 So I'm going to talk about some software that is actually developed by the government of the United States, and it actually is something that's important and real and Please listen to bear with me for the next few minutes I'm going to talk about Vista on Linux, which is a Vista is the software It's a complete free and open-source software stack for electronic health records and Just the obligatory marketing slide about the RDB and by company Okay, anyone recognize this place. It's about a half hour away place called Butner, North Carolina It's one of the three mental health inpatient facilities operated by the state of North Carolina and It saved North Carolina taxpayers millions or tens of millions of dollars more likely by implementing a Vista based open source Stack for electronic health records now. They have patients who are there for life This is a mental health institution and they use software that is developed by the Department of Veterans Affairs the Vista software So what is Vista? So it's developed by the Department of Veterans Affairs It is used throughout the VA system and For those who don't know, you know, you hear all the news about Some VA hospitals having issues with scheduling and so on but the bottom line is the VA system actually works very well There's a book that I highly recommend called the best care anywhere and It's a few years old, but it's by a guy called Philip Longman and he argues that The Vista is one of the things that makes the VA system work well They have patients who are sicker than average. They have patients who are there for longer than average But they their costs have actually been going up Slower than the overall national health care cost So it's used throughout the VA all of the hospitals all of the clinics and Interestingly, it's also used in other parts of the federal government like the Department of Defense Where the Department of Defense actually put out a contract for an electronic health record system some company Got Vista from the VA and the Department of Defense had some requirements that were not part of the VA system like pediatrics need their own or pediatric veterans and So whereas they have the Department of Defense had those needs So this company took Vista, which is in the public domain Through the Freedom of Information Act added these other modules sold it back to the Department of Defense for millions of dollars Indian Health Service which is part of the Department of Health and Human Services had similar needs They took Vista again. They have needs like OBGYN and pediatrics. They added those to Vista. They actually use it throughout the you know Indian Health Service in the in the United States and It's actually been deployed by multiple states. I talked about North Carolina. It's also been deployed by the state of New York You know, Oklahoma, Tennessee and in Washington and others and also in hospitals and clinics in the United States so Orville, California where which has been in the news lately because of their Floods with the dams and then forest fires and all sorts of other things. It's actually a beautiful place if you go visit But they have the Orville Hospital actually took Vista from the VA deployed it internally Saved themselves a ton of money by doing it and then even at the individual clinic level. There's a Clinic that I know that they deployed it and one of the owners of the clinic actually was a Programmer and an electrical engineer before he became a doctor. So I don't expect everyone to be able to do this And internationally it's been deployed in other countries like Jordan and India So in Jordan the Ministry of Health and the Royal Medical Services Approximately two-thirds of all of the healthcare in Jordan is covered by these two systems They've taken Vista from the Department of Veterans Affairs Deployed it and done it at a fraction of the cost of what a commercial EHR might cost Little bit of history It was actually developed by developers sitting side-by-side with the with the physicians and pharmacists and nurses and The central office often did things like you know, so they weren't supposed to be doing this So they actually fired people they took away their computers and whatnot But they actually ordered these things called word processors and actually wrote software on word processors that ultimately turned into Vista And it actually came up with a lot of things like namespacing and Concurrent development and so on long before these things were common to the rest of us A little bit of technology stack so the back end is actually written in a language called M. It's terminal based and You can see the rest of that Front-end there are some clients and then there's a complete ecosystem and some of these are obviously not Not open source like the drug interaction database and diagnostic codes and so on