The VA has released a draft RFP to create a new open source project around their electronic health record system, VistA. This is a landmark event for both the VA and the open source community. The need for cheap and robust EHR systems is clear, and the VA has one of the leading platforms.
VistA’s a challenge, though. The community is notoriously fragmented as a result of regular FOIA requests for the VistA source code. The project is based on MUMPS, which a relatively unpopular platform, so developers for VistA are in short supply. Since there’s no clear mainstream for the project, the VA VistA project competes against this fragmented community for a shallow pool of developer talent. There’s the for-profit Medsphere, which has built its own offering called OpenVistA. There’s also the WorldVistA community and http://www.hardhats.org/. FOIA requests for VistA source code are so common that VistA appears on VA’s FOIA FAQ page, but few (if any) of the contributions from any private-sector VistA communities feed back into the VA VistA project.
“VA believes that VistA’s rate of innovation and improvement has slowed substantially, and the codebase is unnecessarily isolated from private sector components, technology, and outcome-improving impact. To address this issue, VA is establishing a mechanism that will open the aperture to broader-based public and private sector contributions.”
Over the last couple years, many of us involved with open source in government have had discussions about what it means for citizen coders to become involved in state, local and federal efforts. There are all kinds of legal, ethical, and logistics questions that haven’t been answered. Everyone seems to be solving them individually, but it’s not well-coordinated. This means that agencies who want to engage developers are wasting valuable time trying to figure out the “right way” to work with the public.
The domain is large and already bearing fruit; I think we’re all enthusiastic about CivicCommons, CrisisCommons, and a host of public service oriented application development contests in many major cities.
If this is the future of computing as a whole, why should U.S. health IT be an exception? Indeed, given the scientific and ethical complexities of medicine, it is hard to think of any other realm where a commitment to transparency and collaboration in information technology is more appropriate. And, in fact, the largest and most successful example of digital medicine is an open-source program called VistA…