December 15, 2017

Project 76–An American Affair, Inc.


“VistA is not a code; it’s a process,” is how one of its key developers puts it. This process has fostered a medical culture that by now has put the VA at least twenty years ahead of the rest of the U.S. healthcare system in exploiting the full potential of digitalized medicine.

R—RFI for VistA Open Source (2.0) will position VA another three decades ahead. And this information will help describe two would-be strategic non-profit partners for VA in the development of this technology.

Project 76—An American Affair, Inc. and the New American Foundation (health policy think tank) are not-for-profit entities that complement and can facilitate VA being able to achieve the goals setout in this RFI.

Project 76 for example: is currently taking steps to implement a “Nationwide, Not-for-profit Health Service” (NHS) that will brand; supply capital for; and operate private networks of:

● Non-profit providers (clinics; health centers; hospitals and medical schools);

● Non-profit suppliers (healthcare supply, equipment and solution intermediaries);

● Non-profit health insurers (“Nationwide Qualified Health Plans” and “Consumer Operated and Oriented Plans”); and a

● New, non-profit “open source” health information technology infrastructure (that would be interoperable and support: a national health information database; a nationwide electronic health record; individual lifetime electronic medical records; and multi-state health information and insurance exchanges).

And while New America Foundation (“NAF”) does not intend to play a direct role in healthcare operations, it is seeking grant support, which VA may wish to consider providing, to continue the use of NAF expertise, contacts and influence to develop an initial business plan and take other steps to lay a solid foundation for the launch of a new and “separate” entity that NAF is provisionally referring to as “Vista Total Health Network” (VTHN) of a nonprofit non-government providers to emerge and perform much in the same function as a “civilian VA.”

“The essential idea is to link existing public health clinics, community hospitals and other non-profit healthcare and social service organizations into a digitally integrated, ‘virtual’ network and that by adopting VA’s health information technology platforms (VistA FOIA and VistA 2.0 Open Source); protocols of care; and quality standards, the VTHN would replicate the best features of VA’ delivery system model … building upon the three essential ingredients of VA’ quality transformation:

● The shrewd, widespread deployment of a tax-payer financed health IT (the world renowned “VistA” software system, written by doctors for doctors);
● VA’ scale, integration, and long-term relationships with its patients; and the
● VA’ culture of public service and commitment to science (“through a process of self-selection, VA’s workforce of salaried managers, doctors, and other healthcare professionals tend toward an ethos of service and commitment to medical research above concern for individual profit maximization.”)

The new NHS will furnish the VTHN with:

● Expertise, staff work, and contacts needed to become qualified for newly available federal subsidies as accountable care organizations ($12 billion under the Affordable Care Act and another $17 billion under emerging “meaningful use” regulations of the Health Information Technology for Economic and Clinical Health Act or HITECH);

● Technical assistance in installing and implementing VistA (by arranging “two for one installations – no money down – of the Freedom Of Information Act and the reengineered versions of VistA Open Source software); and by supplying;

● Financial assistance in building capital and reserves (as many VTHN non-profit providers “face short-term cash flow and longer-term capital inadequacies” (Longman, NAF Concept Paper 2010) that make them less competitive in seeking managed care contracts offered by state and local governments. In these cases the NHS will endow VTHN administrators with bridge loans or capital infusions).
Problem Statement

The problem: There exists neither a health information technology, nor a healthcare consumer intermediary in the private sector that is as proven as VistA, or as dominant, influential or effective as the Department of Veterans Affairs is in the public sector.

“The public policy environment surrounding American healthcare has not allowed for the emergence of such an entity until recently.” (Longman, opcit 2010)

“Yet passage of health care reform legislation, (particularly mandates and subsidies created by the Affordable Care Act and HITECH), combined with ongoing trends toward commoditization in the healthcare marketplace, have created a first-time business opportunity to implement transformative change in how U.S. healthcare is delivered.” (Longman opcit 2010) “And account for the current efforts to assemble a VistA 2.0 Open Source powered, civilian VA to become the major mechanism by which health care delivery system reform is achieved, and the means by which a plurality of Americans will receive healthcare within the next decade.” (Longman opcit 2010)

The primary hindrances preventing U.S. healthcare from breaking free of the strangle hold of an unsatisfying, uniformed, wasteful and unsafe delivery system are; antiquated and, more often than not, non-existent health information technology (HIT); squandered economies of scale; and disparate practices and procedures.

And while the Affordable Care Act and HITECH can help change this, they are powerless to do so in an environment of multiple competing HIT platforms, none of which would compare with a reengineered Vista.

