individual
clinics may have quite different needs, but we still might explore this
issue. I would like to talk to people who are most familiar with the VistA
Lite initiative.

Another theme involves a possible migration from M-language to Oracle for
VistA. We
understand, for example, that the redesign of Scheduling is being written
in an extension of
Oracle (PSQL?) that may be a little cheaper in the short run, but which
gives Oracle a leg up
on bidding for implementation. It may also make it harder for other
applications to plug into Scheduling
without some kind of interface. We may be totally off-base about this, but
would like to know more. We also have heard that the proposed Health Data
Repository may be written in Oracle although that notion may be wrong as
well. In that Oracle was a central player in the CoreFLS debacle, we
wonder if there is any rethinking going on at
headquarters. Things like scheduling and certainly the database itself are
much closer to the
heart of clinical functions than are the financial modules that CoreFLS
was designed to replace. We
have much to learn about these issues and would like to hear from anyone
who knows about them.

We are particularly eager to hear from someone who is familiar with, and
essentially agrees
with, the current thinking at VA headquarters. They are under a lot of
pressure, and by the very
nature of large bureaucracies, sometimes can't speak frankly with the
press. That can make it difficult fpr them to get their point of view into
the public eye. Maybe there is someone who recently left the VA, for
example, who could articulate their position. The fans of VistA and Cache
are usually more willing to speak. We want to avoid getting a skewed view
of things because we are hearing only from one side. Congressional
requirements aside, there remain fundamental questions about whether
VistA's structure is adequate for the long run and, if not, how it should
be changed. Even assuming that it is best integrated, large scale clinical
system now in existence does not necessarily mean it is the best system
for the future.

These appear to be incredibly important decisions. Billions of dollars and
the health of
millions of vets may be impacted.

We are willing to talk to people on background, which means we will not
use your name in print
or in conversation. We also don't write stories that say things like ""A
source in the OIFO
says yada yada yada.''

If you have light to shed on these issues, or any other issues of
importance, please e-mail me or
telephone. If you are part of the VA family, do not use your work e-mail,
which can be traced.
One of your colleagues recently e-mailed me some public records, as a
courtesy, then
mistakenly came under suspicion as the person who sent us the forum
e-mails.

Sincerely,
Stephen Nohlgren
1-800-333-7505 x 8442

My colleague Paul de la Garza, who originated our reporting on this issue,
can be reached at
extension 3432


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<br><font size=2 face="sans-serif">Dear Hardhats:</font>
<br>
<br><font size=2 face="sans-serif">On 8/2, we published a story about the strengths of VistA, including e-mail quotes from VA </font>
<br><font size=2 face="sans-serif">computer specialists who questioned the wisdom of top-down replacement of homegrown modules.  You can read it at www.sptimes.com by typing ""CoreFLS'' into the archives box.</font>
<br>
<br><font size=2 face="sans-serif">We are now thinking of pursuing two other themes and would like your help.</font>
<br>
<br><font size=2 face="sans-serif">One involves VistALite. It appears that one part of the government may be promoting VistA as </font>
<br><font size=2 face="sans-serif">a model for computerizing doctor offices and clinics, while the VA has a long range plan to </font>
<br><font size=2 face="sans-serif">alter or dismantle VistA as an M-language database and decentralized computing community. Granted, a huge integrated system and individual clinics may have quite different needs, but we still might explore this issue. I would like to talk to people who are most familiar with the VistA Lite initiative.</font>
<br>
<br><font size=2 face="sans-serif">Another theme involves a possible migration from M-language to Oracle for VistA. We </font>
<br><font size=2 face="sans-serif">understand, for example, that the redesign of Scheduling is being written in an extension of </font>
<br><font size=2 face="sans-serif">Oracle (PSQL?) that may be a little cheaper in the short run, but which gives Oracle a leg up </font>
<br><font size=2 face="sans-serif">on bidding for implementation. It may also make it harder for other applications to plug into Scheduling </font>
<br><font size=2 face="sans-serif">without some kind of interface. We may be totally off-base about this, but would like to know more. We also have heard that the proposed Health Data Repository may be written in Oracle although that notion may be wrong as well. In that Oracle was a central player in the CoreFLS debacle, we wonder if there is any rethinking going on at </font>
<br><font size=2 face="sans-serif">headquarters. Things like scheduling and certainly the database itself are much closer to the </font>
<br><font size=2 face="sans-serif">heart of clinical functions than are the financial modules that CoreFLS was designed to replace. We </font>
<br><font size=2 face="sans-serif">have much to learn about these issues and would like to hear from anyone who knows about them.</font>
<br>
<br><font size=2 face="sans-serif">We are particularly eager to hear from someone who is familiar with, and essentially agrees </font>
<br><font size=2 face="sans-serif">with, the current thinking at VA headquarters. They are under a lot of pressure, and by the very </font>
<br><font size=2 face="sans-serif">nature of large bureaucracies, sometimes can't speak frankly with the press. That can make it difficult fpr them to get their point of view into the public eye. Maybe there is someone who recently left the VA, for example, who could articulate their position. The fans of VistA and Cache are usually more willing to speak. We want to avoid getting a skewed view of things because we are hearing only from one side. Congressional requirements aside, there remain fundamental questions about whether VistA's structure is adequate for the long run and, if not, how it should be changed. Even assuming that it is best integrated, large scale clinical system now in existence does not necessarily mean it is the best system for the future.</font>
<br>
<br><font size=2 face="sans-serif">These appear to be incredibly important decisions. Billions of dollars and the health of </font>
<br><font size=2 face="sans-serif">millions of vets may be impacted.</font>
<br>
<br><font size=2 face="sans-serif">We are willing to talk to people on background, which means we will not use your name in print </font>
<br><font size=2 face="sans-serif">or in conversation. We also don't write stories that say things like ""A source in the OIFO </font>
<br><font size=2 face="sans-serif">says yada yada yada.''</font>
<br>
<br><font size=2 face="sans-serif">If you have light to shed on these issues, or any other issues of importance, please e-mail me or </font>
<br><font size=2 face="sans-serif">telephone. If you are part of the VA family, do not use your work e-mail, which can be traced. </font>
<br><font size=2 face="sans-serif">One of your colleagues recently e-mailed me some public records, as a courtesy, then </font>
<br><font size=2 face="sans-serif">mistakenly came under suspicion as the person who sent us the forum e-mails.</font>
<br>
<br><font size=2 face="sans-serif">Sincerely,</font>
<br><font size=2 face="sans-serif">Stephen Nohlgren</font>
<br><font size=2 face="sans-serif">1-800-333-7505 x 8442</font>
<br>
<br><font size=2 face="sans-serif">My colleague Paul de la Garza, who originated our reporting on this issue, can be reached at </font>
<br><font size=2 face="sans-serif">extension 3432 </font>
<br><font size=2 face="sans-serif"> </font>
<br><font size=2 face="sans-serif"> </font>
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