<s>
The	O
Veterans	B-Application
Health	I-Application
Information	I-Application
Systems	I-Application
and	I-Application
Technology	I-Application
Architecture	I-Application
(	O
VISTA	B-Application
)	O
is	O
a	O
health	O
information	O
system	O
deployed	O
across	O
all	O
veteran	O
care	O
sites	O
in	O
the	O
United	O
States	O
.	O
</s>
<s>
VISTA	B-Application
provides	O
clinical	O
,	O
administrative	O
,	O
and	O
financial	O
functions	O
for	O
all	O
of	O
the	O
1700+	O
hospitals	O
and	O
clinics	O
of	O
the	O
Veterans	O
Health	O
Administration	O
VISTA	B-Application
consists	O
of	O
180	O
clinical	O
,	O
financial	O
,	O
and	O
administrative	O
applications	O
integrated	O
within	O
a	O
single	O
transactional	O
database	O
(	O
see	O
figure	O
1	O
)	O
.	O
</s>
<s>
VISTA	B-Application
received	O
the	O
Computerworld	O
Smithsonian	O
Award	O
for	O
best	O
use	O
of	O
Information	O
Technology	O
in	O
Medicine	O
,	O
and	O
continues	O
to	O
the	O
present	O
day	O
to	O
receive	O
the	O
highest	O
physician	O
satisfaction	O
scores	O
in	O
national	O
Electronic	B-Application
Health	I-Application
Record	I-Application
(	O
EHR	B-Application
)	O
surveys	O
.	O
</s>
<s>
In	O
2014	O
and	O
again	O
in	O
2016	O
national	O
surveys	O
of	O
over	O
15,000	O
physician	O
users	O
of	O
EHRs	B-Application
rated	O
VISTA	B-Application
with	O
the	O
highest	O
overall	O
satisfaction	O
rating	O
in	O
the	O
U.S.	O
Over	O
65%	O
of	O
all	O
physicians	O
trained	O
in	O
the	O
U.S.	O
rotate	O
through	O
the	O
VHA	O
and	O
use	O
VISTA	B-Application
,	O
making	O
VISTA	B-Application
the	O
most	O
familiar	O
EHR	B-Application
in	O
the	O
U.S.	O
</s>
<s>
In	O
May	O
,	O
2018	O
,	O
the	O
VA	O
awarded	O
a	O
contract	O
to	O
Cerner	O
Corp	O
to	O
replace	O
VistA	B-Application
with	O
the	O
commercial	O
off-the-shelf	O
EHR	B-Application
,	O
Cerner	O
Millenium	O
.	O
</s>
<s>
For	O
its	O
development	O
of	O
VistA	B-Application
,	O
the	O
United	O
States	O
Department	O
of	O
Veterans	O
Affairs	O
(	O
VA	O
)	O
/	O
Veterans	O
Health	O
Administration	O
(	O
VHA	O
)	O
was	O
named	O
the	O
recipient	O
of	O
the	O
Innovations	O
in	O
American	O
Government	O
Award	O
presented	O
by	O
the	O
Ash	O
Institute	O
of	O
the	O
John	O
F	O
.	O
Kennedy	O
School	O
of	O
Government	O
at	O
Harvard	O
University	O
in	O
July	O
,	O
2006	O
.	O
</s>
<s>
The	O
adoption	O
of	O
VistA	B-Application
has	O
allowed	O
the	O
VA	O
to	O
achieve	O
a	O
pharmacy	O
prescription	O
accuracy	O
rate	O
of	O
99.997	O
%	O
,	O
and	O
the	O
VA	O
outperforms	O
most	O
public	O
sector	O
hospitals	O
on	O
many	O
other	O
quality	O
metrics	O
,	O
all	O
attributable	O
to	O
VistA	B-Application
.	O
</s>
<s>
Hospitals	O
using	O
VistA	B-Application
are	O
one	O
of	O
only	O
a	O
few	O
healthcare	O
systems	O
in	O
the	O
U.S.	O
that	O
have	O
achieved	O
the	O
highest	O
level	O
of	O
electronic	B-Application
health	I-Application
record	I-Application
integration	O
HIMSS	O
Stage	O
7	O
,	O
while	O
a	O
non-VA	O
hospital	O
using	O
VistA	B-Application
is	O
one	O
of	O
only	O
42	O
US	O
hospitals	O
that	O
has	O
achieved	O
HIMSS	O
stage	O
6	O
.	O
</s>
<s>
The	O
VistA	B-Application
