VA's RFI seeks open-source VistA development ecosystem

If the Veterans Affairs Department chooses to update its legacy VistA electronic health records system with open source development, the VA still would retain certification authority of any applications for its medical centers, Roger Baker, VA chief information officer and assistant secretary for information and technology, said today.

He added that VA also is likely to retain some legacy code.

The VA recently published a Request for Information for a custodial agent — most likely a vendor — to operate an open-source ecosystem for modernizing VistA.

As Baker sees it, the VA would become a “large participant” in the mostly private sector ecosystem, but would retain certain authorities.

“We are looking at open source models, and starting to develop a concept of how an open source ecosystem might work,” Baker said.

And that includes going to industry for their expertise, he added. “If there is one thing we know, it is that we are not the experts in how to do an open source product and make it work,” Baker said.

Under such a system, VA would continue to be the “tester and certifier of any product that goes into our hospitals,” he said, adding that the VA also is likely to retain some of its legacy MUMPs code that has been operating its VistA digital medical system.

“If we go open source, will there still be MUMPS code?" Baker asked. "I wouldn’t be surprised if that was the case. There are 15 million lines of code.”

“My definition of legacy code is code that works. VistA is 99 percent available,” he added. The same would apply to other computer languages currently integrated into VistA.

Under the vision outlined in the RFI, the VA would release a VistA code base to the custodial agent. To update sections of the code, a contract would go to a vendor and the new code would be published to the open source community for improvements.

VistA’s capabilities are being limited by its current architecture and an open-source model might provide greater potential for innovation and modernization.

“Today's health care environment - in which new models of care are continuously developed and deployed - is utterly dependent upon the accelerating technological development of new medical devices, improved IT infrastructure, services and wireless communications,” the RFI states. “In order to sensibly benefit from these advances, VA must address fundamental structural constraints that will inhibit its ability to keep pace with health services delivery.”

Facilitating a “structured, deliberate and predictable migration from our custom and proprietary EHR software to an openly architected, modular and standards-based platform” would help the VA innovate, improve outcomes and reduce costs, the RFI said.