As to the squandered economies of scale, the Wal-Mart Stores business model is proof positive that “scale” is routinely exploited for tremendous savings, and that interoperable IT such as Wal-Mart deploys (and that VistA 2.0 Open Source would re-introduce) enables it to see huge operating savings.

There is no excusable alternative for failing to achieve this result in our private, health care economy. Yet, for once in our political system VA is government (as the influential IT consumer intermediary) in the ideal spot to make the HIT (PMR, EHR and HIE) call.

Otherwise, the problem is that there exists no health information technology, consumer intermediary in the private sector that is as proven as VistA or as dominant, influential and effective as VA is in the public sector.


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  1. AlxHamiltn says:

    August 31, 2011 at 6:11 pm • Edit
    Today’s Top News

    1. VA open source custodial agent opens doors

    By David Perera

    The Veterans Affairs Department officially launched Aug. 30 a central body dubbed the “custodial agent” to oversee open source electronic health record projects.

    The body, now going by the official name of the Open Source Electronic Health Record Agent, or OSEHRA (pronounced “oh- sarah”), is meant to be the first step in creating an open source successor to VA and Defense Department EHRs. Code for the VA system–known as VistA–has long been available as an open source download, but the VA has never before intended to incorporate outside changes to the code.

    The joint DoD and VA successor system, the iEHR, “when we get done, will be in the open source,” VA Chief Information Officer Roger Baker told reporters during an Aug. 30 call.

    The DoD and VA posted online Aug. 22 a special notice encouraging vendors “to develop or modify their potential solutions to fit into an open architecture model.”

    “If they want to be in that category of having the DoD and VA use their standard as a common standard and potentially promulgated across the country, we think a really good way to do that would be to make certain that it’s either in the public domain or in an open source vehicle with appropriate widely-available licensing,” Baker said.

    The iEHR will rely on an enterprise service bus for data portability, Baker also said. The ESB “will be the absolute heart of the EHR, because that’s how all of the various modules will plug together,” he added.

    For more:

    – go to the OSEHRA website

    – listen to the Aug. 30 Roger Baker press call

    Related Articles:

    Spotlight: VA awards contract for iEHR open source custodial agent
    iEHR will be in place 4 to 6 years from now, says Baker
    In North Chicago, a glimpse of the iEHR to come

  2. admin says:

    Nationwide Not-for-profit Health Service and “Vista Total Health Network” (2.0) August 25, 2010

  3. AlxHamiltn says:

    The White House

    Office of the Press Secretary

    For Immediate Release September 12, 2011
    Presidential Proclamation–National Health Information Technology Week




    Technological advances have always driven America’s economy forward and improved the lives of our people, from the industrial innovations of the nineteenth century to today’s cutting edge science. Progress in our Nation’s health care system is no different, and hinges on the work of hospitals, private practices, and information specialists as they modernize our health information systems. During National Health Information Technology Week, we highlight the critical importance of secure and efficient information systems to improving the delivery of health care in the United States.

    Health information technology connects doctors and patients to more complete and accurate health records. Tools like electronic health records and electronic prescriptions help patients and providers make safer, smarter decisions about health care. This technology is critical to improving patient care, enabling coordination between providers and patients, reducing the risk of dangerous drug interactions, and helping patients access prevention and disease management services. It is currently being used with great success to coordinate and improve care for members of our Armed Forces, as well as our Nation’s veterans. Better technology can also cut costs for providers by reducing paperwork and duplicative tests.

    Ensuring the security of health information records is a top priority for my Administration. The American Recovery and Reinvestment Act, passed in 2009, promotes the use of Health IT while significantly strengthening Federal laws protecting patient privacy. Entities violating privacy laws are now subject to increased penalties. The Recovery Act also provides landmark financial incentives to eligible professionals and hospitals that adopt and meaningfully use electronic health records while protecting the privacy and security of health information.

    Everyone can play a role in improving our health care system. An important part of this vision is recognizing the pivotal role patients play in maintaining and improving their own health. Patients can work with their doctors to access information about their care. And those who design and implement Health IT systems can enable software that puts patients and their families at the center of their own care, empowering and engaging them in reaching their health goals.

    America is home to the world’s best universities and technical schools, and the most creative scientists and entrepreneurs. As we challenge ourselves to push forward into a new century of health technology, we will continue to foster and promote the innovative spirit that has made our country what it is today.

    NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 11 through September 17, 2011, as National Health Information Technology Week. I urge all Americans to learn more about the benefits of Health IT by visiting, take action to increase adoption and meaningful use of Health IT, and utilize the information Health IT provides to improve the quality, safety, and cost effectiveness of health care in the United States.

