The Department of Veterans Affairs has taken a major step toward opening its electronic health record system to open source development.
The Web portal, where collaborative development on the electronic health record system will take place officially launched last week, and developers who are interested in contributing to the project can start signing up.
“There was a lot of confetti and balloons around the office,” said Roger Baker, VA’s chief information officer, during a conference call with reporters last week. “This has been two years in the making, and it’s huge.”
The only thing that’s missing is the source code, itself, for the health record system, which is known as VistA and is used in 153 VA hospitals and more than 800 community-based outpatient clinics nationwide.
VA will soon release the entire VistA system to the open source world under the Freedom of Information Act, and Baker said the code base and any modifications to it will stay open and freely available.
“VA has committed that everything we do in the moving forward of VistA will be contributed to the open source,” he said. “We are the charter member of the open source effort, and we’ve been firm on that commitment from the beginning.”
The Web portal is run by an independent organization, the Open Source Electronic Health Record Agent, which the Informatics Applications Group is currently operating under a $5 million contract VA awarded this summer.
But the software code and any improvements to it will be free and available to the public. Baker said making the code freely available and conducting development work in the open will VA modernize its health record system in a more agile fashion over time, and others in the health IT world will be able to benefit from work VA has already done.
“This hasn’t been the easiest thing any of us ever did, but it is huge,” he said. “It is just huge in thinking about the way government thinks about massive, impactful systems and code. I have great optimism that this will start to lead the way in thinking about the way government systems get done.”
“If you think about how government contracts for large, complex, mission-critical systems, they end up narrowing it down to one small group that does this for them,” said Meagher, who is now a vice president at Computer Sciences Corporation. “This is actually the opposite. This is broadening it out to the point where he now has everybody available to him. This probably won’t cost a lot less than what it would cost if they went proprietary, but then at the end of the day, it’s available to everyone. It’s a growing thing, it can continue to be improved. When you step back and think about it, you have to ask why we haven’t been doing it this way all the time.”
Meagher said the idea will end up being a win not just for VA, but for the IT industry. He said there will end up being four basic groups that contribute source code and ideas to the VistA modernization: VA’s own employees, its contractors, the volunteer open source community, and commercial-off-the-shelf healthcare technology vendors who want to do business with the VA healthcare system.
He said the commercial vendors still would be able to work with VA and would continue to collect license fees from the department for its use of their systems, but predicted VA would require such companies to develop open-standards interfaces to let their systems communicate with VistA.
“They won’t have to go open source, but you want to make sure that if they’re delivering something of value, they can play here too,” he said. “And it would be to their advantage as well. They can turn around and sell that, say, ‘Look, the VA uses our product, how would you like to use it as well?’ So Roger’s creating a new marketplace here. It’s going to be a vibrant marketplace, and I think there are going to be fortunes made inside it. It’s going to be good for everybody.”
The VA’s major venture into the open source world happens at the same time that it’s working with the Defense Department to create a joint electronic health record that both agencies can use as servicemembers transition out of the military in to the care of VA.
Baker said rather than DoD and VA fighting over which health record system will form the foundation of the joint system, he thinks the open source effort will morph into something that will effectively support both departments.
“Way back a year ago, the question was how open source and the joint EHR would go together. That question has been very nicely answered to the point that DoD sees the open source as a very strong contributor to how we move ahead,” he said.
“As we look at things that we’re going to want to incorporate in the joint EHR, we’ll look to the open source community and what they have available as one of the primary ways of sourcing that. The second thing is as VA moves VistA forward on our end to become the joint health record system-I use the phrase morph-we’re going to do that through the open source. So in effect, the iEHR, when we get done, will be in the open source. As we’ve worked through this more and more with our DoD partners, they’ve gotten pretty excited about what open source brings to this.”
Baker said the department recently issued a request for information to industry for an “enterprise services bus” and already has started to receive comments. That architecture will form the heart of how heath IT systems communicate with each other between VA and DoD.