The VA and VistA:
A Role Model for
Radical Improvement
of Health Systems
Phillip Longman
Senior Research Fellow
New America Foundation
Senior Fellow
Washington Monthly
Tom Cruise’s depiction of life in
a Bronx VA Hospital, 1989
Sample dialogue: This place is a
f***ing slum!
Articles About VA’s Quality Revolution
“ . . . Overall, VHA patients receive better
care than patients in other settings”
Elements of VA Quality Revolution
 Fully integrated, patient-centered, evidence-based care.
 Focus on wellness, prevention, and effective disease
 Low rates of medical error.
 Realized economies of scale (drugs, medical supplies and
 Low cost per patient.
 High rates of patient of satisfaction.
The History of the Hard Hats
“There is no reason
for any person to
have a computer in
their home”
~Ken Olson,
President, Digital
Corporation, at the
Convention of the
World Future Society,
Wally Fort
George Timson - 1980
 MUMPS (Massachusetts General Hospital Utility MultiProgramming System), or alternatively M, is a programming
language created in the late 1960s, originally for use in the
healthcare industry.
 It was designed for the production of multi-user database-driven
applications. It predates C and most other popular languages in
current usage, and has very different syntax and terminology.
 Appeared in 1966
 Designed by
Neil Pappalardo
“Hard Hat” Greg Kreis
The Origins of VistA
To overcome a Central Office ban on personal
computers, “Hard Hats” ordered and then
modified word processors designed for secretaries.
A Two-User Wang 3300 System, circa 1970
Open Source before Open Source
VistA today
The Proprietary Threat
Code Red:
How software
companies could
screw up Obama’s
health care reform.
Washington Monthly
July/August 2009
VistA 2.0?
 “VistA is not a program; it’s a process”
Rick Marshall
Executive Director
VistaExpertise Network
VistA 2.0?
 Question: Should VistA be established as a national
 standard? What are the implications of this action?
Answer: Given the resources that VA has expended to
date and can bring to bear in the future, VistA 2.0 could
become the international standard for medical center
information systems. This could result in huge financial
savings in the healthcare community, but VistA 2.0 could
result in huge advances in evidence based medicine,
medical research and data standardization and
 American Council on Technology, VistA Modernization, “Legacy to
Leadership” Report, May 2010
Phillip Longman
Senior Research Fellow
New America Foundation
Senior Fellow
Washington Monthly