The endless war

Veteran IT watchers who caught the webcast of the Senate Veterans Affairs Committee last week saw something all too familiar.

The IT history of the Veterans Affairs Department has been one of intermittent battling between two groups: One is the programmers and clinicians who, starting in the late 1970s, built their public-domain IT system from scratch. The other side is composed of political and bureaucratic supporters of a centralized command-and-control IT bureaucracy who have sought to thwart the home-grown effort, typically in favor of purchasing or programming software from the commercial market.

That dichotomy resurfaced at the Oct. 6 hearing.

The VA clinical system, first named the Decentralized Hospital Computer Program in 1981 after a hard-fought victory over the forces of central command, was renamed VistA in 1994.

For most of the past decade or so, anti-VistA forces in the VA have been ascendant. Pieces of the department's public-domain software have been targeted for replacement with commercial-off-the-shelf systems while work on upgrading the existing VistA code base has languished.

And for the nearly 10 years I have been covering health IT, there has been a steady sniping at VistA because of its purportedly old, outmoded, legacy MUMPS programming language and database structure.

MUMPS had its defenders at the Senate hearing, most notably Tom Munnecke, a pioneer programmer with the VA. Also keeping faith from afar was Kenneth Kizer, who on his watch as the VA's undersecretary for health from 1994 through 1999 defended and promoted VistA.

Munnecke recalled how the VA's DHCP was developed through collaboration between programmers working shoulder to shoulder with clinicians in hospitals across the vast VA healthcare enterprise.

In his written testimony submitted to the committee, Kizer (who did not appear in person) described VistA as "a national treasure" that should be viewed "as a critical resource in the federal government's efforts to promote the widespread use of electronic health records." Kizer is chairman of Medsphere Systems, which is selling an open-source version of VistA to public- and private-sector hospitals outside the VA.

Whacks at VistA continued at the Senate hearing, as well, led by Glen Tullman, chief executive officer of Allscripts, a Chicago-based developer of electronic health-record systems.

"There is no question that VistA was a groundbreaking technology when it was first developed," Tullman said. "But now, things have changed."

Sen. Richard Burr of North Carolina, the ranking Republican member of the committee, addressed Roger Baker, the assistant secretary for information technology at the VA, and asked: "You listened to two competing views on future architecture, for MUMPS and against MUMPS, who's right?"

Earlier, Baker had stated his support for an industry council recommendation that the VA create an open-source software development ecosystem.

"We must create an open-source model for the VistA electronic health record, bringing back the innovation that made VistA the best electronic health-records system in the country," Baker said.

Click on Endless War to access Joe Conn's original blog post and accompanying comments.