You may have missed it, but on May 4th (ed. note that’s May 4th 2010), a working group of 42 industry luminaries released the VistA Modernization Report. This report, chartered by the Industry Advisory Council (IAC) at the request of the U.S. Department of Veterans Affairs (VA), is the single smartest and boldest document that I have seen come out of the roiling currents of healthcare reform.
VistA is one of the most widely used electronic health records (EHRs) in the world, serving as the de facto EHR in all 150+ VA hospitals, 800+ VA clinics and 130+ VA nursing homes. The basic VistA code is also used by the Department of Defense (DoD), the Indian (Native American) Health Service, numerous private and non-profit U.S. hospitals and clinics and by various international hospitals from Finland to Germany, Egypt and Nigeria, among others. Developed in the 1970’s, it’s code base entered the public domain in the 1980’s, in the 1990’s a thriving open-source community grew around VistA, formalized into the non-profit WorldVistA corporation in 2003. The VA’s early adoption, extensive development and widespread deployment of VistA has, according to at least one study, conservatively saved the VA more than $3 billion net. Yet for all these successes, VistA’s architecture and engines are essentially the same as they were in the 70’s.
Recognizing this, ten years ago the VA embarked on a redesign and upgrade of VistA, known as HealtheVet. As of 2007, $600 million had been spent on HealtheVet with little to show other than a patient portal and delivery dates pushed out by nearly a decade to 2018.
Against this background and clearly struggling to put together a coherent and achievable roadmap, the VA requested that the IAC, in conjunction with the American Council for Technology (ACT), put together a blue ribbon panel of industry leaders to review and make recommendations on the future of VistA. After nearly 6 months of intensive work, comprehensive interviews and an extensive review of the all the options available to the VA, the panel unanimously delivered the following recommendations:
- The VA should move to an open-source, open-standards model for reengineering VistA as VistA 2.0.
- The current VistA code should be aggressively stabilized with updates and enhancements only for patient-safety and regulatory mandates.
- The VA should commission the development of a VistA 2.0 Open-Source Core Ecosystem – this ecosystem must be scalable, segmented, open-source, open-standards, secure and highly-performant.
- The VA should fund the creation of an independent, non-profit Open-Source Foundation to manage, operate, maintain and provide governance to the VistA 2.0 Open-Source Core Ecosystem.
- The VA should direct and fund a functional decomposition of the current VistA Application Suite to harvest state-of-the-art functional and design specifications which will be used to guide the architecture and development of the VistA 2.0 Open-Source Core Ecosystem.
- The VA should plan to run the VistA and VistA 2.0 concurrently for as long as is necessary to validate the feature-completeness and functionality of VistA 2.0.
The report itself goes into great detail explaining the panel’s reasoning behind each of these recommendation, as well as giving fuller definition to these recommendations with elaborations on meaning and guidance on implementation.
I strongly recommend that you give the report at least 10-15 minutes of your time for a quick read through. In my next post I will review the five key concepts in the VistA Modernization Report’s recommendations, discuss how the report is proposing a modern-day equivalent of a Manhattan Project for healthcare IT which, if successfully implemented, will put every private enterprise healthcare IT vendor out of business.
-Marc d. Paradis, SM
Originally Published June 10th, 2010 as a blog for HealthsystemCIO.com.
This article can also be found on Marc d. Paradis’ and SIYOM Consulting’s LinkedIn posts
Disclaimer: The opinions expressed herein are my own personal opinions and do not represent any of my previous employers’ views in any way.