Hello NHS – Hope You Enjoy VistA 

tom in london phone booth

Hello National Health Service.  I’m glad that you are looking in to the adaptation of VA’s VistA into your IT activities over there.  I’ve been an outside observer and sometimes consultant to various NHS groups for years, and am particularly interested in helping you understand the VistA phenomenon.  Trying to understand VistA by looking at its source code is like trying to understand Wikipedia by studying the PHP of the underlying wiki.  The wealth is in the community of users, not the source code.

By way of introduction, as a VA employee, I was one of the original software architects for VistA.  I then moved to Science Applications International Corporation (SAIC) in San Diego, Ca. where I played the same role for the US Dept. of Defense’s Composite Health Care System (CHCS).  These are the two largest health care systems in the US, so I’ve seen issues of scale, portability, bureaucratic infighting, and no end of technical argument about how to do things.  Internationally, I’ve designed or consulted on health IT in France, Spain, Switzerland, Finland, Japan, Australia, and Nigeria.  I’ve testified before the US Senate Committee on Veterans’ Affairs on the Future of Health IT.

I spent some years looking at future technology for the VA (here are some of my papers), then took an early retirement from my position as VP and Chief Scientist at SAIC to broaden my interests of applying technology for humanitarian, philanthropic, and educational uses.  I took a year as a Visiting Scholar at Stanford University’s Digital Visions Program, founded a humanitarian think tank called the Uplift Academy, in which I’ve developed a workshop format I call Slow Conversations.

I was one of the initial members and leaders of the Underground Railroad, the “skunkworks” group that did the original design of the system that was to become VistA.  I gave an Unlimited Free Passage certificate to Chuck Hagel, then of the VA, now US Secretary of Defense.   The Hardhats were another group, consisting of the programmers who were doing the actual implementation of the technology.  The Underground Railroad included a more eclectic group of people interested in the broader aspects of the issues of the role of Health IT in the VA.  Here are some videos of speeches at some Underground Railroad Banquets over the years.

As Chief of Conceptual Integrity of the Underground Railroad, I took the the ethos we were building very seriously.  In addition to my programming interests, I was a keen student of linguistics, particular the Whorf/Sapir hypothesis, Ludwig Wittgenstein, and S.I. Hayakawa.  I was building a speech community to talk about health, across the organizational stovepipes so prominent in large bureaucracies.

Some topics that might interest folks:

Here is my presentation to the US Senate Veterans Affairs Committee on the Future of Health IT.

I talk a bit about the VistA Ethos in this conversation with Ward Cunningham, inventor of the Wiki.

A conversation with Philip Longman, author of Best Care Anywhere, documenting the VA’s dramatic transformation, in part triggered by the introduction of VistA.

An interview with Ross Fletcher, MD, Chief of Staff of the Washington VA Medical Center, discussing how VistA represents a new health care model.

I’ve started the New Health Project to look at the broader implications of health care and information technology.  We’ve had two workshops in California, and one at the W3C offices at MIT. Speakers have included Sci Fi writer/futurist David Brin, Sci Fi writer Vernor Vinge, who coined the term “Technological Singularity,”  Peter Norvig, Director of Research at Google, and others.

I would be very interested in helping NHS understand the VistA Ethos, as well as establish a bridge between US and NHS to continue the conversation.

P.S. The world of VistA as seen within Washington DC beltway is radically different from what happens in the field.  DC operates from a top-down “power” model, while VistA thrived as a bottom-up “energy” model.  So, while I’m sure that there is lots of value to power-based London/Washington connections, the real value to accrue would come from connecting a broader group of the folks who are actually using the software.

I would be happy to help communicate and hopefully, enhance, the VistA ethos.