While the Defense Department continues its procurement process for an electronic health record, the custodial agent established by the Veterans Affairs Department to manage the open source aspects of iEHR is preparing for its third annual summit.
And plenty of folks are scratching their heads, wondering if the DoD might still select the VA’s VistA, or turn down a different path entirely.
Government Health IT Editor Tom Sullivan spoke with Seong K. Mun, CEO and president of Open Source Electronic Health Record Agent, otherwise known as OSEHRA, about the prospects for DoD actually picking VistA, his agency’s work on a standard code base that, in the long run, all the VA hospitals could adopt, and what to expect at this year’s conference, which runs from September 4-6, in Bethesda, Maryland.
Q: What will be the overarching theme at the upcoming OSEHRA Summit?
A: This is our second summit and this year our primary focus is to be the showcase for a lot of innovations that are taking place around open source and VistA. And unlike last year we are offering a one-day tutorial of open source and agile development. These are fairly new concepts to health IT so we’re going to orient our community on the ins and outs of open source.
Q: Regarding those innovations, what are the highlights that health professionals should look for?
A: Different members of the VistA community are making different capabilities for the software. For instance, a university consortium is making their open source code that is compatible with VistA available. And different community members are making more code contributed to our website.
Q: How do the changes to the iEHR plan impact OSEHRA and what it does?
A: We’ve been obviously following that very closely and actually I’m really pleased with the development because unlike a couple years ago open source is now at a level playing field. So I feel very good about the way things are evolving.
Q: Do you say that particular to open source, iEHR, or both?
A: In terms of iEHR. Our friends at the Department of Defense have announced that they’re going to investigate commercial products — and open source really is part of a commercial solution. OSEHRA does not sell code. Whatever code that they want will have to be picked up by a large systems integrator to add additional capabilities to meet DoD requirements. So we’re quite pleased that they are looking at that approach.
Q: Now, how many commercial products do you think can actually meet the DoD’s requirements?
A: There are several organizations that have had a lot of VistA capability in the past. We hope that they will integrate new VistA capabilities into whatever additional capabilities that they have.
Q: So it sounds like the DoD could still opt for VistA or some of its components?
A: Yes, I think so. There are some requirements that I’m sure the DoD has that the VA and VistA can’t meet but these are the things that commercial software providers can add.
Q: There was a lot of talk even before DoD changed its iEHR plans that it was not utilizing open source nearly as much it could or even should be and not playing much of a role in OSEHRA. Do you see that changing?
A: There’s a growing appreciation of open source there. I recall having a workshop when I was at Georgetown with friends at DoD — this was 7 or 8 years ago — and the position at that time was ‘open source? No way.’ So I think they’ve come a long way. And also if you go and build around a certain operating system, like Unix, that is open source, it is tested and provided to the end-user with certification, service, warranty, installation, all that. So the code base we have will still have to go through a systems integrator’s scrutiny for it to become an operating product for DoD.
Q: Particular to OSEHRA, what does the year ahead hold?
A: Right now we are putting a lot of our focus on trying to come up with a common code base for all our members. As you know, VistA has been public domain code for many years so there are dozens and dozens of different flavors of VistA sold by different small and medium-sized companies. We are working with them, together with the VA, to create a common code base eventually so we can provide shared development.
Q: And might that code base be available by OSEHRA’s third summit, presuming there is one?
A: Oh, it might take more than a year. That depends on how the community decides the common code base will evolve. For instance, the code base we manage comes from VA, it’s the latest enterprise version that’s part of VA’s standardization activity and that’s the code our commercial partners have. They’ve installed these in many places around the world. But there are differences and we need to make sure those gaps are narrowed. So managing VistA to support shared development is our number one priority.
Q: And when you say managing the VistA product – is that just the core EHR? The VA has talked a lot about iEHR’s architecture having a data layer, an enterprise services bus, applications layer and then on top of those the GUI. Does OSEHRA manage all those working parts?
A: At this point we manage most of it. As you know VA has 150 some odd hospitals and there is no standard code that is common across all of those. VA standardization taking place is so that we get in the next year or two, I’ll just pick a number, but out of 150 hospitals maybe 80 percent of them will be identical. That’s what we support.
Q: And what’s the anticipated payoff for standardizing the code across all those VA hospitals?
A: If you don’t have standardized code and you’re trying to address enterprise-wide solutions you have to have 155 variations. So having standardized code will enable VA to much more efficiently address enterprise solutions. For instance, the evaluation of a scheduling module through their contest. If they’re tying to add that to 150 hospitals with 150 variations, well, they’d have to have 150 solutions.
Q: Something of a nightmare…
A: Yes, and though I wasn’t involved with the previous scheduling module effort, I think that’s one of the reasons why it was pulled. So we are an integral part of standardizing the code. As that happens, we release the code to our community and that includes everyone. Part of that process, we do a level of certification and, of course, we clean up the code during the standardization process.
Q: In addition to helping with upgrades of enterprise features, I imagine a common code base would make maintenance, bug fixes, easier and it must also help with interoperability of health data?
A: Certainly, yes.
Q: So what else should I be asking about the upcoming OSEHRA summit?
A: The upcoming summit, well, the tutorials will be interesting. Then we have a number of different workgroups talking about specific technical issues that have to do with VistA modernization. The big news going into this year is that the U.K’s National Health Services announced they're going to do a VistA installation pilot project at three of their hospitals.
Q: Have they elected a particular flavor of VistA to use?
A: They will be using the VistA version that we manage. That’s the most recently integrated code that has a clear lineage back to the VA’s standardized code. I don't know the timing but they made the announcement this summer and already they have identified some 240 million pounds for this project. So that’s really big news for us.
Also, there is a lot of interest at the state level. For instance, New York state is now in the process of installing VistA in all their mental health facilities. The state of Tennessee is in the process of starting such a project and there are a couple other states very interested in VistA.
