Screenshots

Here we include some screenshots from the application to illustrate the key patterns

This is the landing page, which begins with a chart for all those patients registered in the system

You can see this is within a standard viewport, with north west centre east and south panels.

This UI pattern is aimed at one of the 3 key process levels seen in healthcare, ie aggregate data for research/audit/performance management, eg dashboards etc

A click onto one of those chart then takes us into the next level

Here we see the second level which matches a common pattern in healthcare process, managing discrete groups of patients, eg all those in the Emergency Department, in a particular ward or outpatient clinic

We see the same patterns are used, a standard viewport, with north, west, centre, east and south panels

Here the grid is used in the centre, which can be sorted many ways, with icons for further steps into the next level of detail..

Here a patient has been selected from the Patients Group grid. Again the same view port is used to view this deeper level of detail.
The patient detail data can be grouped by episode or sorted based on other elements.
As a particular element of patient detail is selected the detail is displayed in the east panel.

Also note the filters in the west panel that allow us to filter the patient detail.

Finally see below the pattern used for data entry, with a popup to indicate that this is a transient process …

 

 

Following the initial 10days of development, during the VistA Community Meeting (over 2 days), a small team worked on applying this ClinUiP framework onto an existing VistA test box. See the result below..

 

Tony

9 thoughts on “Screenshots

  1. sorcerer says:

    The video is a very nice overview of what you intended to do. 2 questions. The GUI you built from Lumsy is just a quick GUI demo you want to get your interpretation of what kind of info you can extract from vistA. Correct? Secondly, on your 3rd last slide, you outlined what you might do to work with vistA and others in open source project such as openEHR. Isn’t openEHR’s 2 levels modelling scheme not compatible with vistA? Also, vistA uses HL7 and openEHR uses ADL archetype and templates (??). I don’t think these modules are compatible with each other. How would one go by integrating opensource projects like these?

    • Tony Shannon says:

      Thanks for the comment. (I’m sorry I don’t know your name)

      The Lumzy demo is/was intended to give a hint as to what data you could take from/enter into VistA.. or a.n.other system. With the right architecture in place, in my view, it’s at least possible to pull data from several sources into the 1 UI framework, attribute the source (eg Problems 1&2 from VistA, Problem 3 from an.other system), then let the clinical professionals use that data as they see fit..

      On the question of VistA/openEHR alignment, its true that there are no particular joins between these efforts at the moment. However I don’t see any reason why in time these efforts can’t be more closely aligned and integrated. In fact over time I think that will happen.
      My instinct is that VistA could benefit from the 2 level modelling approach to openEHR. In a way if you look deep into the VistA code case I sense some of the same principles already at play…. i.e. in terms of reusable components being called by other elements of code for instance. I’m not a VistA expert but thats a subject I would like to see discussed further.
      Effort is required to align the code bases of course, but openEHR could/should also benefit from the learning that implementation within VistA would bring..

      Good questions, happy to explore further..

      Regards,

      Tony

  2. sorcerer says:

    Tony, thanks for the feedback. Like you (but I am on amateur level), I am exploring the virtual of both VistA and openEHR models. I can find some implementation architectural diagrams for openEHR, I google to death and failed to find any architectural functional diagrams for VistA. I looked at affiliated projects liike openVistA, worldVistA – no help there either. Do you have a links to any such highlevel schematic diagram for VistA? If you do, would you be kind enough to provide the link please?
    Thanks in advance.
    John

  3. sorcerer says:

    Hello Tony,
    Thank you for the WEALTH of information!! Much appreciated.
    Regards,
    John

  4. sorcerer says:

    Tony,
    Few questions to your references.
    1/ Architecture of VistA: In Rick Marshall video, I find this video is a good intro to VistA. However, I sensed a couple of odd facts. First, Rich shown 2 versions of legacy system architectures that he is aware. Then went on and presented his onion layer model. VistA started mid-1980’s and has been working for 20+ years. Do you find it odd that there is no official architecture diagram for this project? (Isn’t it true that for a project to develop, there got to be a clear layout plan first? Otherwise the entire project is ad hoc at best.) Is Rick onion diagram a new interpretation/implementation of VistA?
    2/ Fig3 in the paper “va_rfi_gui_iehr_sept2011.pdf” is very informative (BTW, thank you very much for the link). I sensed OSEHRA is replacing VistA and the other system in a few year. Correct? If this is correct, wonder why Rick still give “new interpretation” of VistA architecture?
    I understand you are presenting your vision of an open source based EHR. While I was googling EHR, I ran into this article: http://www.huffingtonpost.com/stephen-soumerai/dont-repeat-the-uks-elect_b_790470.html
    Is the content of this news clip correct? In other word, there is still no such thing as a national EHR program in UK?
    Do you think where you are, no matter what you (and others) do, you still run into the same problems described in this news clip?
    I read a paper by Prof. Huang from USC. There is a EHR implementation in Hong Kong. It is a government project. It works very well. I think Singapore has similar program in place too. Why do these places success whereas the one described in the above link failed? Could the root cause be propriety SW from private companies coupling with the size of the project? (I guess I am asking what are the lessons learn.)
    Regards,
    John
    P.S. Good luck to your GB team in the Olympics.

