Open-sourcing VistA Could Revolutionize Healthcare Records

The VA's VistA system began as a collaboration; an open-source revamp could benefit all American taxpayers.

Converting the Veterans Administration's electronic health record-keeping to an open source project isn't too much of a stretch.

As I wrote a couple weeks ago, the unanimous recommendation to the VA for updating its VistA system—which, despite its age, is highly regarded worldwide—was to go open source.

There's a lot of precedent for such a move—VistA itself was created in an open-source-like environment, even if it wasn't called open source at the time. VA employees wrote the code on their own time to help improve the care the agency could give to the veterans it served. And many hospitals around the country are working with OpenVistA, a flavor of VistA managed by Medsphere. And what Medsphere's done with OpenVistA could serve as a road map for the VA.

The core of VistA is available to anyone who wants it, though it's written in MUMPS, a programming language written in the 1960s primarily for the healthcare industry. Problem is, MUMPS isn't used much anymore, so new ways have to be developed to bring younger programmers and coders into the fold. Medsphere's done that with APIs that bring a converter layer on top of the code, said Rick Jung, Medsphere's COO.

Brian Profitt explained it well at

"The interesting thing about VistA is that the entire architecture is public domain, which is even more free than the GPL. That means anyone can take the code and use it however they want. So anyone who wants to build an electronic patient record system has an $8.6 billion headstart investment in the code, courtesy of the US taxpayers. This has led to the deployment of VistA systems in several non-VA (and even non-US) hospitals, and quite a strong industry of firms that have grown up to implement VistA tools."

All hospitals that subscribe have to contribute any changes to the core back to the project. But anything they build through the APIs, they can keep as proprietary assets or sell them to other users of OpenVistA. One such project is a mobile app that enables doctors to keep track of the critical indicators of diabetic outpatients.

Any template or other contribution is quality-tested by Medsphere, Jung said. "This is healthcare; not some kids banging out code in a garage. This project is not just about the code—it's about the content." And the content is sensitive health information of hundreds of thousands of patients.

Meanwhile, some hospitals have given dozens of templates back to the core, sharing best practices.

Jung said—perhaps channeling the Spacing Guild from Dune—"The data has to flow." (Close enough, OK?)

Given the collaborative roots of VistA and all the third-party development that's been done on top of it, in use in hospitals all over the nation, it makes sense to make this a full-fledged open source project, engaging the best coders and developers out there to build the best system for our veterans. And with the federal government moving toward electronic record-keeping for all healthcare, this gold standard could be applied across the board.

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