system	O
is	O
public	O
domain	O
software	O
,	O
available	O
through	O
the	O
Freedom	O
Of	O
Information	O
Act	O
directly	O
from	O
the	O
VA	O
website	O
or	O
through	O
a	O
growing	O
network	O
of	O
distributors	O
,	O
such	O
as	O
.	O
</s>
<s>
VistA	B-Application
was	O
developed	O
using	O
the	O
M	B-Language
or	O
MUMPS	B-Language
integrated	O
application	O
database	O
.	O
</s>
<s>
The	O
VA	O
currently	O
runs	O
its	O
VistA	B-Application
systems	O
on	O
a	O
proprietary	O
version	O
of	O
MUMPS	B-Language
called	O
Caché	B-Language
,	O
but	O
an	O
open	O
source	O
MUMPS	B-Language
database	O
engine	O
,	O
called	O
GT.M	B-Application
,	O
for	O
Linux	B-Application
and	O
Unix	B-Application
systems	I-Application
has	O
also	O
been	O
developed	O
.	O
</s>
<s>
The	O
Veterans	O
Administration	O
developed	O
VistA	B-Algorithm
Imaging	I-Algorithm
,	O
which	O
is	O
a	O
PACS	B-Application
(	O
radiology	O
imaging	O
)	O
systems	O
and	O
for	O
integrating	O
image-based	O
information	O
,	O
such	O
as	O
X-Rays	O
,	O
CAT-scans	O
,	O
EKGs	O
,	O
pathology	O
slides	O
,	O
and	O
scanned	O
documents	O
into	O
the	O
VistA	B-Application
electronic	B-Application
medical	I-Application
records	I-Application
system	O
.	O
</s>
<s>
The	O
VistA	B-Application
electronic	O
healthcare	O
record	O
has	O
been	O
widely	O
credited	O
for	O
reforming	O
the	O
VA	O
healthcare	O
system	O
,	O
improving	O
safety	O
and	O
efficiency	O
substantially	O
.	O
</s>
<s>
The	O
results	O
have	O
spurred	O
a	O
national	O
impetus	O
to	O
adopt	O
electronic	B-Application
medical	I-Application
records	I-Application
similar	O
to	O
VistA	B-Application
nationwide	O
.	O
</s>
<s>
This	O
is	O
accomplished	O
through	O
the	O
Bidirectonal	O
Health	O
Information	O
Exchange	O
(	O
BHIE	B-Application
)	O
.	O
</s>
<s>
VistA	B-Application
has	O
been	O
interfaced	O
with	O
commercial	O
off-the-shelf	O
products	O
.	O
</s>
<s>
Tools	O
for	O
CCR/CCD	O
support	O
have	O
been	O
developed	O
for	O
VistA	B-Application
,	O
allowing	O
VistA	B-Application
to	O
communicate	O
with	O
other	O
EHRs	B-Application
using	O
these	O
standardized	O
information	O
exchange	O
protocols	O
.	O
</s>
<s>
This	O
includes	O
the	O
Mirth	B-Application
open	O
source	O
cross	O
platform	O
HL7	O
interface	O
and	O
NHIN	O
Connect	O
,	O
the	O
open	O
source	O
health	O
information	O
exchange	O
adaptor	O
.	O
</s>
<s>
The	O
VistA	B-Application
EHR	I-Application
has	O
been	O
used	O
by	O
the	O
VA	O
in	O
combination	O
with	O
Telemedicine	O
to	O
provide	O
surgical	O
care	O
to	O
rural	O
areas	O
in	O
Nebraska	O
and	O
Western	O
Iowa	O
over	O
a	O
area	O
.	O
</s>
<s>
Under	O
the	O
Freedom	O
of	O
Information	O
Act	O
(	O
FOIA	O
)	O
,	O
the	O
VistA	B-Application
system	O
,	O
the	O
CPRS	O
graphical	O
interface	O
,	O
and	O
unlimited	O
ongoing	O
updates	O
(	O
500	O
–	O
600	O
per	O
year	O
)	O
are	O
provided	O
as	O
public	O
domain	O
software	O
.	O
</s>
<s>
This	O
was	O
done	O
by	O
the	O
U.S.	O
government	O
in	O
an	O
effort	O
to	O
make	O
VistA	B-Application
available	O
as	O
a	O
low	O
cost	O
Electronic	B-Application
Health	I-Application
Record	I-Application
