Jan 06 2013
I am pleased to read that Chuck Hagel has been nominated to the position of Secretary of Defense. He was the Deputy Director of the VA when I worked for the Loma Linda VA Hospital, working on what would become the VistA Electronic Health Record System, one of the largest and most successful EHRs. Starting with very humble beginnings as a “skunkworks”, Chuck played a key role in helping to evolve our early back room prototypes into a VA-wide electronic health record that has won many awards and accolades by physicians.
I was part of the small group of programmers hired by Ted O’Neill to develop a decentralized hospital computer system. This caused huge tensions with the central data processing folks, who wanted to centralize everything in a massive computer in Austin, Texas.
VistA blazed many trails in health IT. It was the first to integrate SMTP email (I worked directly with internet pioneer Jon Postel, writing one of the first SMTP servers.) We used what would today would be called Agile Development, starting with a prototype that was “good enough” and getting it into the hands of real users – the more feedback, the better. We pioneered Open Systems thinking, making our software public domain and collaborating with Indian Health Service, DoD, National Health Service in Finland, and others. We pioneered social networking/digital conferencing with VA FORUM, which at one time, supported 50,000 VA employees, all learning/teaching about the system, submitting bug reports, and just plain communicating with each other (a rare circumstance in mega-bureaucracies)
The centralists told upper VA management that our decentralized system would never work, but when then chief medical director Don Custis, MD saw the system actually being used, he quipped, “It looks like we have an underground railroad here.” Nancy Tomich, editor of US Medicine at the time, described this event.
I took this as a sign that we should name our group the Underground Railroad. I printed business cards, and started holding banquets to honor people who had made major contributions to the effort. We had two awards: the Joseph T. O’Neill Outstanding Engineering Achievement award for technical folks (who we called Hardhats) and The Unlimited Free Passage on the Underground for the non-hardhats who helped our cause.
Here is a copy of the award I gave Chuck Hagel when he was deputy director of the VA:
Chuck went on to leverage the immense prestige of this award to become a US Senator, and now, nominee for Secretary of Defense. He probably cherishes this as much as being designated an Admiral of the Great State of Nebraska.
Congressman Sonny Montgomery, then Chairman of the Committee on Veterans Affairs, praised Chuck’s efforts in this Nov 5, 1984 letter to the Underground Railroad banquet:
Underground Railroad Members and Guests
Blackie’s House of Beef
1717 22nd Street, N. w.
Washington, D. c. 20817
On the occasion of your annual Underground Railroad Banquet, may I take this opportunity to send my greeting to you, and to shares ome of my thoughts concerning the Veterans’ Administration Decentralized Hospital Computer Program system with you.
As you know, the Committee and I fully supported Chuck Hagel’s decentralized ADP plan when he announced it in March of 1982 during his tenure as the VA Deputy Administrator. After Chuck left the VA, the plan, which relied heavily on the resources of the Underground Railroad, was derailed and appeared to be approaching its demise.
In order to get it back on track, I wrote a strong letter to the Administrator, and solicited the help of Chairman Boland of the HUD-Independent Agencies Subcommittee of the Committee on Appropriations. Subsequently, the Congress provided the funds and the VA, with the outstanding assistance of the Underground Railroad, performed a near miracle in bringing the largest health care system in the western world into the present day ADP world!
You, as members of the Underground Railroad, can take great pride in your outstanding accomplishment. The task required great dedication and unselfish personal effort. Regrettably, it resulted in some very calamitous casualties along the way. The job is not over, and I know that all of you will continue in your efforts to make this system the finest medical ADP system in the world. I pledge to you that I will continue my unwavering support of your important work and will maintain close oversight of all activities here in Washington and in the field to ensure that our mutual goal is met.
I recall Chuck as being very intelligent and charismatic, and a natural-born leader. I thank him for his role in shaping the VistA system, and his vision in supporting the unknown “skunkworks” out of which VistA sprang.
And Chuck: if you are reading this, there is no expiration date on this certificate. If you need the help of the Underground Railroad to help straighten out the VA/DoD EHR mess, we’re ready to help. I figure we could save the DoD $10 billion or so. And if the code we wrote back then might have aged a bit, I think that the principles we espoused are even more current in today’s federal health IT environment.
And an Open Source VistA community is alive and thriving. The VistA Community Meeting is happening this month in California, and OSEHRA (Open Source Electronic Health Record Agent) is actively supporting open source VistA.