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 Post subject: Transactionalized VistA
PostPosted: Fri Nov 12, 2010 8:36 am 
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Joined: Fri Nov 05, 2010 5:50 am
Posts: 19
Location: Pittsburg, California
Real Name: Chris Richardson
Began Programming in MUMPS: 07 Sep 1977
This is an idea whose time has come. The VA has worked hard to centralize patient information for over 5 years. The effort has been to move the patient information away from the point of care to a central location at a regional data center perhaps hundreds of miles away. While this would look like a savings, it is actually a huge amount of duplication which has left a lot of eggs in a single basket. Single points of failure abound (power coupling failure, water-sensor faulting and shutting down the regional data center) and the biggest hit of all is the massive amount of bandwidth required to handle all of the healthcare providers at say 20 hospitals, is response time. A doctor has about 14 minutes to see a patient. Frequently, it can be 8 minutes spent waiting for the screens to be filled and 6 minutes actually working with the patient. While there are huge band-width lines from the medical centers to the regional data centers, the lines to the clinics is usually much more austere. By moving the patient data closer to the patients again, we can complete these transaction (most of the time) in the local area network, then extracting the completed transaction as an atomic update to the patient record and sent up the line.

While the patient data may be at the medical center, the complete patient clinical record can be located at the ward, and the regional as well as the national repository. The changes, for the most part, come from the point of care. It is critical that this data is there and the transactions can be completed there at the point of care and then sent up as atomic transmissions. Then the network can break at any point and the ward and the point of care can carry on and provide complete service (except for scheduling in the event of an outage). But that happens only worse with the regionalized model. Outages can be local or systemic. The transactionalized system need only keep accumulating these transactions during the outage. The atomic transactions flow upward to the medical center to update the patient record there, and then to the regional and then to the national data repository. If such a system existed during Katrina, there would have been much less data to recover and the records fro most patients moved out of the area could have been recreated anywhere in the country in a very short time as they started showing up at remote data centers.

What we are proposing here is

File comment: This is a white paper on the topic and it is open for discussion. The numbers at the end of the file name are a File Manager data. This is a work in progress.
Transactionalized VistA-3101109.odt [36.55 KiB]
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 Post subject: Re: Transactionalized VistA
PostPosted: Fri Nov 12, 2010 8:40 am 
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Joined: Mon Nov 01, 2010 1:58 pm
Posts: 205
Location: Seattle, Washington
Real Name: Frederick D. S. "Rick" Marshall
Began Programming in MUMPS: 15 Jun 1984
Congratulations to Chris on being the first to try out attachments on Mumpster. He found we needed to adjust the system configuration to allow it.

Frederick D. S. "Rick" Marshall, VISTA Expertise Network, 819 North 49th Street, Suite 203, Seattle, Washington 98103, (206) 465-5765, rick dot marshall at vistaexpertise dot net
"The hidden harmony is best." - Heraclitus of Ephesus

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