(	O
EHR	B-Application
)	O
for	O
non-governmental	O
hospitals	O
and	O
other	O
healthcare	O
entities	O
.	O
</s>
<s>
The	O
VA	O
has	O
produced	O
a	O
version	O
of	O
VistA	B-Application
that	O
runs	O
on	O
GT.M	B-Application
in	O
a	O
Linux	B-Application
operating	I-Application
system	I-Application
,	O
and	O
which	O
was	O
suitable	O
for	O
use	O
in	O
private	O
settings	O
.	O
</s>
<s>
VistA	B-Application
has	O
since	O
been	O
adapted	O
by	O
companies	O
such	O
as	O
to	O
hundreds	O
of	O
hospitals	O
and	O
clinics	O
in	O
the	O
private	O
sector	O
.	O
</s>
<s>
VistA	B-Application
has	O
been	O
deployed	O
internationally	O
,	O
running	O
the	O
healthcare	O
information	O
system	O
of	O
entire	O
national	O
healthcare	O
systems	O
,	O
such	O
as	O
the	O
Kingdom	O
of	O
Jordan	O
.	O
</s>
<s>
Some	O
United	O
States	O
universities	O
,	O
such	O
as	O
UC	O
Davis	O
and	O
Texas	O
Tech	O
,	O
have	O
implemented	O
VistA	B-Application
.	O
</s>
<s>
The	O
non-profit	O
organization	O
,	O
WorldVistA	O
,	O
was	O
established	O
to	O
extend	O
and	O
collaboratively	O
improve	O
the	O
VistA	B-Application
electronic	B-Application
health	I-Application
record	I-Application
and	O
health	O
information	O
system	O
for	O
use	O
outside	O
in	O
the	O
private	O
and	O
public	O
sector	O
throughout	O
the	O
U.S.	O
and	O
internationally	O
.	O
</s>
<s>
VistA	B-Application
(	O
and	O
other	O
derivative	O
EMR/EHR	O
systems	O
)	O
can	O
be	O
interfaced	O
with	O
healthcare	O
databases	O
not	O
initially	O
used	O
by	O
the	O
VA	O
system	O
,	O
including	O
billing	O
software	O
,	O
lab	O
databases	O
,	O
and	O
image	O
databases	O
(	O
radiology	O
,	O
for	O
example	O
)	O
.	O
</s>
<s>
VistA	B-Application
implementations	O
have	O
been	O
deployed	O
(	O
or	O
are	O
currently	O
being	O
deployed	O
)	O
in	O
non-VA	O
healthcare	O
facilities	O
in	O
Texas	O
,	O
Arizona	O
,	O
Florida	O
,	O
Hawaii	O
,	O
New	O
Jersey	O
,	O
Oklahoma	O
,	O
West	O
Virginia	O
,	O
California	O
,	O
New	O
York	O
,	O
and	O
Washington	O
,	O
D.C.	O
</s>
<s>
In	O
one	O
state	O
,	O
the	O
cost	O
of	O
a	O
multiple	O
hospital	O
VistA-based	O
EHR	B-Application
network	O
was	O
implemented	O
for	O
one	O
tenth	O
the	O
price	O
of	O
a	O
commercial	O
EHR	B-Application
network	O
in	O
another	O
hospital	O
network	O
in	O
the	O
same	O
state	O
( $9	O
million	O
versus	O
$90	O
million	O
for	O
7	O
–	O
8	O
hospitals	O
each	O
)	O
.	O
</s>
<s>
(	O
Both	O
VistA	B-Application
and	O
the	O
commercial	O
system	O
used	O
the	O
MUMPS	B-Language
database	O
)	O
.	O
</s>
<s>
VistA	B-Application
has	O
even	O
been	O
adapted	O
into	O
a	O
Health	O
Information	O
System	O
(	O
VMACS	O
)	O
at	O
the	O
veterinary	O
medical	O
teaching	O
hospital	O
at	O
UC	O
Davis	O
.	O
</s>
<s>
VistA	B-Application
software	O
modules	O
have	O
been	O
installed	O
around	O
the	O
world	O
,	O
or	O
are	O
being	O
considered	O
for	O
installation	O
,	O
in	O
healthcare	O
institutions	O
such	O
as	O
the	O
World	O
Health	O
Organization	O
,	O
and	O
in	O
countries	O
such	O
as	O
Mexico	O
,	O
American	O
Samoa	O
,	O
Kurdistan	O
,	O
Iraq	O
,	O
Finland	O
,	O
Jordan	O
,	O
Germany	O
,	O
Kenya	O
