The Veterans Affairs Department should adopt an open source, open standards approach to developing the next generation of its VistA electronic medical record, according to an industry group tapped by the VA to recommend ways to modernize the clinically praised health IT system.
The VA Health Information Systems and Technology Architecture, or VistA, is an integrated EMR system which that was written in vintage MUMPS code and tweaked and upgraded over the last 32 years. While highly regarded by clinicians, its decentralized architecture has made it costly and complex to maintain and upgrade.
An open source version of VistA, cultivated by independent software developers and healthcare providers outside of the VA, would be less expensive and easier to deploy and upgrade, according to the Industry Advisory Council (IAC), a Washington, D.C.-based IT vendors group in a set of recommendations announced May 6.
"Open source provides the best way forward in terms of engaging the entire community, making anything that is developed easy to enhance, flexible, and manageable in cost," said Ed Meagher, the chairman of the IAC workgroup that wrote the report.
"It also relates to the level of sophistication that the open source movement has changed to over time," Meagher said in a teleconference with reporters. Meagher is also the former VA deputy chief information officer (CIO).
For the time being, VA should stabilize its current VistA deployment by pursuing only those enhancements driven by patient safety and other mandates, said Meagher, currently director of global health strategic initiatives at SRA International.
IAC delivered its recommendations on May 3 to VA CIO Roger Baker, who had asked the IAC group last September to come up with proposals to modernize VistA.
Meagher called VistA, "the finest set of functional specifications ever developed," and said it should be viewed as a well-tested set of business rules that should be captured and extended for a new generation of users.
With re-engineering, VistA could be turned into a modern, robust platform, language and operating environment, the sum total of which IAC described as the "VistA 2.0 Open Source Ecosystem." In the VA's current version of VistA, these components are tightly coupled with MUMPS code, Meagher said.
VistA 2.0 would enhance the VA's ability to exchange health information securely over the Internet using standards
Developed for a national health information network (NHIN). Currently VA is using Connect, a set of interoperability specifications for large healthcare organizations, to exchange health records with commercial provider Kaiser Permanente.
"We think the standardization generated by VistA 2.0 will actually enhance the adoption of Connect and use of the NHIN," Meagher said, who also envisioned VistA 2.0 as a "guide star," around which users could steer the development of the NHIN.
"One of the reasons VistA is so effective is that it so thoroughly involves users, clinicians and caregivers, and it is a must that that continues," Meagher said.
To accomplish all this, IAC recommended that VA contract with one or more federally funded research and development centers to provide technical recommendations for VistA 2.0 as well as with a not-for-profit Open Source Foundation to manage, operate and maintain it.
Outside open source developers had a mixed reaction to the IAC recommendations. Fred Trotter, a member of WorldVistA, a group formed to lead open-source VistA development outside of the VA, said, "a new organization to create an open source replacement for VistA is a great idea; dictating how that organization should operate and detailing what technical strategy it should take is a bad idea."
"The whole notion of open source development is that the best ideas emerge from the community, they are not dictated by the leadership council of any organization," said Trotter, who has developed a cloud-computing-based VistA offering.
"Any new organization designed to build a VistA replacement should be built by adding the very best minds, funded and then given free-reign to try multiple different technical strategies, including those that contradict the assertions made in this paper."
The report can be obtained online here.
