WorldVistA EHR

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WorldVistA consists of two parts: a database server and a collection of client modules. The server runs in Linux, whereas the clients are generally Windows-based (at this time). The first step is to install the WorldVistA server. It can be installed on the operating system of a stand-alone computer or on the guest operating system of a virtual machine (usually running on the same computer as the client modules).

When the VistA server is run within a virtual machine on the same computer as the client modules, a fully self-contained WorldVistA EHR is created on a single computer.

  • If you will run the WorldVistA server within a virtual machine, then install the Ubuntu Server edition (virtual machine minimal install) into a virtual machine first. See these instructions.

Then proceed in a similar fashion (in each type of operating system installation) for the subsequent installation of Astronaut VistA.

Contents

Preparing your server

  • The Astronaut installer uses an emerging standardized installation framework for VistA derivatives (WorldVistA and OpenVistA currently). These instruction reflect this framework, with modifications I have used in setting up my system on Ubuntu.
  • A secure SSH tunnel is created between the Astronaut client(s) and the Astronaut VistA server using port 22. Information coming from a client's port 9260 is sent through this tunnel and received by the the VistA server's port 9260. (The network only sees traffic over port 22.) So that the network can always find the VistA server, it should have a static IP address on the LAN. Your LAN (router) should then forward port 22 (and perhaps port 9260 during testing) traffic to the VistA server's IP address on the LAN. Make sure any firewall running on the VistA server firewall allows port 22 (and, to be safe, port 9260) traffic through.

It is easiest to set this up before using the Astronaut installer, since the Astronaut server installer autodetects IP address settings.

Installation

WorldVistA is the largest and most robust CCHIT-approved electronic health record platform in the public domain. It is is based on the US Veterans Administration health record system and is GPL licensed. The database and server can be installed on a standalone server (which would then be accessed over a network by clients on other computers) or can be installed in a virtual machine on a computer which also contains the clients (creating a self-contained EHR on a single computer). There are several installation packages. (The original WorldVistA site is here.)

  • Apache2 is required. It can be installed individually (sudo apt-get install apache2) or as part of a LAMP (Linux, Apache2, MySQL, PHP) installation:
sudo apt-get install tasksel
sudo tasksel install lamp-server
sudo apt-get install tasksel
sudo tasksel install openssh-server
  • If you are installing on a Server edition without a desktop, you will also need:
sudo apt-get install wget iptables nano
  • Install prerequisites:
sudo apt-get install xinetd update-inetd whois apache2-suexec
  • Astronaut VistA is made for a 32-bit operating system. If you are using a 64-bit Ubuntu operating system, then also install ia32-libs:
sudo apt-get ia32-libs
  • A package can be installed directly from the Astronaut VistA repositories (replace lucid with karmic if using Karmic Koala 9.10) by adding the the repository:
sudo echo "deb http://software.astronautvista.com/deb lucid main" >> /etc/apt/sources.list.d/lucid-partner.list
sudo apt-get update
then installing the Astronaut version of the WorldVistA server:
sudo apt-get install astronaut-wv-server-beta
Note: During the VistA server installation, you may wish to save (as a text file) the installation notes that are displayed for future reference.
  • Open incoming ports 9260 and 22 in your firewall. If behind a router, make sure these ports are forwarded to the IP address of the computer acting as the WorldVistA server.
  • Note: Astronaut routes all communications through an SSH tunnel (port 22) using PuTTY (on the client side) and OpenSSH (on the server side). If you will only connect using this SSH tunnel, you do not need port 9260 to be open on (or forwarded by) your router. Alternatively, if you connect between clients and the server directly (using port 9260), then you do not need port 22 to be open. Note that connecting directly through port 9260 directly is slightly less secure, so it is discouraged when connecting through the Internet.
  • Note: This installation installs the WorldVistA database and server in an Ubuntu Linux OS (that resides either on a standalone computer or in a virtual machine). The CPRS user client for WorldVistA is written in Delphi for Windows (and works imperfectly in Wine). The CPRS client is therefore usually installed onto a Windows-based PCs (or onto USB flashdrives). These CPRS clients connect through the network to the WorldVistA server on a Ubuntu Linux-based server PC, or directly to the server running in a virtual machine.