,	O
Nigeria	O
,	O
Egypt	O
,	O
Malaysia	O
,	O
India	O
,	O
Brazil	O
,	O
Pakistan	O
,	O
and	O
Denmark	O
.	O
</s>
<s>
In	O
September	O
2009	O
,	O
Dell	O
Computer	O
bought	O
Perot	O
Systems	O
,	O
the	O
company	O
installing	O
VistA	B-Application
in	O
Jordan	O
(	O
the	O
Hakeem	O
project	O
)	O
.	O
</s>
<s>
The	O
name	O
"	O
VistA	B-Application
"	O
(	O
Veterans	O
Health	O
Information	O
System	O
and	O
Technology	O
Architecture	O
)	O
was	O
adopted	O
by	O
the	O
VA	O
in	O
1994	O
,	O
when	O
the	O
Under	O
Secretary	O
for	O
Health	O
of	O
the	O
U.S.	O
Department	O
of	O
Veterans	O
Affairs	O
(	O
VA	O
)	O
,	O
Dr.	O
Ken	O
Kizer	O
,	O
renamed	O
what	O
was	O
previously	O
called	O
the	O
Decentralized	B-Application
Hospital	I-Application
Computer	I-Application
Program	I-Application
(	O
DHCP	O
)	O
.	O
</s>
<s>
Both	O
Dr.	O
Robert	O
Kolodner	O
(	O
National	O
Health	O
Information	O
Technology	O
Coordinator	O
)	O
and	O
George	O
Timson	O
(	O
an	O
architect	O
of	O
VistA	B-Application
who	O
has	O
been	O
involved	O
with	O
it	O
since	O
the	O
early	O
years	O
)	O
date	O
VistA	B-Application
's	O
actual	O
architecture	O
genesis	O
,	O
then	O
,	O
to	O
1977	O
.	O
</s>
<s>
The	O
program	O
was	O
named	O
the	O
Decentralized	B-Application
Hospital	I-Application
Computer	I-Application
Program	I-Application
(	O
DHCP	O
)	O
in	O
1981	O
.	O
</s>
<s>
In	O
December	O
1981	O
,	O
Congressman	O
Sonny	O
Montgomery	O
of	O
Mississippi	O
arranged	O
for	O
the	O
Decentralized	B-Application
Hospital	I-Application
Computer	I-Application
Program	I-Application
(	O
DHCP	O
)	O
to	O
be	O
written	O
into	O
law	O
as	O
the	O
medical-information	O
systems	O
development	O
program	O
of	O
the	O
VA	O
.	O
VA	O
Administrator	O
Robert	O
P	O
.	O
Nimmo	O
signed	O
an	O
Executive	O
Order	O
in	O
February	O
1982	O
describing	O
how	O
the	O
DHCP	O
was	O
to	O
be	O
organized	O
and	O
managed	O
within	O
the	O
VA	O
's	O
Department	O
of	O
Medicine	O
and	O
Surgery	O
.	O
</s>
<s>
Subsequent	O
VistA	B-Application
systems	O
therefore	O
included	O
elements	O
from	O
both	O
RPMS	B-Application
and	O
DHCP	O
.	O
</s>
<s>
The	O
U.S.	O
Department	O
of	O
Defense	O
(	O
DoD	O
)	O
then	O
contracted	O
with	O
Science	O
Applications	O
International	O
Corporation	O
(	O
SAIC	O
)	O
for	O
a	O
heavily	O
modified	O
and	O
extended	O
form	O
of	O
the	O
DHCP	O
system	O
for	O
use	O
in	O
DoD	O
healthcare	O
facilities	O
,	O
naming	O
it	O
the	O
Composite	B-Application
Health	I-Application
Care	I-Application
System	I-Application
(	O
CHCS	B-Application
)	O
.	O
</s>
<s>
Meanwhile	O
,	O
in	O
the	O
early	O
1980s	O
,	O
major	O
hospitals	O
in	O
Finland	O
were	O
the	O
first	O
institutions	O
outside	O
of	O
the	O
United	O
States	O
to	O
adopt	O
and	O
adapt	O
the	O
VistA	B-Application
system	O
to	O
their	O
language	O
and	O
institutional	O
processes	O
,	O
creating	O
a	O
suite	O
of	O
applications	O
called	O
MUSTI	O
and	O
Multilab	O
.	O
</s>
<s>
The	O
four	O
major	O
adopters	O
of	O
VistA	B-Application
–	O
VA	O
(	O
VistA	B-Application
)	O
,	O
DoD	O
(	O
CHCS	B-Application
)	O
,	O
IHS	O
(	O
RPMS	B-Application
)	O
,	O
and	O
the	O
Finnish	O