    IN WITNESS WHEREOF, I have hereunto set my hand this twelfth day of September, in the year of our Lord two thousand eleven, and of the Independence of the United States of America the two hundred and thirty-sixth.


  4. AlxHamiltn says:

    1. Report: SGR reckoning will be damaging to Medicare, providers
    By Ron Shinkman Comment | Forward | Twitter | Facebook | LinkedIn

    The nearly decade-long series of Congressional delays in implementing the sustainable growth rate (SGR) formula for Medicare has the potential to create significant fiscal damage to the program, its participating physicians, and perhaps even the creditworthiness of the provider community, reports MedeAnalytics.

    “Putting off reform of the SGR even for a year would result in implementation of a very significant decrease to Medicare physician fees in calendar year 2012,” said Ken Pererz, a Medeanalytics vice president who authored the report. Currently, the physicians are scheduled to undergo a 29.5 percent fee cut as of January 1.

    However, Perez also cautions that the so-called “permanent fix” to SGR will also “impose costly years of reckoning.” And implementing another temporary fix–which has been customary over the past decade–would only increase the cost of any permanent solutions.

    “Although arcane and heretofore obscure, SGR reform merits entry into the calculus of deficit reduction and will be factored into the appraisal of our nation’s creditworthiness by the credit rating agencies,” Perez said.

  5. AlxHamiltn says:

    1. Hospital fraudulently forced into bankruptcy, attorney says

    By Alicia Caramenico

    Already criticized for giving its CEO a $600,000 payout, the financial actions of Hoboken (N.J.) University Medical Center are once again the subject of scrunity. This time, the former attorney for Hoboken University Medical Center said the city fraudulently pushed the hospital into bankruptcy, leading to his resignation, reports Herald News.

    According to Donald Scarinci, who acted as general counsel from 2009 until July 16 of this year, Hoboken Municipal Hospital Authority held back millions in contractual payments so that the facility appeared to be in financial distress.

    “I was the firsthand witness to a pattern of conduct by the Hoboken Municipal Hospital Authority board members to intimidate, threaten, control, abuse and attempt to force the CEO of [the hospital] and members of the board to take actions adverse to its charter and otherwise violate the laws of the state of New Jersey,” he said in a court document filed yesterday.

    The Hospital Authority attorney didn’t respond to the fraud allegations, claiming they have no factual basis, notes the Herald.

    As bankruptcy gains traction as a business option for hospitals and cash-strapped facilities are looking for ways to manage their obligations, hospitals should be cautious in filing Chapter 11 papers, as the public is growing increasingly skeptical of hospitals’ motives.

  6. admin says:

    Friday, September 16, 2011

    Report: Medi-Cal Cuts Could Harm Millions of California Residents

    Medi-Cal cuts could create risks for millions of Californians who depend on the program for treatment of chronic or terminal health conditions, according to a new report, Kaiser Health News’ “Capsules” reports. Medi-Cal is California’s Medicaid program (Barr, “Capsules,” Kaiser Health News, 9/14).

    The patient advocacy group Families USA, the American Cancer Society, the American Diabetes Association and the American Lung Association collaborated to produce the report, which is one in a series of reports examining how many people with certain chronic diseases access medical care through Medicaid.
    The report on California — released at the same time as reports on Illinois, New York and Texas — comes as the congressional debt-reduction “supercommittee” seeks ways to slash the federal deficit by $1.5 trillion (Pecquet, “Healthwatch,” The Hill, 9/14). The debt panel is expected to look closely at Medicaid because the program’s costs are growing at an unsustainable rate (“Capsules,” Kaiser Health News, 9/14).

    Key Points of California Report

    According to the report, cuts to Medi-Cal could force many California residents with serious medical conditions to forgo filling prescriptions, visiting a physician or receiving key health screenings (Families USA release, 9/14).

    The report noted that Medi-Cal covers millions of Californians who have serious health conditions, including:

    About 1.2 million stroke patients or people with heart disease;

    About 850,510 people with chronic lung diseases;

    About 562,720 people with diabetes; and

    About 140,340 people with cancer (“Capsules,” Kaiser Health News, 9/14).

    California Healthline is published daily for the California HealthCare Foundation by The Advisory Board Company.


    Paul Billings — vice president of national policy and advocacy for the American Lung Association — said that Medicaid cuts could result in higher health care costs and more emergency department visits (Families USA release, 9/14).

