Baker responds to VA VistA report

Roger Baker, assistant secretary for information and technology at the Veterans Affairs Department, today thanked an industry panel for its “exhaustive” study on modernization of the VA’s VistA electronic medical record system.

The panel, convened at Baker’s request, was sponsored by the American Council for Technology-Industry Advisory Council and chaired by Ed Meagher, a former deputy CIO at the VA. It recommended on May 3 to move VistA to an open source platform and phase out its reliance on the MUMPS computer language.

“The VA is pleased with the efforts of the ACT-IAC to review the option for moving VistA into an Open Source endeavor and especially the dedicated efforts of the members of the work group and leadership of ACT-IAC,” Baker said in an e-mailed statement today.

“Clearly the group did an exhaustive study covering the significant technical and governance aspects important to making decisions in the Open Source arena. We are currently reviewing the many recommendations covered in the report and look forward to a rich dialog and exchange of ideas and concepts with industry. VistA is the preeminent example of what a patient centered Electronic Health Record [EHR) can do, and its improvement will take the joined efforts of clinical experts, government and industry. The VA looks forward to continuing this review,” Baker wrote.

The 34 vendor panelists were said to be unanimous on the recommendation; however, reaction in the broader health IT has been divided.

VistA is considered a superior system with strong clinical content and effectiveness, but it operates with the relatively unpopular computer language known as MUMPS. Some supporters and practitioners of MUMPS strongly laud its qualities, while detractors assert that MUMPS is outdated.

I’m certainly no expert on MUMPS, so I will offer only one brief observation.

From what I’ve heard, one of the elements that makes VistA superior to many commercial EHRs is that it was created with substantial input from physicians who would be using it. It has been described to me as “clinically rich.” Because the doctors are — or should be -- the ultimate arbiters of how their own records should be kept, it seems to me it would be important to hear from physicians on whether the clinical richness would be threatened by moving to an open source development.

I asked Meagher about physician input into the industry committee’s work, and he told me the panel spent two months consulting with VA doctors and other VA officials about their needs. He also said VA physicians and “end users” would be included in the open source development process.

A principle of modernization is that “whatever is done must be at least as good as what we have,” Meagher said. “We want to make the system as robust as possible.”

Good intentions are certainly a necessary first step. It would be great if the VA physicians could get involved in this public discussion about a very significant issue that may have much broader implications for health IT implementations.