1. History of the Veterans Administration Established in 1930 to provide care for war veterans – Started with 54 hospitals Today, the VA serves as the largest integrated health care system in the U.S. for Veterans. – Number of patients increased by 29% in 2008 – 4.5 million in 2001 to 5.5 million in 2008 Currently the VA has: – 153 medical centers – 909 ambulatory care and outpatient clinics – 135 nursing homes – 47 rehabilitation treatment programs – 232 veterans centers

2. Focus on Quality 1960s-70s: VA heavily criticized for its quality of care – Complaints from Vietnam veterans – Unhappy staff – Congressional concerns and complaints

3. Computer Technology Computer technology controlled by the Office of Data Management and Telecommunications (ODM&T) in late 70s – Used large mainframe computers – Largely vendor used software – Poor performance and lack of inoperability – Time consuming development of applications

4. Origins of VistA Medical professionals began to develop their own software in response to ODM&T lack of quality – Known as the Hard Hats – Used MUMPS language “The database we chose was called MUMPS. It is really an old clunky program, but it proved to be a very good program to hone into an individual patient chart. It drills down information very quickly into one file. However, it is not good at cross referencing the same field in multiple charts. We started with this and did quite well.” (Dr. Lewis Coulson, Jesse Brown VA, Illinois)

5. Origins of VistA Computerized Assisted System Staff (CASS) – Development of the DHCP Backlash from ODM&T and private-sector – ‘Underground Railroad’ movement DHCP written into law as the information systems program for the VA in 1981 – Implemented nationally by 1989 – Became known as VistA in 1996