–	O
each	O
took	O
VistA	B-Application
in	O
a	O
different	O
direction	O
,	O
creating	O
related	O
but	O
distinct	O
"	O
dialects	O
"	O
of	O
VistA	B-Application
.	O
</s>
<s>
VA	O
VistA	B-Application
and	O
RPMS	B-Application
exchanged	O
ideas	O
and	O
software	O
repeatedly	O
over	O
the	O
years	O
,	O
and	O
RPMS	B-Application
periodically	O
folded	O
back	O
into	O
its	O
code	O
base	O
new	O
versions	O
of	O
the	O
VA	O
VistA	B-Application
packages	O
.	O
</s>
<s>
The	O
Musti	O
software	O
drifted	O
further	O
away	O
from	O
these	O
two	O
but	O
retained	O
compatibility	O
with	O
the	O
infrastructure	O
of	O
RPMS	B-Application
and	O
VA	O
VistA	B-Application
(	O
while	O
adding	O
additional	O
GUI	O
and	O
web	O
capabilities	O
to	O
improve	O
function	O
)	O
.	O
</s>
<s>
Meanwhile	O
,	O
the	O
CHCS	B-Application
code	O
base	O
diverged	O
from	O
that	O
of	O
the	O
VA	O
's	O
VistA	B-Application
in	O
the	O
mid-eighties	O
and	O
has	O
never	O
been	O
reintegrated	O
.	O
</s>
<s>
More	O
recently	O
,	O
CHCS	B-Application
's	O
development	O
was	O
brought	O
to	O
a	O
complete	O
stop	O
by	O
continued	O
political	O
opposition	O
within	O
the	O
DoD	O
,	O
and	O
it	O
has	O
now	O
been	O
supplanted	O
by	O
a	O
related	O
,	O
but	O
different	O
,	O
system	O
called	O
AHLTA	B-Application
.	O
</s>
<s>
While	O
AHLTA	B-Application
is	O
the	O
new	O
system	O
for	O
DoD	O
,	O
the	O
core	O
systems	O
beneath	O
AHLTA	B-Application
(	O
for	O
Computerized	O
Physician	O
Order	O
Entry	O
,	O
appointing	O
,	O
referral	O
management	O
,	O
and	O
creation	O
of	O
new	O
patient	O
registrations	O
)	O
remain	O
those	O
of	O
the	O
underlying	O
CHCS	B-Application
system	O
.	O
</s>
<s>
(	O
While	O
some	O
ongoing	O
development	O
has	O
occurred	O
for	O
CHCS	B-Application
,	O
the	O
majority	O
of	O
funds	O
are	O
consumed	O
by	O
the	O
AHLTA	B-Application
project	O
.	O
)	O
</s>
<s>
Thus	O
,	O
the	O
VistA	B-Application
code	O
base	O
was	O
split	O
four	O
ways	O
.	O
</s>
<s>
Many	O
VistA	B-Application
professionals	O
then	O
informally	O
banded	O
together	O
as	O
the	O
"	O
Hardhats	O
"	O
(	O
a	O
name	O
the	O
original	O
VistA	B-Application
programmers	O
used	O
for	O
themselves	O
)	O
to	O
promote	O
that	O
the	O
FOIA	O
(	O
Freedom	O
of	O
Information	O
Act	O
)	O
release	O
of	O
VA	O
VistA	B-Application
(	O
that	O
allows	O
it	O
to	O
be	O
in	O
the	O
public	O
domain	O
)	O
be	O
standardized	O
for	O
universal	O
usage	O
.	O
</s>
<s>
It	O
is	O
,	O
however	O
,	O
an	O
organization	O
independent	O
of	O
the	O
VA	O
system	O
and	O
its	O
version	O
of	O
VistA	B-Application
therefore	O
differs	O
from	O
that	O
of	O
the	O
VA	O
's	O
.	O
</s>
<s>
It	O
has	O
developed	O
for	O
multiple	O
operating	B-General_Concept
systems	I-General_Concept
,	O
including	O
Linux	B-Application
(	O
Debian/Ubuntu	O
and	O
Red	O
Hat	O
)	O
-based	O
and	O
Microsoft	O
Windows-based	O
operating	B-General_Concept
systems	I-General_Concept
.	O
</s>
<s>
Co-operation	O
with	O
the	O
maintainers	O
and	O
vendors	O
of	O
,	O
another	O
widely	O
deployed	O
open	O
source	O
public	O
version	O
of	O
VistA	B-Application
,	O
helps	O
maintain	O
