VA moves toward open source for electronic health record system

The Veterans Affairs Department asked industry, government agencies and academic researchers last week for insights on using open source software as a key component of a modernized electronic heath record system, a move that could have serious implications for the Obama administration's initiative for adoption of digital medical files nationwide.

In a request for information issued on Aug. 11, VA said it is evaluating the viability of including open source as part of the development of upgrading its decades-old health record system, Veterans Health Information Systems and Technology Architecture (VistA).

Veterans Affairs officials said President Obama's agenda for "sweeping transformation" of health care delivery in the United States presents many opportunities for VA. "Leveraging VistA to drive expansion of electronic health records is one of the opportunities VA is exploring," the request noted. "Innovation on VistA is a challenge that could be taken on immediately by opening VistA code to the open source community."

The request for information reflects a report that an industry group issued on VistA in May. The Industry Advisory Council, a group of 550 technology companies in the Washington metropolitan area, recommended VA develop an open source-based version of VistA as the key component of its electronic health record modernization plans. VA Chief Information Officer Roger Baker had asked the council to analyze how to leverage the original open source VistA for "the betterment of the country."

At a press briefing this month, Baker called IAC's recommendations "good advice. It is being incorporated into our thought processes."

VistA software can be obtained under the Freedom of Information Act, and developers such as Medsphere Systems Corp. in San Diego have used the code to configure open source electronic health records systems. VA wants to take advantage of third-party developers such as Medsphere to improve and develop a modern VistA system. The project could lead to "broader proliferation of common electronic health record software and solutions," VA officials said.

While collaboration in the open source community brings with it "tremendous options," officials added, it also requires sensitivity to intellectual property rights and the development of a governance system to ensure stability.

VA asked for comments and insights on how to use open source software in its modernization efforts, including the role it should play in an "open source ecosystem and the role that non-VA developers should play in that ecosystem." The department also wants input on how other federal agencies could participate or benefit from an open source approach to develop a modernized electronic health record.

Ed Meagher, chairman of the industry council's VistA working group and former VA deputy CIO, said putting out a call for industry comments on open source is the next logical step in an exhaustive process of vetting any decision to move to open source.

Meagher, now director of strategic health initiatives at SRA International, said pursuing open source to develop what he called VistA 2.0 is the best alternative because it allows VA to control its own destiny.

Few commercial products have the capability to expand to meet VA's sophisticated requirements, and if the department selected a commercial product, it would end up mired in protests that would delay VistA modernization, he said. VA also would have to use proprietary software that it had no control over, Meagher said.

Joseph Dal Molin, a Toronto-based VistA developer who is working on a pilot test of VistA in the Kingdom of Jordan, said, "It is very encouraging to see that the VA is still interested in open source as a strategy for improving VistA and that through this RFI has opened up the consultation process to the general public."

VA has put the comment period on a fast track, asking for responses by Aug. 25.