Contract to create VistA shepherd goes to newbie

I just learned, (from a modern healthcare article, of course) that the contract has been awarded to Tiag.

At first blush, this news was not concerning. I am only peripherally involved in the VistA community, and there are lots of solid VistA-related contracting companies that I do not know of. It was a little surprising I must admit, I was expecting this to go to Perot Systems (now Dell), or DSS, both of which have deep VistA pedigree. My second guess would have been a big contractor like IBM or CSC.

But I have done a little analysis and now I am pretty concerned about this.

First I used Google to do a site search for the term “VistA” on the Tiag website. The syntax for that is “site:http://tiag.net VistA

Results.. nothing..

doh!

Ok, but even though there website does not list anything about VistA, maybe the leadership is invested in the VistA community. Its pretty easy to sort participation in VistA community, it all happens across the Hardhats mailing list. So I did a search on the hardhats mailing list for the proper names of each of the people listed under the Leadership Bios on the hardhats mailing list. Here is a sample for Tiag CEO Dalita Harmon. Nothing.

doh!

Ok, the Tiag leadership is not participating in the VistA development community, but perhaps they have “underling involvement”. I search on the hardhats mailing list for anything coming from tiag.net returns nothing. (it might return a thread I started about them now….)

doh!

Maybe they prefer to participate in person, attending WorldVistA meetings? Nope.

doh!

Maybe the organization is just deeply skilled in health IT. It looks like they have some military health IT experience, which is not at all the same as VA health IT. The resume of the Tiag CEO shows that she is not a computer scientist, or a self-taught developer. This is pretty important, because Tiag is registered as a small business. The CEO will probably be making significant decisions about this project, and she is not a software developer. Moreover her resume speaks to industry-hopping with “leadership experience” as the result. Given that background, there is a very real danger that she might be confident without being competent regarding VistA.

doh!

Perhaps, they have experience with Open Source? Nope.

doh!

How about experience with MUMPS? Nope.

doh!

Are these google searches working at all? Perhaps Google has not indexed tiag.net. Nope, a search for the CEOs name returns lots of pages. Including this one, which details the history and philosophy of the company, from that page:

one of our core differences is going against the industry standard of treating people like commodities.  tiag hires the best talent out there and treats them like talent

This is kind of troubling, because VistA, in my experience is one of the most complex and difficult technical arenas in health IT. The system is amazing, but making VistA go is a dark art, and experience really matters here. From what I can tell, they have no VistA experience to speak of. This, and the generally buzz-word compliant and beautiful tone of the website lead to a dangerous potential conclusion: This is an organization that has expertise in writing beautiful proposals, rather than any kind of industry experience. What if this is yet another “beltway bandit” with a limited, “across the fence” understanding of the VistA community inside the VA and no concept of the VistA community outside the VA.

doh!

At this point, I am going to put out the soft feelers to the VistA community, for indications that my research is wrong. But at first blush, it appears that the VA has chosen VistA-outsiders for this role. There a several ways that this analysis could be wrong, for instance, if they had just hired George Timson, or perhaps partnered with someone like Open Health Tools, and they have not yet updated their website. So these concerns could be simply irrelevant.  So first, I hope I am wrong in this analysis. Second, I can only hope that choosing a VistA-outsider was intentional on the part of the VA.

-if- it was intentional, it might not be a bad thing.

It appears, at first blush, that these guys are all going to be VistA newbies. The first thing they need to understand is that they are in fact newbies. I know a lot about Health IT, but knowing VistA… thats something else. Understanding what VistA appears to be, and understanding it at the level of a CAC or VistA programmer… thats something else entirely. It also appears that they are newbies to Open Source generally. I would have loved to see some Linux Foundation/Apache Foundation/Mozilla Foundation type credentials. I do not see that here either.

While I was initially investigating VistA, I wrote the WorldVistA wiki page “What is VistA really?“. Its a chronicle of a health IT outsider becoming a VistA insider (remember I said “insider” not “expert”). Nothing written in that article would come as a surprise to a VistA insider, but if you read it… and you are surprised by anything there, then that is a pretty good indicator that you are a VistA newbie.

Being a VistA newbie is fine, as long as you understand that you are a VistA newbie.

If this “Open Source VistA” thing is going to work, then the people leading that effort are going to have to be deeply aware of what “Open Source” and “VistA” really mean, -or- they are going to have to have a lot of humility.

In Open Source, reputation and leadership are the same thing. If Tiag is as unknown to the rest of the VistA community as they are to me, they have a long way to go. This does not mean they will do a bad job, Harris Corp was pretty inexperienced with Open Source, but they ended up doing a pretty good job on CONNECT. In the end, they earned a good reputation. I was pretty freaked out when that contract went to Open Source novices, but it turned out O.K. in the end.

