We want the NHS to adopt VistA. But rather than have it imposed on the NHS top-down, we VistA to spread organically, one NHS organisation at a time.
Eight steps to make NHSVistA a reality
- Gold Version - secure funding to adapt the VA version of VistA into the NHSVistA gold version. This will be a one-off cost and is estimated at £15-20 million. Funding could either come from a central source and/or from a group of contributing NHS Trusts
- Non-profit organisation - establish a non-profit organisation to maintain the NHSVistA gold version and to provide MUMPS training to software developers and NHS clinicians who are software enthusiasts
- Volunteer hospitals - a small number of NHS hospitals volunteer to implement NHSVistA
- Adaptations - volunteer NHS hospitals can make adaptations to VistA to suit local requirements. Changes can be made either by in-house staff or by contract with any appropriate supplier. All changes must be published openly and ensure continued compatibility the UK gold version, including the capture of all mandated data elements in a prescribed, standardised, format
- Darwinian improvement - the non-profit organisation incorporates successful adaptations into the latest version of NHSVistA gold version, leading to Darwinian improvement
- More hospitals - based on the experiences of the early adopters, other hospitals begin volunteering to implement NHSVistA themselves
- Primary care & social care - a few GP clinics and social care departments now volunteer to adopt NHSVistA as their clinical record system so that they become fully integrated with the NHSVistA hospital record
- Ecosystem -a self-sustaining IT ecosystem develops across the NHS, with VistA providing a clinically-led electronic health record system that is low-cost, fully integrated and continually improving and the nonprofit organisation ensuring careful regulation for the gold version
The important point to note is that our 8-step plan is not another big IT Project – at least in the traditional sense of involving a top-down, multi-billion pound procurement. Instead, we are proposing a relatively small central project (the development and maintenance of a gold version) followed by a modest, bottom-up, voluntary, organic, iterative process.
We are proposing the following model:
adapt → pilot → modify → pilot → roll-out-as-demanded
We expect that the open nature of VistA will inevitably lead to a self-sustaining evolution of NHSVistA. Local enhancements that are beneficial will become incorporated into the NHSVistA “gold version” and then made available across the health service.
Finally, it may also be worth noting that in the new era of austerity, NHS hospitals and Clinical Commissioning Groups will be looking for IT solutions that not only improve the quality and safety of their service, but which also reduce costs. VistA has a proven record of delivering on both counts.