VISTA Enterprise Network - Successful Implementation, World Class Support

Saturday, April 28, 2007


Dear Reader,

The subject of this weblog, VISTA, has no name. The name "VISTA" names part of this subject for part of its time, but it does not name all of it nor even most of it, and it has not always been the name of that part nor even for most of its history.

In the beginning it had no name. Amazingly, those who fought their David-and-Goliath battle to bring VISTA to the world merely described it rather than naming it, almost unthinkable in this era of branding urges so powerful we had to coin the term "vaporware" for our empty software names. Instead, the fathers of VISTA offered us abundant anonymity, a wealth of medical informatics with no name.

Ted O'Neill and Marty Johnson, two of the fathers of VISTA, called the software their team built "MUMPS systems," since they were written in the American National Standard (ANS) dialect of the Massachusetts General Hospital Utility Multi-Programming System (or Standard MUMPS, now also referred to as Standard M); they also referred to them as the "VA MUMPS medical systems." They also called the various VISTA packages "hospital-based programs," to distinguish them from the programs developed by their central-office competitors, the Office of Data Management and Telecommunications (ODM&T, also called "the enemy" by the brave hardhats of those lean years). The hardhats sometimes referred to their work as "committing portability," again to distinguish their work from the vendor-specific, nonportable software created by the ODM&T bureaucrats. Sometimes they referred to their work as the "DM&S systems," referring to the Department of Medicine and Surgery (comparable to today's Veterans Health Administration, VHA) within the Veterans Administration (VA, today's Department of Veterans Affairs) and thereby to their own work created by DM&S personnel to meet their own needs. The DM&S office Ted, Marty, and the early hardhats worked out of before being driven underground was called the Computer Assisted Software Staff (or CASS), so sometimes today we refer to their work as the "CASS system." Although CASS was a centralized office within DM&S, most of its developers worked remotely in the field at VA Medical Centers, so they often referred to their software as the "field-developed systems" or the "DM&S field-developed systems." The generic term Marty Johnson used as the subject of his historic June 10, 1981 memo was the "DM&S Medical Information Systems," and he described the emerging MUMPS medical applications as making up a prototype "VA Health Care Information System" (HCIS).

Today, the terminology needed to describe the approach they used has become much richer—eXtreme Programming, rapid prototyping, user-driven development, open-source development, and on and on—but at the time their work was original enough that their theoretical framework was described in terms of the papers, memos, and studies that guided them to attempt what they did. At the time, they often used the general term "the VA approach" to sum up their strategy, though that has to be understood as in contrast to "the official VA approach" of expensive, vendor-dependent, piecemeal juggernauts created by ODM&T. The absence of a name compelled them to discuss and consider the significance of what they were doing, leaving them rich in understanding but poor in such public-relations tools as branding.

In 1982, the VA rebranded the VA MUMPS systems as the Decentralized Hospital Computer Program (DHCP), and in 1996 re-rebranded them the Veterans Health Information Systems and Technology Architecture (VISTA). Sometime in the 2000s, VA re-re-rebranded the system HealtheVet (pronounced Healthy Vet), and then later re-re-re-rebranded it HealtheVet VistA (or HealtheVet-VistA, the punctuation varies), with an additional re-re-re-re-rebrand aimed beyond the VA called HealthePeople-VistA.

The VA's version of VISTA is just one dialect of a family of related medical information systems all ultimately derived from the CASS team's work. When the U.S. Indian Health Service adopted VISTA, they named their revised version of it the Resource and Patient Management System (RPMS). When the U.S. Department of Defense adopted VISTA, their revised version of it was named the Composite Health Care System (CHCS). The Finnish consortium that adopted VISTA before even the VA did named their version of it MUSTI. The Nigerian consortium that adopted VISTA named theirs the Made In Nigeria Primary Health Information System (MINPHIS).

When WorldVistA began working on VISTA outside the VA, they called their work OpenVistA, the name that the Medsphere Corporation trademarked and made their own. When the U.S. Department of Health and Human Services (HHS) launched their initiative to make a free version of VISTA available for clinics and doctors' offices, they dubbed their version VistA-Office EHR. Later, after commercial EHR vendors politically sabotaged the VistA-Office EHR initiative, WorldVistA built upon that work to create WorldVistA EHR, the name of the version for which WorldVistA has had responsibility ever since.

There are more dialects of VISTA than this, and more names, but surely this is enough to understand why there has been a backlash against this balkanization of terminology and against the VA's passion for rebranding. The community has embraced the name "VISTA" reflexively, out of resistance to this pointless confusion, in an effort to nail down a coherent, sufficiently embracing identity for this vital legacy of software and culture. It is not good enough, not complete enough, does not clearly enough put its nominalist finger on the core of that identity, and it has to struggle against the partly negative, obscurantist intentions that led to that rebranding, but it partly transcends these things, has a positive enough connotation, was coined by worthy and well-meaning people, and in the end above all, VISTA is a good enough name for us to build our identity around. So we have.

Sincerely yours,

Rick Marshall
Executive Director
VISTA Expertise Network