Defense, VA should convert old code to build new record system

Two software companies claim the Defense and Veteran Affairs departments could spend a fraction of the billions of dollars they say they need to develop an electronic health records system from scratch if they converted old software to new open-source code.

As a way to answer President Obama's call last week to create a joint Defense-VA electronic health record system, the departments should consider a project that converted decades-old software in a legacy health records system operated by VA into open-source Java programming language, said Greg Tablock, vice president of sales for The Software Revolution Inc., which conducted the conversion.

VA awarded the company a contract in 2005 to convert 300,000 lines of old code in the time-keeping application of the Veterans Health Information Systems and Technology Architecture (VistA), which VA uses to manage the health records of veterans and their families. Software Revolution, based in Kirkland, Wash., converted the legacy code, known as the Massachusetts General Hospital Utility Multi-Programming System (MUMPS), to the Java programming language in seven minutes, said Phillip Newcomb, the company's chief executive officer.

Software Revolution then spent most of the four-month demonstration project optimizing the new Java time-keeping database, he said.

In February, the company converted on its own about 2.5 million lines of additional VistA MUMPS code to Java, a process that took about 20 hours, according to Newcomb.

He said for about $125 million, a contractor could convert all of VistA's operating software to Java, including deploying new hardware to replace VA's antiquated Alpha computers, which were manufactured by long-defunct Digital Equipment Corp. In September 2008, S. Ward Casscells, assistant secretary of Defense for Health Affairs, estimated it would cost Defense and VA about $15 billion to develop an electronic health records system.

Tablock said VA could complete the conversion process in two to five years, a project that would require installing the new software at all 153 VA medical centers, with the software hosted locally at each medical center.

Defense uses MUMPS software in its Composite Health Care System, which is the core of its AHLTA health record system. Science Applications International Corp. built AHLTA under a $1 billion contract awarded in 1988. In March 2008, Israel-based CAV Systems Ltd., in partnership with SAIC, successfully converted more than 40,000 lines of MUMPS code that operated the system's radiology module to Java in eight days. The project was conducted under a contract awarded by the Army's Telemedicine and Advanced Technology Research Center.

Alex Hill, vice president of corporate development at CAV, declined to reveal the cost to convert the module, but said the changeover would save Defense money in a number of ways, including the use of more affordable hardware. Hill also said full conversion from MUMPS to Java would eliminate the need for Defense to license a Cache database from InterSystems Corp. and rely solely on data housed in an Oracle database. A similar conversion of VistA code would allow Defense and VA to use the same Oracle database technology, he said.

Robert McFarland, who served as VA's chief information officer from 2004 to 2006, said he was unable to review the Software Revolution pilot in 2005. But he believes he pilot and the CAV Systems project make a strong case for Defense and VA to study converting MUMPS code to Java as a possible inexpensive way to migrate to a new health record system that both departments could operate.

Newcomb said if Defense and VA converted their electronic health systems to open-source code and new databases, the new systems could serve as the basis for a national open-source electronic health record system.

Tommy Morris, acting director of the Office for Health Protection and Readiness Programs at the Military Health System, said in an e-mail that Defense believes the Composite Health Care System should be phased out, "with its functionality migrated . . . [to] a more modern system."

Officials with VA and the Army Medical Department did not respond to questions submitted more than two weeks ago.