VistA Office EHR, the version of the Veterans Health
Administration’s clinical information system adapted
for use by office-based physicians, will be submitted
for national certification this spring and could be ready for public distribution by the end of April.
An update on the progress of VOE was given Tuesday at the
14th annual meeting of the WorldVistA community, which
is wrapping up a three-day session today at the
National Institute of Standards and Testing in
Gaithersburg, Md.
VOE is a joint project of the CMS and the VA, which
developed and uses the Veterans Health Information
System and Technology Architecture, or VistA, at 1,300
care sites, including more than 130 VA hospitals.
The software, once dubbed VistA Lite, was first
scheduled for release in November 2004. But developers
blew through that and two successive launch dates set
for the following summer without producing a software
product suitable for public release. Finally, in
September 2005, the Iowa Foundation for Medical Care --
the prime CMS contractor on the VOE project -- delayed
the launch indefinitely. IFMC, the Medicare quality
improvement program contractor for Iowa, handed over
the bulk of the development work to WorldVistA as a
subcontractor. WorldVistA is a not-for-profit
organization. Many of its members are current or former
VA programmers.
The CMS contracts with IFMC and WorldVistA end Jan. 31, but by then the software should be ready for
submission to the federally funded Certification
Commission for Healthcare Information Technology,
according to Joseph Dal Molin, vice president of
business development for World VistA and program
manager for the VOE project. Dal Molin runs an IT
consulting business in Toronto.
CCHIT, a Chicago-based not-for-profit organization, has
a contract with HHS to test and certify healthcare IT
systems primarily for functionality and security. CCHIT began
last summer testing EHR systems marketed for use in the
ambulatory-care setting. Thus far, CCHIT has certified
37 EHR systems through two rounds of testing. A third
batch of vendors’ products is being tested now and a
fourth and final round of testing will begin next month
under what has been called the 2006 criteria.
"There is one final window for doing that, and that
starts in the beginning of February," Dal Molin said. In addition, WorldVistA aims to follow
the CCHIT road map, which calls for adding criteria to
its certification testing programs in 2007 and 2008,
Dal Molin said.
"Our goal is to maintain certification as they add new
criteria," he said.
Dal Molin said the WorldVistA organization also has
been adopting procedures to keep VOE in synch with the
VistA "patch stream," a steady flow of software updates
and bug fixes pouring forth from the VA’s VistA
developers at the rate of 500 to 600 a year.
Of the 132 criteria CCHIT has set for its 2006 round of
testing, VOE can fully meet 105, can partially meet
another 11 and cannot, at the moment, meet another 16,
according to Mark Amundson, a pharmacist and IT
consultant based in Fargo, N.D., who is working under
contract with WorldVistA to prepare VOE for the
upcoming CCHIT certification tests.
Many of the gaps in VOE are due to VistA being designed
to meet the unique needs of veterans receiving care
through the VA healthcare system, he said. For example,
the VA runs its own pharmacies, which electronically
receive prescription information from physicians
through VistA’s order entry system. As a result,
WorldVistA developers of VOE had to modify VistA to
print prescriptions, a requirement for CCHIT
certification, Amundson said.
VistA also is capable of performing calculations using
the patient’s date of birth and the current date to
determine the patient’s age in years, but VOE had to be
reconfigured to count in days to enable the system to
fire off immunization alerts for children less than a
year old, Amundson said.
"Not only will we trigger a reminder, it will give the
dose amount for the nurse." Amundson said. "For us,
immunization was kind of a big deal. We felt we could
address it."
Amundson said all of the shortfalls are being addressed
by programmers. He expressed confidence the software
will pass muster with CCHIT when it is submitted for
testing next month.
The stakes will be high. To achieve CCHIT
certification, a program must demonstrate it has
satisfied all of the test criteria.
"I think CCHIT has achieved a critical mass of
legitimacy," Dal Molin said. "Initially, people
(vendors) were hedging their bets, but I think that
will work in our favor. Getting CCHIT certification
will be like that Good Housekeeping Seal of approval."
WorldVistA member Cameron Schlehuber had already earned a
doctoral degree in neuroscience when he was lured into
programming at the neuropsychology laboratory at the VA
hospital in Salt Lake City in 1978. That was the first
full year of a concerted effort by an upstart group of
programmers to develop a systemwide clinical computing
program at the VA. In the 1980s, the system would first
be christened the Decentralized Hospital Computer
Program, and in the 1990s, VistA.
In an interview after his presentation about the way
forward for VOE, Schlehuber said the initial false
starts of VOE in 2005 mirrored the series of setbacks
that plagued the first VA programmers back in the late
1970s and early 1980s. Schlehuber said it probably was
a good thing that the 2004 and 2005 versions of VOE
didn’t come out on schedule, because those early
editions could not have matched the high level of
expectations that had built up before them.
"It takes a fair amount of time to grow things that
are going to be large," he said. "VistA, when it was
called DHCP, took years. It was a research project, and
it still is, largely, a research project."
Still, he said, "The next two months will be critical."
In addition to their quest for CCHIT certification,
WorldVistA organizers have to develop a mechanism to
keep VOE current with the VistA patch stream, a task
that will consume about 15 to 20 hours of programming
time a week.
"Open source could handle it," Schlehuber said. "I
think if even two or three vendors stood up and said
I’m going to have this person available for the next
six months," that would be enough. "It’s in their best
interest to keep this together." The VA itself should
be obliged to take on a portion of the work, he said.
"If you’re going to have a kid, you’re making a
commitment," he said. "It’s just not a thing you shrink-wrap and hand over and you’re finished with
it."
"Medicine isn’t finished," he said, and neither are the
computer systems that support it.
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