    Christopher Hansen — president of the American Cancer Society Cancer Action Network — said the debt panel should make clear the importance of the health care safety net (“Capsules,” Kaiser Health News, 9/14).

  7. AlxHamiltn says:

    EMR and HIPAA via to me

    If You Had a Healthcare IT Audience…What Would You Say? – EMR and HIPAA

    If You Had a Healthcare IT Audience…What Would You Say?
    Posted: 16 Sep 2011 01:41 PM PDT

    I’ve been really intrigued lately by the changing media landscape. Things like Blogs and Twitter are providing opportunities for basically anyone to be able to share a message with the world. Certainly, many of the blogs don’t get read and a tweet on Twitter falls off people’s radar very quickly. However, some of the better or more interesting ones rise to the top and provide an interesting and sometimes dissenting voice to the conversation. Personally, I think this type of open discussion around topics is valuable and beneficial as long as people maintain a certain level of respect and decency.

    My question to you then, is what would you say to a Healthcare IT audience?

    As I considered on this difficult question myself, I decided the message that I would want to deliver: You can resist all you want, but the future of healthcare will require IT.

    Pretty much every day, someone comes on this site to talk about the benefits and challenges associated with EMR and EHR in their office. As I’ve listened to the various challenges that people have posted, I’m sympathetic to them. However, almost all of those I’ve heard boil down to poor EMR selection or poor EMR implementation.

    To me, the EMR selection is the absolute most important part of the EMR implementation process. Far too many doctors and clinics don’t take the time and effort that’s required to really go through a proper EMR selection process. I’m very sympathetic to them for a lot of reasons (ie. It’s not their job or interest, there are 300 EHR vendors, there aren’t great resources for differentiating EHR, there are a lot of perverse incentives, etc). However, it’s worth the cost to do it right. Otherwise, you should wait until you can do it right.

    However, I believe that EMR is still only one small part of how healthcare IT is going to impact healthcare. Just last night I was at a local event and someone who use to work in the casino industry has been working for the past year or so on an app that helps improve doctor to doctor communication. Fascinating stuff.

    Personally, I see us just at the very begging of a revolution in healthcare IT. IT is going to start invading every part of healthcare and will pretty much be impossible to avoid.

    Certainly there will be some (possibly many) who continue to resist the adoption of technology in their clinic. However, I’m seeing more of a shift by patients and doctors that are interested in finding more ways to integrate technology into their healthcare. Most of the doctors aren’t sure what to do next, but they’re looking.

    I can certainly understand and appreciate those that say that the current EMR and healthcare IT offerings aren’t up to snuff. The fact is that many of them aren’t. However, that doesn’t change my belief that IT is still going to change how healthcare is provided. It just may mean that healthcare will be changed by an IT offering that most of us don’t know about today.

    My greatest wish would be that we could close the case on whether healthcare IT is important and/or it can change healthcare. Instead, let’s put our energy into finding the ways that it can change healthcare IT for good. All of us focused on using healthcare IT and EMR for good in healthcare would produce some amazing results.

    • AlxHamiltn says:

      You can join NHS now, before you realize you must to start over or you can join NHS later, after you have come to that realization. But, you will, join us because a not-for-profit, global, health information database that provides uniform access to standardized public and private health records and medical information IS the salvation of health care as a right, not a privilege.

      It is uniform; standardized; cost effective (free); safer; produces better outcomes; and is very MUCH more satisfying for patients AND caregivers.

  8. AlxHamiltn says:

    Harnessing the Power of Data: Todd Park’s Vision for Rebooting U.S. Healthcare
    by BRIAN KLEIN on Sep 26, 2011 • 11:14 am 1 Comment

    The Department of Health and Human Services (HHS) hasn’t traditionally been thought of as a bold, risk-taking agency. HHS Chief Technology Officer (CTO) Todd Park has been working hard to change that. Park, who co-founded healthcare technology firm Athenahealth and later Castlight Health, was offered his current position two years ago. HHS asked Park to come work for them as an entrepreneur in residence. “The [CTO] job title is a little bit of a red herring; I actually don’t run technology at HHS. I’m 100% focused on being an internal change agent,” Park said at a recent roundtable meeting with journalists on September 23. His main task is to help the agency figure out how to tap “the power of data and technology in innovative ways to improve the health of the American people.”

    “They brought me in as an entrepreneur,” Parks says. “But what I would say is that the most entrepreneurial years of my life have been the last two, because [HHS has been] launching initiatives that behave very much like Silicon Valley startups,” he explains. “There are interdisciplinary teams that work on Silicon Valley time in hyperrapid cycles in a really lean, startup style way. And these incredibly talented groups of HHS-ers have done just incredible things.”