    • Tony Shannon says:

      Thanks John,
      Will try to tackle some of these..

      1) Architectural diagrams of VistA.
      Id suggest directing this Q at Rick Marshall.. but in my opinion it is not odd to have started an IT programme without a clear layout plan.
      The key difference here is between agile and waterfall methods of software development which is mentioned in the presentation. Worth reading up from a software engineering text.. The history of VistA is very much agile and agile fits well with complex systems such as healthcare, hence the agile nature of this 10day project. Contrast with Waterfall eg NPfIT which is prone to failure in complex systems such as healthcare.
      The Onion Diagram hides much of the complexity and the patterns with VistA. I think the patterns within VistA have been poorly explained by the VistA community to date. ie they need to be able to explain them better to newcomers. My instinct is they would say the patterns are within the code! (which is hard to understand if new to this scene).
      Will hold comment on whether iEHR will be more agile or waterfall.. time will tell..

      2) VA replace VistA in a few years?
      No I dont think so. I think VistA will find a means to renew itself ,eg via EWD and other means of abstraction for a start..

      3)National Programmes & IT.
      Well certainly these are prone to risk and poor results (in my experience of the NHS IT Programme..
      see
      http://frectal.com/book
      and
      http://frectal.com/book/healthcare-change-the-way-forward/healthcare-change-why-%E2%80%9Copen-source%E2%80%9D-is-part-of-the-recipe/
      for more on this..
      I would share concerns about the US Health IT efforts, though at least the principles of “Meaningful Use” should in theory aim to ensure earlier benefits. The VA leadership in the OS space means they understand this is complex systems stuff..
      Not familiar with Hong Kongs plans but I know Singapore has good folk involved who are trying to do things well. Again not sure of the results of late..
      So hard to say they have succeeded yet! Happy to look at evidence if you have it.
      My view is those that succeed understand the right mix of people (esp clinical leadership); process (Lean Thinking etc) and Technology (as enabler) and importance of an evolutionary approach.

      At an international level the effort involved will remain considerable until there is more effective collaboration in this space.. which will require greater use of open source software, hence efforts like ClinUiP!

  5. john says:

    Tony,
    Again thank you for the wealth of information. It will keep me busy for a while.

    I am not familiar with any systems in Asia as I am in the US. I just read a lot:(
    Regarding the system in Hong Kong, it is described as a detail example at the second half of the paper which is listed as article 11 “Short History of PACS, Part 1” at
    http://www.ipilab.org/People/Bernie%20Huang.php
    I think that system is successful, because AuntMinne had an article on it last year
    http://www.auntminnieeurope.com/index.aspx?sec=sup&sub=pac&pag=dis&itemId=605570

    Have a terminology question. EMR is part of EHR, correct? I think these 2 terms are misused in a lot of publications (web in particular).

    From this blog, I saw you were at US (NIH) for a while, do you know is EPR being regulated by HIPAA at all or HIPAA only have jurisdiction (such as patient privacy & security) on EHR and EMR?

    Also, in the passing, you said somewhere in this blog that you are not sure how long this blog will exist. Are you planning on closing this down soon? I am liking this intellectual exchange.
    Regard,
    John

    • Tony Shannon says:

      John

      The Hong Kong review looks good, but without the source code its hard to comment further!

      I wouldn’t worry about agreeing EMR/EHR definitions, folk spend hours/days on debating definitions.. I’d suggest you look to build stuff that works.

      My time in Washington DC was at Washington Hospital Center with the developers of what became Amalga, so not NIH.
      http://en.wikipedia.org/wiki/Microsoft_Amalga
      So can’t comment on your HIPAA question.

      No plans to end the blog anytime soon, but its future depends on where ClinUiP goes next..

      Tony

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