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Can An Open Source Electronic Health Record Ever Be Ready for Prime-Time?

by Zina Moukheiber

In October, the Open Source Health Record Agent (OSEHRA) will hold its first summit, bringing together the government and open source developers, two radically different camps united in their goal to improve a lauded electronic health record in need of a face lift—the Veterans Affairs’ VistA. “We believe open source will help us innovate quickly,” says Mike O’Neill who sits on the board of OSEHRA, and is senior advisor to the Director, Veterans Affairs Innovation Initiative.

Considered one of the best EHRs, VistA’s creation dates back to the 1970s, when a band of programmers at VA hospitals persisted in developing the EHR, even after VA bureaucrats shut their project down. The VA eventually adopted it, and it serves as the backbone of its 163 hospitals and 800 clinics—the single largest health care system in the U.S. Political red tape, however, prevented innovation over the years.

While the VA’s VistA stagnated, an enterprising community of open source developers devoted to VistA, took advantage of the free, publicly-available EHR (via the Freedom of Information Act), and made their own improvements. Venture-backed company Medsphere Systems even turned VistA into a business, adding modules such as ob-gyn and pediatrics, and making money on implementation and support.

To modernize VistA,VA chief information officer Roger Baker and chief technology officer Peter Levin made a smart decision—and probably the only sensible one. They turned to open source developers. Last August, the VA and the Department of Defense formed OSEHRA, opening up VistA’s code, and defining terms of collaboration.  “It’s like having little atolls, and then Australia joins,” says Edmund Billings, Medsphere’s chief medical officer. The VA adopted a business-friendly license where contributions can be copyrighted.

The impact can have repercussions beyond the VA health care system in terms of access to an up-to-date and low cost EHR. “In some ways it’s similar to generic drugs,” says Seong Mun, OSEHRA’s president.

Only if there is collaboration. Some developers also fear that the government might pull the plug, and that money set aside—an estimated $10 million so far, might not be enough. “If you want to accelerate the pace, you need to raise the amount of money a little bit, but you don’t want to attract beltway bandits,” says Rick Marshall, executive director of VistA Expertise Network.

Of OSEHRA’s four board members—former and current government officials, as well as health IT evangelist John Halamka of Beth Israel Deaconess Medical Center, none represents the open source community. O’Neill says that the board will grow as the community grows, which is stated in the organization’s mission.

Hopefully soon. The VA’s initiative holds potential, by helping build a marketplace. “It’s a ground war,” says Billings. “When you get a critical mass of hospitals using open source, then others will adopt.”