Is open source the cure for what ails VA's e-records?

 An industry advisory group today recommended that the Veterans Affairs Department modernize its legacy VistA electronic health record system by moving it to an open-source and open-standards platform and phasing out use of the MUMPS computer language.

“Open source provides the best way forward in terms of engaging the entire community,” Ed Meagher, who chaired the American Council for Technology-Industry Advisory Council VistA Modernization Working Group, said in a news conference today releasing the group's report. “Open source was the obvious answer.”

In October, VA Chief Information Officer Roger Baker asked the working group for advice on updating VA's Health Information Systems and Technology Architecture, which contains records for 8 million veterans. VistA, which has been in development and use for three decades, is considered one of the premier medical record systems in the world. However, the MUMPS computer language it uses is no longer popular.

“Our task was complex: We were asked to produce substantive recommendations to modernize a system that works very well but is outdated and difficult to maintain,” said Meagher, who is a former deputy CIO at the VA.

The 34 members of the working group made the recommendation unanimously.

“That unanimity is a real credit to the cohesiveness of this working group. That we recommended an open-source solution is a real ‘game changer’ from the business as usual approach to systems development,” Meagher said.

Under the recommendation, the VA would continue to operate the current VistA while beginning a parallel, open-source development project for VistA 2.0. The application development would occur in an open source ecosystem and the final product would be managed and maintained by a newly created non-profit Open Source Foundation.

An open-source VistA would be more flexible, and more able to be modified, grown or enhanced, Meagher said. It also would be more readily linked to new information-exchange platforms such as the Health and Human Services Department’s Nationwide Health Information Network, he said. Currently, VA and Defense Department are testing a Virtual Lifetime Electronic Record for each service member by sharing data on the nationwide health information network.

Moving to open source “was not a big stretch,” Meagher said. “It reflects the high level of sophistication that open source has achieved.”

At the same time, the existing MUMPS platform for VistA would be phased out over time, Meagher said. “Moving to a new environment, we don’t think MUMPS is the answer,” he said.

The industry group consulted with VA physicians and other clinicians as it prepared its recommendations, and those “end users” of Vista 2.0 would be included in the open source environment to provide input, Meagher added.

“One of the principles is that what gets done must be at least as good as (current) VistA,” Meagher said. Physicians should be involved in approving changes to work processes that might be part of the new system, and the new system ought to accommodate changes recommended by the VA clinicians, he said.

In the recent past, some supporters of VistA and MUMPS have strongly defended the existing system and resisted the idea of phasing out MUMPS. But Meagher said he does not anticipate major resistance to the changes proposed in the report.

“Change is inevitable. Most people acknowledge that change was necessary. There is general agreement that VistA cannot continue much longer,” Meagher said. “There will be questions and discussion, but I don’t see resistance.”