Despite plans to overhaul its Vista clinical system, the Veterans Health Administration will continue to offer copies of its multimillion-dollar software to private-sector users for a nominal fee under the Freedom of Information Act, according to the Department of Veterans Affairs' top physician informaticist.
"We have the full support of the VHA leadership to continue to keep this in the public domain," said Robert Kolodner, M.D., acting chief health informatics officer at the VHA and deputy chief information officer for health at the VA.
On Nov. 8, the VA published a request for vendors to submit statements of their capability to provide the VA with what it called "rehosting support." It also called for vendors to provide routine service and support for the VA's Vista healthcare information technology system.
Kolodner said the move also would have no immediate impact on an effort initiated by the VA and the CMS to develop a version of Vista for the physician office practice. That software should be ready by summer 2005, according to the CMS.
One goal of the proposed five-year contract is to move the VA's healthcare IT system from the programming language and database on which it was first written in the late 1970s and where it remains today: from MUMPS, or the Massachusetts General Hospital Utility Multi-Programming System (now known as M), to, as much as possible, open-source versions of the Java programming language and possibly at least two relational database systems, Kolodner said.
Kolodner said the VA initially plans to run a national database on software from Oracle Corp. and regional databases on the relational database portion of Cache, a program by InterSystems Corp., which incorporates a proprietary version of M now used by the VA.
"But it could be on (Microsoft's) Sequel Server or SQL or any other database," Kolodner said, adding the VA would incur a "relatively small cost" to convert Vista from one database to another if need be.
"We've had a history of staying vendor-independent," he said.
Within the VA, M has developed almost a religious following among programmers for its speed, dependability, flexibility and scalability, and several of today's leading commercial healthcare IT systems have M at their core. But Kolodner said it is time to switch.
"MUMPS has served us very well over the last 20 years," he said. "We have done a lot with it, and it has supported our needs."
However, many M vendors have been bought by InterSystems and a once-thriving MUMPS user group has gone defunct. Today, there are fewer programmers skilled in M than in a more modern language, such as Java.
"There are times when it is much too expensive and takes much too long to make changes and support the needs that we have," he said. "Java is taught in more schools than MUMPS is."
In addition, Java and relational databases are better suited together, he said.