Tom Munnecke

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There seems to be a resurgence of interest in the VistA hospital information system for the US Department of Veteran's Affairs.  Originally called the Decentralized Hospital Computer Program (DHCP), it was installed in 172 VA hospitals nationwide. This software has now been released as open source WorldVista.  Here is a history of the early development of the software.

The Centers for Medicare & Medicaid Services (CMS), and the VA are collaborating to configure VistA, the VHA’s Electronic Healthcare Record (EHR) technology, to the private physician office setting. VistA-Office EHR will include existing VistA functions of order entry, documentation, results reporting, etc. It will be enhanced in the areas of physician-office patient-registration; interface to existing billing systems; and reporting of quality measures.

I was one of the architects of this system, both as a VA employee 1978-1986 and as a vice president/chief scientist at Science Applications International Corporation (1986-2002).  I will be collecting some of my papers and notes from years back on this page.

I consulted with the Indian Health Service adoption of the software, which they called Resource and Patient Management System (RPMS).  I was the first MUMPS programmer hired by SAIC to port the software to Department of Defense hospitals world-wide, in the $1.6 billion Composite Health Care System (CHCS) I also consulted with the MUSTI project in Finland, helping to adopt the software for the Finnish National Health system.  I also visited the Finnish adaptation of the DHCP software in Nigeria  in 1993.  I consulted

I was the co-developer of Hyper-M, a tool used by Partners Health Care for their hospital information system at Brigham and Women's Hospital in Boston.  I have consulted or lectured on large-scale hospital information systems in England, Germany, Japan, Switzerland, France, Australia, and Spain.  I was a member of the ANS standardization effort for the MUMPS language, as well as an officer/board member of the MUMPS Users' Group.

Timeline

June 1978 I Drew initial "Onion Diagram" of the DHCP software on a placemat at Coffee Dan's restaurant in Loma Linda.  This diagram became the core architectural icon for the entire software project.  At its core was a single language with one data type, 19 commands, and 22 functions.

December 1978 Oklahoma City meeting, in which we planned the general architecture of the system, including plans for growth to DoD and Indian Health Service.  (see overheads)

1979-1981 Initial Development.  I co-designed the FileMan, basic toolset, did treatment planning software.

1982-1983 Success of the Underground Railroad.  I printed up membership cards, passed out "Outstanding Engineering on the Underground Railroad Achievement Awards" to hardhats; "Unlimited Free Passage on the Underground Railroad" awards to Jack McDonnell, staffer to Sonny Montgomery, and Chuck Hagel, then deputy administrator of the VA.

1983 After brief use of Confer II, and consultation with Bob Parnes, its author, I write MailMan as a tool to bring together the many "stovepipes" in the VA.  This becomes the most-used application in the entire system.

1984. I start a project to install the VA software at March AFB, Riverside, CA.  with Lt. Beth Teeple.  This system is so successful that Congress decides to require that one of the "fly-off" vendors in the DoD's Composite Health Care System use the DHCP software.

1986 I move to SAIC to assist in the development of the CHCS software.  After intense development and benchmarking, SAIC wins the contract at about half the price of its nearest competitor.

1988- current CHCS is installed and operational at all DoD medical facilities world wide.  Attempts to replace it with a highly centralized CHCS II are underway.

1995-current I become disillusioned about where healthcare is heading, and whether or not Information Technology is actually helping the situation.  I visit the Santa Fe Institute to study complexity theory and evolutionary systems, meet Tim Berners-Lee while he is designing the Web and attend the inaugural meeting of the World Wide Web Consortium at MIT.  I worked with Dee Hock on an attempt to create a chaordic approach to health care reform.  I conceptualized HealthSpace, a space-oriented architecture in which positive, health-inducing activities and ideas would thrive.  I write a series of papers on the future of health care information technology.  I hold workshops trying to follow up on Jonas Salk's Epidemic of Health.

Papers

Opening Chapter (co-authored with Rob Kolodner)  to: Person-Centered Health Records : Toward HealthePeople,  by James E. Demetriades (Editor), Robert M. Kolodner (Editor), Gary A. Christopherson (Editor), Springer-Verlag, 2005