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United Kingdom Eyes VA’s Electronic Health Record

Eric Limon/

The Veterans Affairs Department and the United Kingdom’s National Health Service have teamed up to share ideas, strategies and leadership for development of health information technology, opening the possibility that the NHS could use VA’s electronic health record system.

Peter Levin, the former VA Chief Technology Officer who retired this month, told Nextgov the Pentagon also should adopt VA electronic health record.

On March 13, VA, the 3millionlives telehealth project backed by the U.K. Department of Health, and 2020Health, a U.K. think tank, released a 90-page report, Making Connections, which calls for greater collaboration between NHS and the Veterans Health Administration on health IT.

Julia Manning, chief executive of 2020Health, said in an introduction to the report that cooperation between VHA and NHS could trigger deployment of digital health services in the UK and contribute to the development of specialized telehealth services within VHA.

The NHS launched a national electronic health record project, the NHS National Programme for IT in 2004 but canceled it in 2011 following delays and cost overruns. The health ministry said at the time “the nationally imposed system is neither necessary nor appropriate” and suggested development of local, hospital-based systems. Due to the project’s collapse, hospitals in the U.K. still use paper records, the Making Connections report said.

The report suggested the NHS could exploit VA’s electronic health record system, the Veterans Health Information Systems and Technology Architecture, or VistA. The report noted that the “open-source nature of the VistA software means it is a continuously developing and highly adaptable programme.”

The report said a U.K. volunteer group, the Campaign for NHS VistA, aims to drive adoption of VistA by NHS. The group estimated it would cost NHS between $22 million and $30 million to adopt a “gold" version of VistA with the software maintained by a non-profit organization that would also train programmers on the MUMPS language, which powers VistA.

The Campaign for NHS VistA said its advocacy for using VistA is the opposite of “a top-down, multi-billion pound procurement. Instead, we are proposing a relatively small central project (the development and maintenance of a gold version) followed by a modest, bottom-up, voluntary, organic, iterative process.”

Tom Munnecke, who helped develop VistA, said the Making Connections report has helped launch a very timely discussion. “I would like to stress that VistA is more than just the computer source code or the specific functions it performs, but is also a community of people using information to improve their delivery of health care,” he said.

Munnecke said the greatest potential for collaboration would be in sharing an open source approach to dealing with health IT. “These tools could be shared, but used according to their location-specific needs. It's a bit like using the same email system to handle clinic appointments and results reporting.  It's the same messaging system, only with different contents,” he said.

Munnecke will hold a workshop on NHS and VistA in London on May 13.

Elizabeth McGrath, deputy chief management officer for Defense, told lawmakers at a Feb. 27 hearing of the House Veterans Affairs Committee that the department will conduct an analysis of VistA along with commercial systems for its next generation EHR.  Dr. Jonathan Woodson, assistant secretary of Defense for health affairs, told the House hearing that while Defense will consider using VistA, he is concerned that VA might not be able to provide the kind of support Defense would receive from a commercial vendor.

Former VA CTO Levin told Nextgov that the only way VA and Defense can hope to deploy any kind of joint system by 2014 is to use VistA. VA and Defense plan to use joint supporting services already in development, such as a common data dictionary and a graphical user interface.

(Image via Eric Limon/

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