VA to up­date VistA EHR

Modern Healthcare - - The Week In Healthcare - Joseph Conn

The Vet­er­ans Af­fairs Depart­ment is mov­ing for­ward with a mas­sive open-source soft­ware de­vel­op­ment pro­gram to up­date its ven­er­a­ble VistA elec­tronic health-records sys­tem. The an­nounce­ment comes af­ter more than a year of de­lib­er­a­tion at the VA over a way for­ward for VistA, which traces its de­vel­op­ment roots to 1977. “We can do bet­ter for the VA and for the coun­try by de­moc­ra­tiz­ing VistA,” said Roger Baker, as­sis­tant sec­re­tary for in­for­ma­tion tech­nol­ogy at the VA.

Baker de­liv­ered the news last week to mem­bers of WorldVistA, a not-for-profit or­ga­ni­za­tion pro­mot­ing the use of an open-source ver­sion of VistA out­side of the VA. The group met last week at Ge­orge Ma­son Univer­sity in Fair­fax, Va.

The de­ci­sion to move ahead with open source came only af­ter an “ex­tremely de­lib­er­a­tive process” dat­ing to a June 2009 meet­ing with Dr. Rob Kolodner, for­mer head of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy at HHS and a VA health IT pi­o­neer, and Dr. Peter Levin, chief tech­nol­ogy of­fi­cer at the VA, and oth­ers.

One goal of the open plat­form is to ac­cel­er­ate im­prove­ments to the EHR to keep pace with change in health­care, Baker said. An­other is to get full value from spend­ing on an EHR that’s cen­tral to health­care op­er­a­tions at the VA.

The VA so­licited bids this year for what’s de­scribed as a “cus­to­dial agent” to over­see fu­ture open-source de­vel­op­ment of the VA’s EHR sys­tem. The dead­line for bid sub­mis­sions was May 20, and the VA aims to se­lect an agent by sum­mer. It is with­hold­ing the names of or­ga­ni­za­tions ap­ply­ing for the job.

Mean­while, the VA and the De­fense Depart­ment are com­mit­ted to hav­ing a uni­fied EHR run­ning in their sep­a­rate health­care sys­tems, al­though de­tails of that ar­range­ment are in­com­plete. For now, Baker said, the VA will re­tain ma­jor­ity con­trol of the board of the open-source cus­to­dial agent, but the De­fense Depart­ment will have a board seat. To de­velop the joint IT sys­tem, he said, “We’ve got four to six years of an aw­ful lot of work ahead of us.”

Ed­ward Meagher, a se­nior ex­ec­u­tive ad­viser to Com­puter Sci­ences Corp., said dur­ing a panel dis­cus­sion at the WorldVista meet­ing that Baker “has $3 bil­lion to fund this.” Meagher led an IT in­dus­try con­sor­tium last year that rec­om­mended the VA use an open­source model to over­haul VistA for about $5 bil­lion to $7 bil­lion.

Dr. Nancy An­thracite, pres­i­dent of WorldVistA, said she was cau­tiously op­ti­mistic about what she heard. WorldVistA is not vy­ing to be the VistA cus­to­dial agent and did not for­mally com­ment on the VA’s re­quest for pro­pos­als. An­thracite said, how­ever, that what was in the re­quest “was not great,” but that the pro­ject re­mains mal­leable. “I think we’re go­ing to have to work hard to make it work,” she said.

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