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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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The VistA Client Server System

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What it is – How it works

By ME-P Staff ReportersME-P Rack Servers

According to Dr. Richard Mata MS, a client-server system configuration occurs when one or more “repository” computers [ known as “servers”] store large amounts of data but perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use.

High Functionality

Both customizability and resource use is high, depending on the desired sophistication. Many clinical medical information systems that process data directly related to patient care use this configuration.

VA Example

For instance, the Veterans Health Administration, which has implemented what is likely the largest integrated healthcare information system in the United States, uses client-server architecture. Known as the Veterans Health Information Systems and Technology Architecture (VistA), this system provides technology infrastructure to about 1,300 care facilities, including hospitals and medical centers, outpatient facilities, and long-term care centers. VistA utilizes a client-server architecture that links together workstations and personal computers using software that is accessed via a graphical user interface.


Overall, for hospitals that have the financial and manpower resources for a significant investment in IT, client-server architectures are the fastest-growing and typically the most preferred of the system architectures, due in large part to their local adaptability and flexibility to meet changing hospital and medical center needs.


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24 Responses

  1. The VA is working on ‘Aviva’

    The VA is working on the next generation of VistA, its 20-plus year-old electronic medical record system, which is often praised by users, but considered a headache to planners working to bring VA health systems fully into the Internet age.




  2. The Veterans Affairs Department is at work on the next-generation of VistA, its 20-plus year-old electronic medical record system, which is often praised by users but considered a headache to planners working to bring VA health systems fully into the Internet age.


    And, a personal health record pilot in South Carolina, which incorporates both Medicare and military Tricare claims data, has been extended through Sept. 30, 2010.


    So, are there any military HIT experts out there to further opine?



  3. VA may loosen policy on physician use of commercial e-tools

    The Veterans Affairs Department is looking at how it can incorporate non-VA commercial Web tools that its physicians sometimes use to help them handle patient loads, which may require it loosening strict policies on the use of such applications.




  4. Army to Deploy WorldVistA eHR for Iraqi Health Net

    The Army seeks contractor to establish WorldVistA eHR system for Iraqi government.




  5. VistA

    The Department of Veterans Affairs (VA) has taken the next step with its VistA (Veterans Integrated System Technology Architecture) electronic health record (EHR) system by drafting a request for proposal (RFP) for a “custodial agent” to develop an open source community.


    And, eMRs may now have to include gender and sexual orientation, too

    Click to access LGBT%20Health%202011%20Report%20Brief.pdf



  6. VA Physicians Continue To Look For EHR Workarounds

    Even well developed systems still have plenty of room for improvement, according to a study published in the International Journal of Medical Informatics.




  7. Taking privacy seriously

    Cute, but Congress should really try to show Americans that privacy is more than just a buzzword around HHS.

    “Despite massive patient record breach, SAIC wins $15M HHS contract”


    Marla Durben Hirsch writes: “Despite endangering the privacy of nearly 5 million TRICARE patients last month, Science Applications International Corporation (SAIC) still was able to secure a lucrative IT support contract from the Department of Health and Human Services.”

    And some thought HHS would never become more transparent!

    Nearly two weeks after the announcement of the breach, SAIC was awarded a $15 million HHS Contract. Here’s the good part: because of HIPAA’s security breach notification rule, an SAIC official who probably received a nice bonus for negotiating the profitable business deal, will have to formally report the breach to HHS. As SAIC subsequently accepts punishment from its new business partner, and takes its place on the HHS “Wall of Shame” for losses involving more than 500 patients, those responsible for the breach will pocket a few million tax dollars (less possible HIPAA fines). Nevertheless, SAIC officials probably still feel really, really bad about the lousy luck of 5 million TRICARE patients.

    So what happens if SAIC fumbles another million or so… again and again?

    Since SAIC is now a business partner with HHS, doesn’t that make it too big to fail no matter how high the HIPAA fines?

    D. Kellus Pruitt DDS


  8. Military Health Plan Data Breach Threatens 4.9 Million
    [Don’t Blame Me – or “Hot Potato”]

    I used to treat CHAMPUS/Tricare military patients [the managed care arm of the US government’s Military Health System], both the enlisted folks and their dependents, back in the day. A nice bunch for the most part, mostly routine stuff but a few interesting cases periodically, pleasant doctor-patient relationships, etc; not so much however, the compensation!

