Most folks, when I tell them that I know VGR have the same question: "What is VGR?" Well, the short answer is that "VGR is a scripting language designed to specify rules for implementing decision support"[2] from within McKesson's Horizon Export Orders system. But that's only half of the story.
Have you ever wondered where the acronym "VGR" came from? Well, here's a bit of a history lesson.
VGR was originally designed for WizOrder, Vanderbilt University Medical Center's (VUMC) computerized physician order entry (CPOE) system. In their words, it was designed to deliver "high-quality decision support to clinical end-users" and "to make it easy for non-programmer domain experts to enter rules."[2]
WizOrder
"WizOrder is a computerized clinician order entry system continuously developed by DBMI [Department of Biomedical Informatics] faculty, working with Informatics Center staff and trainees. WizOrder is used "at the point of care" to support clinicians as they make important decisions regarding a patient’s clinical course, and the system helps to ensure the highest quality of care for VUMC patients while reducing medical errors. It incorporates relevant information resources to enhance and support decision-making...
"WizOrder's major developer, Dr. Antoine Geissbuhler, initially created the system as an applied postdoctoral fellowship project in 1994-96. He and Dr. Randy Miller began the first roll-out of WizOrder in 1995-96." [1]
The VGR Scripting Language
"In order to aid in knowledge-base maintenance and provide a mechanism for implementation of clinical decision support during order entry, a simple programmable rules engine was developed.
"The rules engine works in concert with HTML forms, and uses a locally developed scripting language, known as VGR (Vanderbilt Generic Rules). VGR was designed to be easy for non-programmers to use...
"VGR is a scripting language designed to specify rules for implementing decision support. When triggered during order entry by selection of individual orders tied to scripts, a script is read into memory and executed in a top-to-bottom fashion. Script execution has two phases; an INIT phase occurs prior to the loading of the initial HTML page, and an EDIT phase takes place each subsequent time the user indicates they are 'finished' with an HTML page. There are simple logical statements which include IF-THEN with AND, OR, AND_NOT, and OR_NOT. Within each VGR script, variables are defined and can be mapped to the "name" field of HTML form input tags. Certain patient-specific variables (such as the patients age and most recent platelet count) are made available to VGR at runtime and may be used in the decision support logic or displayed to the end-user. Together with the IF-THEN logic, these variables may also be used to check the quality of an entered value (such as checking for a weight which is above a particular number) as well as to initiate appropriate orders."[2]
McKesson Enters the Scene
In June 2001, it was announced that "Vanderbilt University has sold rights for commercial development and marketing of WizOrder, the highly prized electronic order entry system created and developed at Vanderbilt University Medical Center, to Atlanta-based McKessonHBOC, Inc...
"WizOrder will be marketed under the name Horizon Expert Orders and will provide the backbone for Horizon Clinicals, a suite of products encompassing point-of care clinical documentation as well as laboratory and pharmacy solutions." [3]
HEO is technically a "re-written" version of WizOrder and has seen many modifications, fixes, feature updates, versions, and iterations since that point. Through it all, VGR has remained with its original name intact and has not changed significantly from its original state. And as Paul Harvey would say, "Now you know... the rest of the story."
Scott Morris is available for training, mentoring, troubleshooting, and iForms consulting. Find out more at www.thinkiforms.com
References
- History of WizOrder at VUMC
- Experience Using a Programmable Rules Engine to Implement a Complex Medical Protocol During Order Entry by John M. Starmer, M.D., Douglas A. Talbert, Randolph A. Miller, M.D.
- WizOrder sent out into the world - Paul Govern, 7/27/2001
- The Soul of a New Medicine - Paul Govern
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