interoperability	O
and	O
a	O
standardized	O
framework	O
.	O
</s>
<s>
In	O
2011	O
the	O
Open	O
Source	O
Electronic	B-Application
Health	I-Application
Record	I-Application
Agent	O
(	O
OSEHRA	O
)	O
project	O
was	O
started	O
(	O
in	O
cooperation	O
with	O
the	O
Department	O
of	O
Veterans	O
Affairs	O
)	O
to	O
provide	O
a	O
common	O
code	O
repository	O
for	O
VistA	B-Application
(	O
and	O
other	O
EHR	B-Application
and	O
health	O
IT	O
)	O
software	O
.	O
</s>
<s>
On	O
February	O
10	O
,	O
2020	O
the	O
Open	O
Source	O
Electronic	B-Application
Health	I-Application
Record	I-Application
Alliance	O
(	O
OSEHRA	O
)	O
announced	O
that	O
they	O
would	O
cease	O
operations	O
on	O
February	O
14	O
of	O
2020	O
.	O
</s>
<s>
In	O
summary	O
,	O
it	O
was	O
the	O
joint	O
collaboration	O
of	O
thousands	O
of	O
clinicians	O
and	O
systems	O
experts	O
from	O
the	O
United	O
States	O
and	O
other	O
nations	O
,	O
many	O
of	O
them	O
volunteers	O
,	O
that	O
the	O
VistA	B-Application
system	O
has	O
developed	O
.	O
</s>
<s>
There	O
have	O
been	O
many	O
champions	O
of	O
VistA	B-Application
as	O
the	O
electronic	O
healthcare	O
record	O
system	O
for	O
a	O
universal	O
healthcare	O
plan	O
.	O
</s>
<s>
VistA	B-Application
can	O
act	O
as	O
a	O
standalone	O
system	O
,	O
allowing	O
self-contained	O
management	O
and	O
retention	O
of	O
healthcare	O
data	O
within	O
an	O
institution	O
.	O
</s>
<s>
In	O
addition	O
to	O
the	O
unwavering	O
support	O
of	O
congressional	O
representatives	O
such	O
as	O
Congressman	O
Sonny	O
Montgomery	O
of	O
Mississippi	O
,	O
numerous	O
IT	O
specialists	O
,	O
physicians	O
,	O
and	O
other	O
healthcare	O
professionals	O
have	O
donated	O
significant	O
amounts	O
of	O
time	O
in	O
adapting	O
the	O
VistA	B-Application
system	O
for	O
use	O
in	O
non-governmental	O
healthcare	O
settings	O
.	O
</s>
<s>
The	O
ranking	O
member	O
of	O
the	O
House	O
Veterans	O
Affairs	O
Committee	O
's	O
Oversight	O
and	O
Investigation	O
Subcommittee	O
,	O
Rep.	O
Ginny	O
Brown-Waite	O
of	O
Florida	O
,	O
recommended	O
that	O
the	O
Department	O
of	O
Defense	O
(	O
DOD	O
)	O
adopt	O
VA	O
's	O
VistA	B-Application
system	O
following	O
accusations	O
of	O
inefficiencies	O
in	O
the	O
DOD	O
healthcare	O
system	O
.	O
</s>
<s>
The	O
DOD	O
hospitals	O
use	O
Armed	B-Application
Forces	I-Application
Health	I-Application
Longitudinal	I-Application
Technology	I-Application
Application	I-Application
(	O
AHLTA	B-Application
)	O
which	O
has	O
not	O
been	O
as	O
successful	O
as	O
VistA	B-Application
and	O
has	O
not	O
been	O
adapted	O
to	O
non-military	O
environments	O
(	O
as	O
has	O
been	O
done	O
with	O
VistA	B-Application
)	O
.	O
</s>
<s>
In	O
April	O
2009	O
,	O
Sen.	O
John	O
D	O
.	O
Rockefeller	O
of	O
West	O
Virginia	O
introduced	O
the	O
Health	O
Information	O
Technology	O
Public	O
Utility	O
Act	O
of	O
2009	O
calling	O
for	O
the	O
government	O
to	O
create	O
an	O
open	O
source	O
electronic	B-Application
health	I-Application
records	I-Application
solution	O
and	O
offer	O
it	O
at	O
little	O
or	O
no	O
cost	O
to	O
safety-net	O
hospitals	O
and	O
small	O
rural	O
providers	O
.	O
</s>