Of course, Harris had a stellar technical team. They really understood what they were getting into from a technology standpoint. Does Tiag? One of the critical issues around an Open Source VistA process is that normal version control does not work on VistA. This has to do with the quasi-versioning capability of the KIDS system. Updates in VistA often come in the form of KIDS packages that inject code directly into the VistA database. That code, living in the database, and not on the filesystem, makes tracking VistA with traditional version control impossible. Can you imagine trying to create an Open Source governance structure without the presumption of an underlying version control system in place? The governance of most projects translates to “the process by which we decide who gets access to subversion/git/whatever”. This is just one example of how VistA context is going to be critical for any kind of workable governance. My proposals for VistA governance, are some of the oldest and complete writing on the subject. They date from 2008, which is something like 21 years ago in Internet years (which are, as everyone knows, roughly compatible with dog-years). So I am something of an “expert” on the subject of VistA governance.

There are three working definitions of ‘expert’:

  1. The student: Person who understands the problem well, and might recognize the solution.
  2. The amateur in experts clothing: Person who advertises that they know the solution, but in fact does not understand the problem at all.
  3. The real expert: Person who has solves the problem.

I am, at least, solidly in the first category.

If “What is VistA really?” serves as a good introduction to VistA, this post will serve as a good introduction to Open Source values. What matters in Open Source is “being right” and being right comes from evidence. The evidence in this case (a bunch of Google searches) suggests that Tiag is inexperienced and over their heads on this one. The difference between Open Source developers and other developers is that we talk openly about these types of issues, and criticism, when backed by evidence, needs rebutting. Participating in community discussion and responding to community criticism is what “participating” in Open Source community means. We have lots of heated arguments, and its never personal. Its always about what the right thing is for the sake of the project in question. If Tiag thinks this post is critical, they are in for a whirlwind.

At this point I am pretty nervous. The future of VistA depends greatly on Tiag not screwing this up, and I see no evidence that they have any experience in Open Source, licensing, governance or VistA and its unique development process. There are thousand ways to make a train-wreck here and only a few ways to do this right.

I will try an update this article with more information regarding Tiag’s qualifications.

I really hope Tiag has what it takes.

-FT

6 Responses to “Contract to create VistA shepherd goes to newbie”

  1. Roger Baker

    Fred, I appreciate your interest in VistA Open Source, and that you are contributing to the open discussion. Free software (as in free speech) is what the whole process has been all about.

    I can give you a very few facts. Sorry, but as a federal employee I am constrained by law from saying more than what has been publicly said so far:

    We followed federal procurement law, and the FAR. We followed a long and very transparent process leading up to the RFP. We asked for creativity. We extended the response deadline when requested.

    There were 5 bidders. The selected company was viewed as the best all the way around. By a number of evaluators, including from the DoD. Including people with substantial open source experience.

    If you were part of a bidding company, and you feel VA made a mistake in evaluation of your proposal, you should avail yourself of your legal right to protest.

    If you are interested in being a part of the Open Source project, please wait and see. I didn’t invest in Netscape in 1994, so I’m clear I can’t see the future perfectly, but I’m also clear that winners can emerge when experts are dubious.

    If you’re primarily interested in critiquing, then know that I am a fan of Teddy Roosevelt. I am in the arena. I am committed to the success of VistA Open Source. And we are at award. Vista Open Source is now irreversible!

    We want, need, and solicit the help of the VistA community. It is knowledgable, well meaning, and powerful. Together, we can change not only Vista, but EHRs and health care in America.

    But please recognize what helps and what hurts. I work for the government, and I can’t change the FAR. We had a fair competition, and TIAG won. Help them. Help US be successful.

    Thanks!

    Roger Baker

  2. Peter Groen

    I had the opportunity to meet some of the people from TIAG recently and many of my similar concerns were put to rest. They have several partners on their team that includes experienced ‘M’ and VistA programmer/analysts, a partner that has established custodial agent organizations and successfully taken medical imaging solutions into the open source world, and they are reaching out to many of the right players they need. They are VistA newbies, but they may surprise everyone.

  3. John Weiler, IT-AAC Vice Chairman

    To clarify who is part of the TIAG team, here are the details;

    Bringing extensive executive leadership and program outreach to the initiative,
    Seong K. Mun, PhD of Virginia Tech will serve as the acting Senior Program
    Coordinator of the CA. Kitware and The Washington University, Mallinckrodt Institute
    of Radiology will provide their world class open source software management expertise
    to provide technical support for standing up and supporting the CA’s operations and
    infrastructure. KRM Associates, Inc. brings extensive experience working with VistA and MUMPS-based open source EHR in the public sector. To assist with active
    community enablement, the CA will utilize state-of-the-art social networking tools as
    developed by The Clymer Group, a leading DC-based public-private partnership
    consulting service company

  4. ftrotter

    This does not make me feel more comfortable. Of the organizations that you listed, only KRM appears to have extensive VistA experience. The others appear to be Medical Imaging specialist. Medical Imaging has been dominated by Open Source tools for years which is wonderful, and has little do with VistA. Still, KRM does appear to have some god Vista experience which is wonderful.

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