VistA is powerful, but is it adaptable?

The lead in a Federal Computer Week story pretty well sums up the conundrum: "Is VistA a diva in disguise?" The open-source EMR at the heart of the Department of Veterans Affairs' health IT strategy "is the best health information system in the world, bar none," says Ed Meagher, a former VA deputy assistant secretary of information and technology, but, he adds, it's also an old system that's difficult to manage and very high-maintenance.

Meagher, now a private consultant, has been hired by VA CIO Roger Baker to lead a work group that will make recommendations on how to modernize VistA and make it more adaptable to the private sector. "VistA is very old technology. That does not mean it does not work or is not useful. It is not a perfect answer, but I think there are potential uses for it," explains Dr. David Kibbe, a health IT consultant to the American Academy of Family Physicians. "This is a very good trend that is occurring."

Of course, a number of companies already have taken the source code for VistA and commercialized it as a lower-cost alternative to the many proprietary, enterprise EMRs on the market. "Affordability is a huge issue," says Michael Doyle, president and CEO of one such company, Medsphere Systems. "We can do everything the other systems do at a fraction of the cost," he tells FCW.

Medsphere has converted the VistA source code, developed more than two decades ago in a programming language called MUMPS, to work with a more modern SQL database. Some programmers tend to like MUMPS because of its long history, but there isn't a lot of MUMPS training available these days, nor is there much in the way of a MUMPS development community.