VA launches open source approach for electronic health record modernization

The Veterans Affairs Department kicked off a project last Friday to modernize its decades-old electronic health record system with an open source model that it said will benefit both VA and private health care providers, including doctors and hospitals.

VA said the open source approach to modernization of its Veterans Health Information Systems and Technology Architecture, known as VistA, "will unleash EHR innovation inside and outside" the department and create a national asset that will benefit the entire health care market.

Industry sources said the collaborative approach toward development of the new VistA EHR also could spur development of a new single electronic health record to serve both VA and the Defense Department. Roger Baker, VA's chief information officer, told the House Veterans Affairs Committee last Thursday he expects the two departments to reach an agreement on a single electronic health record within two months.

Craig Newmark, founder of the online classified advertising business craigslist.org and a consultant to VA, called the open source approach a "really big deal, novel in government, which might also improve the health record systems we all use. This could become the basis of a jointly developed health records platform," he said in a blog post yesterday.

In its request for information, VA said the first stage in its project is development of an open source ecosystem, guided by a governing body called the custodial agent, which it said will most likely be a vendor.

VA said it will contribute its existing VistA code base to the custodial agent and that code will serve as the basis for the modernization project. To update a section of code, Veterans Affairs will submit a project request to the custodial agent, and upon approval, contract with a vendor for the task. Then VA will publish the new code to the open source community, solicit feedback for improvements, and then certify it, at which point the new code will become part of the new open VistA code base.

End users, from large enterprises to small physician offices, will have many options for acquisition and deployment of the open source code, including downloading it directly from the custodial agent. An end user also could acquire the open EHR code in bundled software from vendors or nonprofit groups, VA said.

In a speech to the annual Healthcare Information and Management Systems Society conference in Orlando, Fla., yesterday Baker said the open source approach for VistA will allow the private sector to contribute to the evolution of VistA, which will allow integration of proprietary and open source software.

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, called the open source approach a "positive step forward," but said VA needs to ensure this approach is as simple as possible.

The department should look to the design of the Web, as originally envisioned by Tim Berners-Lee, which had the elegance of simplicity -- an interconnected space governed by a few rules, with no central computer control.

Joseph Dal Molin, a Toronto-based VistA consultant, said the open source approach will have a "significant impact" on development of a single electronic health record for Defense and VA, if Defense signs on.

Keith Salzman, former chief of informatics at the Madigan Army Medical Center in Tacoma, Wash., said VA's open source EHR has national implications beyond Defense and Veterans Affairs, but said a single record for both departments will be one that blends the best from the two.

Munnecke predicted it will take 10 years to develop and deploy a single EHR to Defense and VA.