    The first example Park cited was the Health Data Initiative. “Basically it’s an initiative to turn HHS into what we are calling the NOAA [pronounces “Noah”] of health data. “NOAA actually, pretty famously, not just collects tons and tons of weather data, but publishes it online in machine-readable format, downloadable by anybody for free without intellectual property constraint,” Park says. “It then feeds a massive array of private sector innovations like Weather Channel,, iPhone weather apps, etc. that creates huge value for the American people.”

    Park also points out the availability of GPS data, which was made public in the 80′s. That data now feeds everything from FourSquare, supertanker navigation systems, and everything in between, he says. The Health Data Initiative is an attempt to do the same thing for healthcare. “We want to open up the data and stimulate massive private sector innovation play—this time, with vast amounts of health-related data that are sitting in the vaults of HHS.”

    HHS is releasing data that has never been released before and also improving access to data that has already been published. “[This data] has been public in the sense that it’s in books, PDFs, and static webpages, and we’re turning it into forms that developers can actually use,” Park explains. This will “enable the data to become liquid and then be used as fuel for other applications, services, and products.”

    “We are marketing the bejesus out of our data to the innovators of the country,” Park says. Park referenced an “unscientific, but pretty definitive survey of innovators” that indicated 98% of the people capable of doing stuff with didn’t even know that we had this data, let alone that we were making it available to them.”

    An Ecosystem of Innovation and Joy’s Law

    HHS has set up a site to help get the word out that this data is available: The objective is to “[stimulate] innovators to use our data as fuel in applications, products, and services that improve health and healthcare, and create jobs at the same time,” Park says. The real goal behind the efforts is to “stimulate the emergence of an ecosystem of innovation that sits on top of open health data,” he adds.

    “The fundamental precept that drives the whole thing is one our favorite laws in the universe—Joy’s Law,” he adds. “Bill Joy, the co-founder of Sun Microsystems, famously said once that no matter who you are, you have to remember that most of the smart people in the world work for someone else.”

    Park seeks to exploit Joy’s law to drive innovation. As he explained at the roundtable discussion:

    And so the whole underlying assumption behind the Health Data Initiative Forum is that the best way for us to have our data to have a positive impact is not just for our own smart people to use it, but for all of the other smart people in the world to be able to get access to it and use it to improve health and healthcare.

    Maybe the best example of how it has mushroomed is […] “Health Data-Palooza.” (I think the formal name was the Health Data Initiative Forum, but I keep calling it the “Health Data-Palooza.”) And it was executed by the Institute of Medicine and by HHS in Bethesdsa, Maryland, actually. And we issued a open call for people to submit proposals to do TED-style talks—basically short, focused presentations of services, applications, solutions they had built that were powered in part by our data that helped consumers take control of their own health and healthcare, get the information that they need, help doctors and hospitals deliver better care, help employers promote health and wellness, help journalists write better stories, help mayors make better decisions, etc. And the criteria were: they had to add value for one of those constituencies in a very concrete way and secondly, the innovation had to have a sustainable business model. So we weren’t interested in [something analogous to] concept cars that no one would drive; we only were interested in services that could be delivered to actual people, today. Even with those criteria, only 18 months into this, we were overwhelmed by the number of people who had solutions that were compelling. We ended up doing an American Idol-style bake off process, where the innovators would present and the judges would give thumbs up or thumbs down.

    We like to joke now that I was Paula Abdul. I was weeping constantly in joy. Greg [Downing] [Program Director, Personalized Health Care Initiative at HHS] was Simon Cowell saying, well, I don’t know. So with Greg’s help we were able to narrow it down to about 50 companies and other organizations that had deployed these incredible solutions and, if you are curious to see what they are all about, you can go to the Institute of Medicine’s website and look up the June 9th, 2011 Health Data Initiative Forum and you can see all 50-some presentations and they are incredibly inspiring and just illustrate how beautifully out of control this whole ecosystem is already.

    Park adds that there a number of other initiatives and policies that are in place, like ones mentioned above and the CMS Innovation Center, “that are explicitly meant to catalyze innovation across the country.” Of course, it’s important for innovators to actually know that this work is going on. “So, we’ve been doing a ton and we are going to do a lot more outreach to the innovator community to help them understand what we are trying to do to be helpful and, A, you know, we hope that helps to catalyze activity, which it definitely has been, and B, get feedback about what we are doing so we can actually improve it. Because the point of all of this is work is to support them.”

    Editor’s Note: This blog post will the first in a series. Check back soon for more with Todd Park…

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