Installation Notes

  • The MUMPS database (GT.M) is installed into /opt/lsb-gtm/V5.3-004A_i686.
  • The WorldVistA EHR program is installed into /opt/worldvista/EHR.
  • m2web is installed into /opt/worldvista/EHR/web/m2web.
  • A startup file is installed as /etc/init.d/vista-EHR.
  • The listener port for clients like CPRS is 9260.
  • The listener port for m2web is 80.

The following default actions were done:

gtm Mumps interpreter installed in: /opt/lsb-gtm/gtm
Default user id created: worldvistaEHR in /home/worldvistaEHR
textEHR user id created.
VistA software installed in: /opt/worldvista/EHR
Started port listener on port: 9260
Open port: 9260

NEXT STEPS: Log in as user: worldvistaEHR with default password: vista!123 You will be prompted to immediately change the password. Use a strong password. Full disk encryption of your Linux is strongly recommended.

Write down the IP address of this machine and port:

IP address of this machine:
192.168.0.24
Port: 9260

(Obviously, record the IP address of your own server.)

Installing on a Server edition

Note: The command "apt-get -f install" finds and installs unmet dependencies. This is only needed for Server editions in which a package manager is not installed.

Installing WorldVistA Server in a Virtual Machine

There are two methods for doing this.

  • Install the Ubuntu Server edition (virtual machine minimal install) into a virtual machine (like VirtualBox) and then install Astronaut WorldVistA on top of this. See these instructions.
  • The WorldVistA EHR Personal Toaster is a self-contained appliance for Windows that includes a bundled QEMU virtual machine, a Damn Small Linux operating system, and a WorldVistA server (it does not use the Astronaut format). All are installed in a one-step process.

Another example solution is demonstrated in this YouTube video.

Use a static IP address for the server

It will be difficult for the WorldVistA clients to locate the WorldVistA server if the IP address of the server is always changing (i.e. repeatedly assigned a new dynamic IP address by the router/network DHCP server). It is best, therefore, to assign a static IP adress to the server.

The network administrator must assign the static IP address on the LAN for use by the server (especially if a DNS nameserver is in use on the network). Let's say the LAN has a router/gateway address of 192.168.1.1, a static IP address range of 192.168.1.125 - 192.168.1.253, and the server is assigned an IP address of 192.168.1.135. Then the Ubuntu Server can be configured to use this static IP address.

  • When the Ubuntu Server OS is running, edit the /etc/network/interfaces configuration file:
sudo nano /etc/network/interfaces
  • Make sure the settings are similar to:
# The loopback network interface
auto lo
iface lo inet loopback
#
# The primary network interface
auto eth0
#iface eth0 inet dhcp
#
iface eth0 inet static
address 192.168.1.135
broadcast 192.168.1.255
netmask 255.255.255.0
gateway 192.168.1.1
  • Reboot the Ubuntu OS again so that the new IP address is used.
sudo reboot

VistA Server functions

The VistA server functions are generally configured from a text interface. The VistA server is very flexible and powerful, and therefore can seem complex to customize and daunting for new users.

Accessing the interface is possible in several ways:

  • While logged on the server (using any login ID) by starting VistA Commander from a command-line interface Terminal:
/opt/openvista/EHR/bin/vista_com.sh
  • Logging in directly to the server using the provided Linux login (openvistaEHR or worldvistaEHR) and opening a (Konsole) Terminal. This loads the VistA Commander interface automatically. (On Astronaut systems, the default initial password is vista!123.)
  • Using the Text Client, VistA Config, or VistA Server Admin (text9260) (with or without SSH) if installed on your system as part of a client package.
  • Using the built-in VistA Server Text Client menu items/shortcuts in the Ubuntu-Med system.

Then see

Connect with a CPRS client

Using the VistA Configuration Utility

Using the VistA Clinical Scheduling utility

The Clinical Scheduler from the Indian Health System's RPMS system has been imported as one of the modules included with an Astronaut VistA installation.

Configure access to the VistA server from the Internet through a virtual server

Other resources

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