While the resounding opinion is that the Department of Veterans Affairs should replace the proprietary VistA with a commercial EHR, perhaps choosing Cerner as the Defense Department did, that idea does not hold so true within the open source community.
“When you look at the big trends in the IT industry, open source is used everywhere. In fact, some of the most successful mega IT systems have a significant open source component,” said Seong Mun, CEO of the Open Source EHR Record Alliance. “We believe it’s the right methodology to get to where we need to go.”
VA Secretary David Shulkin, MD, is expected to decide in July.
Open source is designed as a community-based source software development and education. The source code is available to the general public for use or modification from the original design, Mun said. It’s not just using another vendor’s code, but a true collaboration such that organizations take code, improve upon it and release those enhancements back into the community.
The VA established OSEHRA for that very reason, Mun said, and much of VistA’s software has been in the public domain for years: Vista-based products are available around the world.
Indeed, that means OSEHRA’s fate is at least tangentially related to VistA — as is that of Medsphere, which provides an open source EHR that leverages VistA called OpenVista.
Medsphere CEO Irv Lichtenwald, in fact, said Medsphere could potentially take the VistA code and evolve it at a fraction of the cost VA would spend on a commercial EHR.
“The answer probably lies in the VA turning over VistA code maintenance to an outside party with sufficient expertise,” Lichtenwald said. “That external technology partner will take the base code and continue to evolve it under VA specifications.”
That is exactly what the VA would be doing with a commercial option, and essentially how large-scale software development projects work.
“Basically, this approach turns VistA into a commercial option itself,” Lichtenwald said.
While EHR code source software is important, it’s really about customizing the package to meet an organization’s needs, Mun said, adding that the VA is soliciting merely views from the wider community with its recent RFIs to understand its options and assess available products but that doesn’t mean it has abandoned the possibility of modernizing VistA altogether at this point.
“VistA is a viable option,” Mun said. “Often times we get focused on product X-Y-Z. But if you look at reports, it’s more about how to manage the software product over the long term. No matter who you buy in the industry, it’s not a solution. You have to evolve whatever you buy.”
While Mun and Lichtenwald favor the open source model it’s up to Shulkin and the VA to wrestle with the choice between open source and a commercial EHR.
“Open source,” Mun said, “can be the way to modify for the enterprise.”