Latest Effort to Derail the Open Source Approach to Modernizing the VA VistA System

On March 22, 2011, an article in the Nextgov news site reported that five members of the Wisconsin congressional delegation asked the Department of Defense (DoD) and the Department of Veterans Affairs (VA) to consider using a single commercial system for their new electronic health records, a move that could benefit one of their state's largest employers, software company Epic Systems Corp. The VA quickly responded and said it plans to stick with the open source approach it has pursued so successfully in partnership with other public and private sector organizations over the past few decades.

On March 22, 2011, an article in the Nextgov news site reported that five members of the Wisconsin congressional delegation asked the Department of Defense (DoD) and the Department of Veterans Affairs (VA) to consider using a single commercial system for their new electronic health records, a move that could benefit one of their state's largest employers, software company Epic Systems Corp. The VA quickly responded and said it plans to stick with the open source approach it has pursued so successfully in partnership with other public and private sector organizations over the past few decades.

Every few years, another health information technology (IT) vendor steps forward and recommends that their proprietary solution ought to be purchased by the VA to replace their existing VistA health information system. The argument is always the same - that buying their system would somehow magically improve functionality, lower costs, improve patient safety. All that is required is that the government get rid of its world renowned system, spend billions of dollars to buy their product, and tie the government to their single vendor solution.

Of course, you have to unplug and shut down an existing system that hundreds of thousands of employees currently use, a system embedded into almost every clinical and business process at the VA.  All you have to do is retrain all of these employees and disrupt care to millions of patients. All you have to do is write a check and lock yourself into a particular vendor's product.  All you have to do is keep writing big checks to the vendor every time you want to make a change to the system. That can be a major problem in the field of medicine which is continuously changing.

The CIO for the VA is to be applauded for his response to the Wisconsin representatives. After a careful and extensive review of alternatives, he is committed to the open source approach that would allow VA to modernize its current VistA system by leveraging the energy and resources of the constantly growing open source healthcare community – a global community of tens of thousands of health care professionals, programmers, and commercial vendors collaborating on the development of innovative next generation health IT solutions. This approach does not lock the VA into a single vendor solution - a vendor that has limited resources and could never hope to rival the level of energy or resources that the open source community can bring to bear.

The open source approach planned and being pursued by the VA will have the effect of freeing up hundreds of millions of dollars over time. It is an inclusive approach that makes use of both open source software solutions and commercial products. The VA has been very successful in developing, maintaining, and continuously enhancing the world renowned, comprehensive VistA health information system over the years using a highly successful 'hybrid' open systems approach.

It is to be hoped that this latest effort to get the government to lock itself into a long range, very expensive, single vendor solution is just one more speed bump along the way. The VA and DoD need to continue with their plans to put in place standards based, interoperable health information systems that meet their unique needs. They need to continue to move forward with their plans to securely exchange patient information so they can create an electronic medical record that merges patient data from both systems into a single, seamless patient record for use by VA and DoD clinical staff across the country and around the world.

In closing, it seems appropriate to repeat some of the remarks by key individuals quoted in the original nextgov article. They simply echo similar comments many others have made over time.

• Craig Newmark, founder of Craigslist, stated that "The open-source approach, in real life, normally means faster, more effective, less expensive development. It's about moving away from customized and proprietary systems and towards openly architected and modular ones."
• Tom Munnecke, a former Chief Scientist at SAIC,  stated that "the open-source VA VistA model was always under attack by those who wanted to lock the government in to their proprietary architecture. The VA showed repeatedly that an open model was superior."
• Ed Meagher, VP of Health Care Strategy at Computer Sciences Corp., said "the open source approach that the VA backs is in the best interest of everyone involved in the process of VistA modernization -- VA, vendors, veterans and the taxpayer -- and will ensure open competition for all vendors, including Epic."

Check out the original nextgov article by Bob Brewin and the comments they have received.

Peter Groen
Open Health News
www.openhealthnews.com