VA drives open-source health records initiative

By Bob Brewin

By Bob Brewin

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Agency could spur adoption of e-health systems worldwide

Twenty-year-old software developed by the Department of Veterans Affairs could serve as the low-cost building block of a nationwide electronic health care record (EHR) system President Bush wants officials to deploy within the next decade, according to health management experts.

This open-source software, based on the VA's Veterans Health Information Systems Technology Architecture (Vista), could also become the basis of affordable EHR systems worldwide, said Maury Pepper, a St. Louis-based computer consultant. Pepper serves as chairman of WorldVista, an organization dedicated to making health care technology more affordable worldwide with systems based on Vista.

Officials at the Centers for Medicare and Medicaid Services (CMS) want to use Vista to stimulate the adoption of EHR systems by doctors with a new public-domain version of the software, Vista-Office EHR, developed in conjunction with VA officials.

Capt. Cynthia Wark, a Public Health Service nurse who is the acting deputy director of the information systems group at CMS' Office of Clinical Standards and Quality, said agency officials are developing Vista-Office to improve the quality of health care while promoting the adoption of health care information technology by doctors' offices and clinics. Officials are targeting Vista-Office to small medical offices that have one to eight doctors. They have been slow to buy new technology because of its cost. Wark estimated the software needed in a small doctors' office to cost between $10,000 and $20,000.

Vista-Office will provide doctors and clinicians with a number of modules adopted from Vista, including the Computerized Patient Record System, which replaces paper charts. CMS developers are adding new modules, including software for pediatricians and gynecologists and a patient registration system, Wark said.

Mike Ginsburg, project manager for the Vista Office software at the Iowa Foundation for Medical Care, a CMS contractor, said agency officials will begin testing Vista-Office with small clinical practices next month. CMS officials plan to make the software electronically available in July 2005 to the roughly 500,000 U.S. physicians via downloads from CMS' Web site.

Vista-Office is available for free, but when officials release the final version, doctors would have to pay a license fee to use the underlying Caché programming language and database management systems from

InterSystems, based in Cambridge, Mass. VA officials use Caché to run Vista in 172 hospitals and 400 clinics. The language is based on the Massachusetts General Hospital Utility Multiprogramming Systems (MUMPS) programming language developed in the late 1960s.

Dr. Stan Saiki Jr., director of the joint Defense Department/VA Pacific Telehealth and Technology Hui (meaning partnership) at Tripler Army Medical Center in Honolulu, said this partnership resolved the license fee issue last year with the release of its Hui OpenVista enterprise software.

Instead of using MUMPS Caché, Saiki said, Hui OpenVista runs on open-source MUMPS called Greystone Technology M from the Sanchez Computer Associates division of Fidelity National Financial, in Jacksonville, Fla. The complete Hui OpenVista package runs on the open-source Linux operating system software, which provides users with a complete, free and sophisticated EHR system, Saiki said.

Saiki said Pacific Telehealth has had about 1,000 downloads of Hui Open Vista software package from its Web site and envisions it serving health care facilities worldwide. Pacific Telehealth developers have built an application service provider prototype of Hui Open Vista, Saiki said. The software is housed on central servers, relieving the need to hire an IT staff to maintain an in-house EHR system.

HHS seeks input on information network

Department of Health and Human Services officials asked for ideas last week on the design, structure and management of a national health information network, which will serve as the backbone of a nationwide electronic health record system.

HHS officials wrote in a Federal Register notice published Nov. 15 that although an interoperable national health care system is necessary to ensure that doctors nationwide can access patients' records, the United States does not have meaningful health information interoperability capabilities.

Dr. David Brailer, national coordinator for health information technology at HHS, issued a request for information seeking comments from health IT organizations, health care providers and the public on the best design for a health network, with emphasis on a system that is nonproprietary and available to everyone.

HHS officials also want insight on developing a network that evolves from private investment, fosters market innovation and provides nationwide interoperability. Brailer also wants to know how such a network can be developed and managed in a way that excludes no area of the country or medical practice.

HHS officials also want insight into the potential impact of such a network on the overall health IT market, and they want to know if industry officials would invest in such a network.

Responses to the RFI are due Jan. 18, 2005.

— Bob Brewin

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