Wisconsin reps try to derail VA/Defense open source health records system

Five members of the Wisconsin congressional delegation asked the Veterans Affairs and Defense departments to consider using a single commercial system for their new electronic health records, a move that could benefit one of the state's largest employers, software company Epic Systems Corp.

VA said it plans to stick with the open source approach it announced last month, but experts say the lawmakers' query could potentially delay the new system.

In a Feb 7 letter, the lawmakers asked top executives of the two departments if the benefits of a commercial system had received "appropriate consideration" in the modernization and integration of their electronic health records.

"Some experts believe that commercial EHRs show significant potential to provide a state-of-the-art replacement quickly and at a reasonable cost," wrote Wisconsin's two senators, Democrat Herb Kohl and Republican Ron Johnson, Republican representative Paul Ryan and Democratic representatives Ron Kind and Tammy Baldwin, whose district includes Verona, where Epic has its headquarters.

The letter added that single-vendor EHRs help protect patient safety by using one consolidated database. A commercial approach also could cut development and installation time, said the letter, which was addressed to Roger Baker, VA chief information officer, and George Peach Taylor of Defense.

The Wisconsin letter might have put a minor speed bump in the way of a long-awaited agreement between VA and Defense to develop a single record, expected later this month, said one industry source familiar with the negotiations between the two departments. The letter also seemed designed to torpedo VA's plans to use an open-source approach to develop its next-generation EHR announced last month, said a congressional source who declined to be identified.

Barbara Hernandez, an Epic spokeswoman, acknowledged the company talked to its representatives and provided technical information to them. The company also talked to representatives from other states, she said, adding that privately held Epic, which has 4,200 employees and took in $825 million in revenues last year, does not use lobbyists.

The company developed the EHR for Kaiser Permanente, the largest private health care provider in the country, which serves 8.3 million people with 35 hospitals, 431 medical offices and a staff of 167,000 employees. Kaiser spent $4 billion during a six-year period from 2003 to 2009 to deploy this system. VA operates 153 hospitals, 135 nursing homes, 50 residential rehabilitation facilities and 15 clinics supported by a staff of 252,925.

In his reply to the Wisconsin representatives, Baker said the open source approach will allow VA to modernize its current Veterans Health Information Systems and Technology Architecture, known as VistA, through integration of commercial products. "This will have the effect of opening up several billion dollars of our annual spending for much broader private sector competition," he wrote.

The Military Health System has not yet responded to the Wisconsin letter, a spokesman said.

Craig Newmark, founder of the online classified advertising business Craigslist, serves as a consultant to VA, and supports the system plans announced last month. "The open-source approach, in real life, normally means faster, more effective, less expensive development," Newmark said. "It's about moving away from customized and proprietary systems and towards openly architected and modular ones."

The open source approach "also spurs genuine innovation and real, high-quality jobs, in part, because it provides a level playing field for developers, and that attracts the most effective software people," he said.

Tom Munnecke, who helped develop VistA at VA and then served as chief scientist for Science Applications International Corp., where he worked on developing the Defense electronic health records system, said attempts to derail open source in VA "is nothing new; the open-source VA VistA model was always under attack by those who wanted to lock the government in to their proprietary architecture. The VA showed repeatedly that an open model was superior."

Ed Meagher, vice president of health care strategy at Computer Sciences Corp. who formerly served as VA's deputy chief information officer, said the open source approach that Baker backs is in the best interest of everyone involved in the process of VistA modernization -- VA, vendors, veterans and the taxpayer -- and will ensure open competition for all vendors, including Epic.

Newmark said open source means a level playing field, which "reflects fundamental American values of fair play. Everyone gets a chance for their part of the American dream."