Who Says a Common VistA Code Base is Unattainable? Certainly not the Open Source Electronic Health Record Alliance (OSEHRA), nor 27 principal developers of VistA who participated in the first OSEHRA Code Alignment Workshop held in Oakland, California, last week.
An unprecedented effort, the workshop brought together government and private organizations dedicated to open source solutions for the challenges facing healthcare. Its primary objective was to facilitate rapid innovation for the Veterans Health Information Systems and Technology Architecture (VistA), the electronic health record (EHR) software used by Veterans Health Administration (VHA) facilities as well as hundreds of medical centers in the U.S. and abroad, totaling approximately 2,500 facilities worldwide.
Since its inception in the mid-1990’s, VistA has been frequently modified by its adoptees, resulting in numerous forks of VistA code. This fragmentation has led some members of the community to doubt the possibility of successful code alignment, a term used broadly to describe the achievement of compatibility among contributed code. This pessimism, combined with the magnitude of the initiative, has prevented code alignment from being a reality—until now.
“A VistA code base with a common community-aligned platform will allow unimpeded exchange of innovations and reduce duplicitous developments among users and developers” said Dr. Seong K. Mun, President of OSEHRA. “This landmark workshop has demonstrated that we have a strong foundation, a strong team, and a solid methodology.” Those are the core assets the community will need to harness to achieve the accelerated March 31, 2015, deadline announced by the workshop participants for final testing and acceptance of contributed code.
A leader in this effort is Mike Henderson, Director of Open Source Product Management for OSEHRA. “We recognize that this is a very serious challenge. However, through the adopted Scaled Agile methodology, we will be able to identify high value propositions for code convergence within the timeframe.” OSEHRA has committed to continued participation in the process, especially in support of its desire for a converged OSEHRA VistA product. As a result of the workshop, an aligned core will be established within OSEHRA VistA, the first increment of which will be made available to the community (complete with its own patch management system) by next spring.
This code alignment effort has been divided into multiple increments between now and March. Sprint 1, which will occur during December, is focused on obtaining and sharing VA documentation on the installation of a new VistA instance, improving the counting of active jobs, and finding MUMPS-version specific code in the latest Freedom of Information Act (FOIA) release of VistA, among other objectives. Sprint 2 is scheduled for January and will expand upon successes attained in December. Efforts in Sprint 2 will be dedicated to removing references to nonexistent entry points, enabling access to all RPCs in non-programmer mode, and integrating adapters for external authentication.
There is “an indication that our community has started to form,” stated Lee Miller, vxVistA Architect at Document Storage Systems (DSS), Inc. “All of us have contributed countless amounts of code to OSEHRA. Now we are starting the hard work of picking the best for a single code base.” A number of other OSEHRA Corporate Members also participated in the discussion, including the BITS Group, FIS GT.M, Medsphere Systems Corporation, Oroville Hospital, the University of Pittsburgh Medical Center, PricewaterhouseCoopers, and the VISTA Expertise Network.
Beyond early 2015, participants in the code alignment effort will converge remote procedure call brokers across VistA distributions and will also improve automated code inspection for standards and conventions (SAC) compliance. Once these near-term objectives are achieved, long-term goals will be addressed. Highlights of the longer-term roadmap range from improvement of compatibility with alternative MUMPS platforms to support for personal identity verification (PIV) cards and other 2-factor authentication mechanisms. These objectives, and all prior milestones, will depend upon the continued commitment of strategic focus and resources by the diverse coalition established in Oakland.
Both OSEHRA Collaborative Partners, the U.S. Department of Veterans Affairs (VA) and Indian Health Service (IHS), were also actively engaged in the workshop. This interagency involvement was symbolic for attendees, including Catherine Pfeil, the Director of VA’s Application Development Competency Division. “One of the things that struck me,” said Pfeil at the conclusion of the workshop, “is that it had the era of the great collaboration meetings that VA used to have in the past.” Pfeil also noted that she and her VA colleagues “were particularly delighted to see the strong push on data collaboration. We all know this helps with interoperability. I am comfortable saying that we will commit resources to this.”
After three days of unparalleled collaboration, the group expressed a high level of enthusiasm during its summary call to the greater OSEHRA community. “What we are doing together is part of an enormous legacy,” said Rick Marshall, Executive Director of the VISTA Expertise Network. As this proposed code alignment is achieved, Marshall’s vision and efforts, as well as those of all participants in this effort, will be validated. As demonstrated by these VistA professionals, who have more than 400 years of expertise among them, the era of code alignment has arrived.
Copies of the Power Point presentations at the meeting are available and can be downloaded here for the first day of the meeting and here for the second day. On the third day of the Code Alignment Workshop, there was a community call where the participants briefed the VistA community at large on the developments of the workshop. The PPT for the community call is here, and this is the WebEx recording.