VA, DOD Choose Open Source To Combine EHRs

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In a decisive break with the past, the Department of Veterans Affairs (VA) and the Department of Defense (DOD), which operate the two largest healthcare systems in the country, on Aug. 30 officially launched an open-source community to help them revamp and unify their electronic health records.

The two departments have created the Open Source Electronic Health Record Agent (OSEHRA) to serve as the governing body of the new public-private community. OSEHRA, an independent, nonprofit organization, now has its own website and is ready to accept contributions from the private sector.

The VA will make the source code for its VistA electronic health record--first released to the public decades ago--available to the community. The Department of Defense is expected to release some portions of the source code for the Military Health System's AHLTA EHR, which contains the health records of military personnel. But DOD has not yet made an announcement on the subject.

The move toward open source, which has been underway at the VA since last spring, represents a sea change for that department and for the effort to create a single health record for service personnel that will follow them from their time with the military through the rest of their lives.

Peter Levin, chief technology officer for the VA, told InformationWeek Healthcare that the two departments decided they had to move away from the conventional procurement process because it was not providing what they needed. "Our EHRs are largely comprised of proprietary, custom, and highly vertically integrated solutions. That's antithetical to the way we now know we should build and procure systems. We're trying to get away from these monolithic enterprise applications that are very difficult to maintain and extend and are inflexible."

The departments want to use an open-source community to develop their new unified system for several reasons, Levin said. He explained that it's a fairer acquisition strategy, because the department is leveling the playing field for vendors so that many can participate instead of just one. Also, the approach should help identify and fix software "bugs" more quickly and provide better security, he said.

In addition, "it will be more effective for tax payers, and we think it will keep us closer to the cutting edge of technology."

In the past, open-source developers that used VistA code to create applications in the private sector had no way to feed those back to the VA. "We had no mechanism to allow them to re-absorb their innovations," Levin noted. "Now we do."

Developers who come up with useful applications, he said, can sell them to the VA or the DOD as "proprietary modules that plug into the backbone or the platform." These will be similar to smartphone apps, he noted. "The only thing that has to be open is the connector." But the plug and play analogy goes only so far, he added, because different parts of the information systems will have "slightly different sockets." For example, there will be different plug-ins for pharmacy, lab, scheduling, and personal health record systems.

In the long run, Levin said, "What we're looking to create is mostly entirely new. It's not going to be just VistA or just AHLTA." But he emphasized that the two systems have much in them that's valuable and that the departments will try to retain as much of that as possible.

The open source strategy won't necessarily cost the government less than the traditional competitive bidding process, Levin stated, "but we're going to be getting much greater value for the money that we do spend." In addition, the departments will be avoiding the chance of getting something that they don't want or can't use.

On the other hand, as the private-sector experience with VistA shows, there are also risks in going the open-source route. Debra Filippi, a former government official who is now principal consultant with Suss Consulting in Jenkintown, Pa., said that the VA and DOD leaders are well aware of this, but they're willing to take the chance. With open source, she said, "You get the experience, the expertise and the ideas of an unlimited number of industry leaders. So I think everyone has concluded that while there are risks associated with this, the payoff is worth the risk."

Filippi, formerly director of the DOD/VA Interagency Program Office, which supervises the Virtual Lifetime EHR project, expects that the open-source process will result in major changes in the VistA and AHLTA systems that go far beyond improving the interfaces between them. The goal is, and has been for some time, to make healthcare data available to both departments at all stages of the care process, she said. "So clinicians could see the same data whether you're seen at a VA facility, a military treatment facility, or a private healthcare facility."

Filippi doubts that DoD will make the entire AHLTA code available to the community initially. To start with, she suggested, it might choose an area that AHLTA and VistA have in common, such as their pharmacy systems, and see what the open-source developers do with that.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)