VA's health record system cited as model for a national network

One of the more perplexing problems facing the Obama administration's pursuit of building a nationwide electronic health records system is the fact that hospitals and doctors can't share medical data seamlessly because the medical networks are incompatible.

But many health officials say they might have found the solution at the Veterans Affairs Department. Medical information technology specialists and industry executives told Nextgov that the open-source version of the VA's electronic health record system called the Veterans Health Information System and Technology Architecture (VistA) could serve as a building block for e-health networks nationwide and provide a variety of plug-and-play medical applications that can be easily shared among clinicians.

Open-source systems allow a range of applications that power information sharing to be shared on a large scale, just as users of Apple Computer's iPhone's open interface can download thousands of various applications off the Internet. The same model should be the primary approach the Obama administration uses when spending the $19 billion stimulus investment in health information technology, two doctors wrote in an article in the latest issue of the New England Journal of Medicine, released on March 25.

Dr. Isaac Kohane, director of informatics at Children's Hospital in Boston, and Dr. Kenneth Mandl, a pediatrician at the hospital and a professor at Harvard Medical School, wrote that the if the iPhone model were applied to health IT, it would stimulate a variety of low-cost medical applications that hospitals and doctors could download from the Internet to apply to the management of health records and patient data.

And the open source version of VistA "is definitely worth looking at" as a platform on which to build similar applications, Kohane told Nextgov in an interview.

Some health networks have already used VistA to deploy open-source records systems. Community Health Network of West Virginia, which operates 80 clinics serving 120,000 patients, deployed a version of OpenVistA in 2005, and the state of West Virginia installed the OpenVistA version in eight hospitals in 2006.

OpenVistA costs a tenth of the price of commercial health IT software, said Jack Shaffer, chief information officer of the nonprofit Community Health Network. For example, the West Virginia University Hospital System spent about $90 million to install commercial health software from EPIC Systems Corp. in seven hospitals, while the state's Health and Human Resources Department installed OpenVista in eight hospitals for $9 million.

The West Virginia state hospitals use the inpatient version of OpenVistA while Shaffer said Community Health Network uses an outpatient version based on the Resource and Patient Management System that was developed as an offshoot of the VistA system used by the Indian Health Service. Both versions of VistA lend themselves to the kind of application development envisioned by Kohane and Mandl, Shaffer said.

When VA began developing VistA in the early 1980s, it called the system the Decentralized Hospital Computer Program, a name indicating that software programmers at any of the 168 VA medical centers wrote applications and modules that could be used by other hospitals in the system, Shaffer said.

Schafer uses that approach today to write and share applications within RPMS such as a new prescription printing program and another tool clinicians use to look up the trade names of pharmaceuticals to find the generic name.

The Indian Health Service also uses RPMS for its widely dispersed health facilities, many of which have limited connectivity, said Dr. Theresa Cullen, the service's chief information officer and a rear admiral in the Public Health Service. IHS serves more than 1.5 million American Indian and Alaska native patients, about 1.4 million of whom receive care at facilities that use the Resource and Patient Management System. IHS, tribal and urban Indian health programs operate more than 700 facilities in 36 states. RPMS also offers broader applications in well child care, prenatal care, population health and performance assessment.

Cullen said the agency could rely on work that Shaffer and others in West Virginia have completed through interagency agreements. "That's the beauty of open source collaboration," she said. As a result of that partnership "we are getting access to additional subject matter experts who provide us with ideas" that IHS can then build into its system.

Because RPMS is funded by taxpayers, it could be adapted as an affordable electronic health record system for wider use and supported by commercial vendors, Cullen said. Shaffer said the Health and Human Services Department should make RPMS or VistA a public utility to boost IT adoption nationwide and said section 3007 of the 2009 American Recovery and Investment Act contains a clause that would allow HHS to do so.

The law states that the department's national coordinator for health information technology "shall support the development and routine update of qualified electronic health record technology . . . and make available such qualified electronic record technology unless the [HHS] secretary determines through an assessment that the needs and demands of the providers are being substantially and adequately met through the marketplace."

Shaffer said the cost advantage of VistA and RPMS, their stability and adaptability makes a strong argument to use the language in the stimulus bill to take RPMS and VistA to market.