The model development activity of the Veteran’s Administration actually began within the National Bureau of Standards of the Dept. of Commerce during its collaboration with the Dept. of Health Education and Welfare beginning in 1972 in developing the Programming language "MUMPS" implementation environment as an information management host environment for the kinds of projects that were being funded individually by DHEW for early EHR pilot systems. It was reasoned at that time that if a common host implementation environment were agreed upon as an ANSI Standard, then federal healthcare agencies, and their patient clients, should benefit through the services provided by these healthcare agencies. The then Chief Medical Director of the VA, Dr. John Chase, recognized this opportunity and organized a special "Computer Assisted Systems Staff" in 1977,directed by J.T. O'Neill, to utilize the new ANSI standard programming language in developing an architecture of information management functional components that could be configured to the needs of the 172 VA hospital facilities then existing. This was an EHR model development on a larger scale than ever attempted and is described in reference Axx noted in this website. Its significance was that it would attempt to define and create common functional modules that were based upon a perceived consensus framework for many of the key underlying concepts that had yet to be addressed by the participating professional specialty disciplines and their societies and to begin use of the information architectures based upon these concepts by means of a common organizational approach throughout the VA Healthcare System. This effort accelerated during 1978 and 1979 but was abruptly terminated in early 1980 when the administrative data processing activities within the agency perceived the extent and dominance of the information activities that were supporting patient care when compared with those supporting administration. These administrative disciplines attempted to take over these care-support functions and to incorporate them into routine administrative and resource management processes, not reckoning with the completely different and complementary nature of the two perspectives. This step was a complete failure and the results were adequately demonstrated to both Congress and to the current Administration by 1982 when the original approach was ordered to be reinstated.

 From:http://www.va.gov/sta/facility.asp?ID-=120

 Following reinstatement of the original project structure beginning in 1983, the model development was organized by designating development teams located at individual VA Hospital sites to work on particular core functional modules that would be exchanged with all other developing sites in order to assemble at those sites and then test an initial core basic architecture that was interoperable, both conceptually and technically, within each of the individual sites. Because of the conceptual core commonality, the architecture was also able to be interoperable within the VA as a Healthcare Enterprise and, later, interoperable among the architectures that evolved in the other federal healthcare agencies such as the Dept. of Defense and the Indian Health Service of the now Dept. of Health and Human Services. Moreover, during this era the individuals within the VA who were involved in implementing the functional components were also now involved in the development of the concept implementation-independent standards that reflected the underlying meaning of the concepts used all across healthcare and which are part of the healthcare informatics standards now available. This participation in health informatics standards activities helped the VA solve the problem of fragmentation of these core concepts of data representation and data structure that had plagued all model development efforts prior to this project structure.

It is important to recognize not only the critical nature of the vision of the original Project Director, Mr. J.T O’Neill, as it was applied to the VA but also the validity of that vision for the health informatics standards activities in the US and worldwide that are now underway and which was stimulated by this model development. The vision applies to both conceptual and to implementation dimensions for all healthcare enterprises and professional specialties that expect to interact during healthcare delivery and to deal with the population healthcare problems now facing world societies. The vision extends across national boundaries and professional specialties. It was this model development that opened mindsets to the scope and variety of activities that would be needed to realize an Electronic Health Record in modern society. It still remains the driving vision and target but the vision has solid demonstrable evidence that it is not only achievable but also well along towards delivering the envisioned benefits through the resulting VA architecture, originally called Decentralized Hospital Computing Program (DHCP) now called Veteran’s Integrated Systems Technology Architecture (VISTA). VISTA is an architecture that can be adapted, and has been adapted, for example, by the State of Washington and several foreign countries, to serve non-VA and non-federal healthcare enterprises, thus demonstrating the value and validity of the underlying conceptual constructs even though they are still incomplete and not fully comprehensive. The details of these conventions will be probed in other Segments of this Website.

   Courtesy of J.T. O’Neill                         Courtesy University of Washington School of Medicine Alumni Office