    And so, my jaw first dropped when I learned that Tricare just lost millions of PHI data and related medical data backup tapes [Social Security numbers, addresses, and phone numbers, as well as clinical notes, prescription information, and some lab data].

    It then fell again when I learned that Tricare says the loss falls under FTC jurisdiction, not HIPAA, so only 90 days of fraud protection is offered.


    NOTE TO UNCLE SAM: Theses patients deserve better!
    Any other thoughts, ME-P readers?

    Dr. David Edward Marcinko MBA, CMP


  9. Million Veteran Program

    The Department of Veterans Affairs [VA] has been keeping computerized medical records for more than two decades. This puts the VA way ahead of the curve, compared with most hospitals and doctors’ offices. And, the VA is now turning that information into a gold mine for medical research.

    The Million Veteran Program, or MVP, will be a huge database with both medical histories and blood samples from 1 million U.S. veterans.


    But, is this a good thing?



  10. Oh No!

    The Department of Veterans Affairs has been dogged for years by complaints that the claims process is painfully slow.


    Now, a recent inspection by the VA Office of Inspector General shows exactly how difficult it can be to physically manage the volume of those cases.



  11. Many V.A. Docs Miss EHR Test Results

    About 30% of physicians in the Department of Veterans Affairs (VA) health system participating in a survey said they had failed to notice important test results, sent via the VA’s electronic records system, on at least one occasion.


    The survey’s authors, most of whom worked in the Michael DeBakey VA Medical Center in Houston, blamed “information overload” related to electronic health records (EHR) systems for the findings.



  12. VA boon-dogle

    Now, the average claim is adjudicated in 279 days. The VA eHR system does not work. And, 97% of all claims are filed under the old paper system.

    Moreover, benefits are scheduled to be reduced the next decade under the chain-CPI calculations.

    What gives, Obama?



  13. VA wasted billions on EHRs

    The Department of Veterans Affairs and the Department of Defense spent at least $1.3 billion during the last four years trying unsuccessfully to develop a single electronic health-records system between the two departments — leaving veterans’ disability claims piling up in paper files, a News21 investigation shows.




  14. VistA,

    Sargent; so it seems as though the VistA EHR system can’t even make an appointment, and according to Obama, uses paper records for appointment scheduling.


    Disgusted Veteran


  15. The VA waitlist debacle

    Don’t blame the VistA EHR system


    Hope Hetico RN MHA


  16. EHRs 2017

    Oh yes, I am reminded that the Veterans Administration has decided to eventually dump its EHR and start all over. Great Britain is in the midst of the same process.

    Dr. Eric


  17. VistA System

    Can you say … goodbye. Hello MHS Genesis – Cerner.



  18. Jeff,

    From “First “to “Worst”

    VA head opts for no-bid approach to EHR upgrade

    Last week’s announcement that the Department of Veterans Affairs would replace its homegrown electronic health record system VistA with a Cerner product came ahead of the expected July 1 deadline for a decision on the matter.

    The move made waves in the health IT sector for several reasons. Most notably, Secretary of Veterans Affairs David Shulkin, M.D., chose to invoke a “public interest exception” in the Cerner pick, bypassing the usual competitive bidding process for government contracts.




  19. VA update

    VA expands telehealth services with new ‘Anywhere to Anywhere’ initiative.




  20. 1-$B One billion dollar waste.

    DoD’s next-gen health records system deemed ‘neither effective nor suitable’


    Ann Miller RN MHA


  21. Genevieve Morris OUT

    Genevieve Morris, chief health information officer of the U.S. Department of Veterans Affairs’ Office of Electronic Health Record Modernization stepped down from her role just one month after moving into the position, a VA spokesperson confirmed to Healthcare IT News.


    Dr. David E. Marcinko MBA


  22. VA Signature HIT Program Is “Trending Towards Red”

    A $10 billion technology upgrade championed by Jared Kushner and the Mar-a-Lago trio is at risk of failing the VA’s 7 million patients.




  23. Feds say VA failed to spend millions allocated for suicide prevention

    The report says that the VA had identified suicide prevention as its highest clinical priority in 2018. Veterans suffer a disproportionately higher rate of suicide than the civilian population, according to the GAO, and the VA has estimated that an average of 20 veterans die by suicide per day.




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