No word yet from the Certification Commission on Health Information Technology on whether a federally funded effort to adapt VistA, the clinical IT system developed by the Veterans Affairs Department, for small physician offices has passed certification testing.
That answer won't come until the end of the month, a CCHIT spokeswoman said.
CCHIT closed applications on Feb. 14 for its fourth batch of testing of electronic health-record systems for the ambulatory-care environment with a record 35 applications received. CCHIT does not reveal the names of system developers seeking certification, but one of them self-disclosed: WorldVistA, the not-for-profit corporation formed in 2004 to develop an open-source version of the VA's VistA system for use outside the VA.
WorldVistA is now the lead developer on the VistA adaptation, which has had the working names VistA Lite and VistA Office EHR, or VOE, and started under a contract initiated in 2004 by the CMS with the Iowa Foundation for Medical Care—the Medicare quality improvement organization for Iowa.
The CMS has spent a little more than $6 million on developing an EHR that could leverage the VA's considerable federal investment in VistA with the hopes of overcoming one of the most often mentioned barriers to EHR adoption in the small-physician-office market: the high cost of the systems. The Iowa QIO served as the primary overseer on the job and Daou Systems of Exton, Pa., at $2.5 million, served as the initial lead software development subcontractor. WorldVistA, whose members include many current and former VA programmers, won a subcontract in the spring of 2005 and when the government's contract with Daou ended in January 2006, WorldVistA "officially" took over development of VOE in February 2006, according to Joseph Dal Molin, interim president and vice president of business development for WorldVistA.
The software, now to be called WorldVistA EHR, is still in the middle of CCHIT testing, Dal Molin said.
Concurrent to its work getting the software ready for testing, Dal Molin said WorldVistA members have put considerable thought and effort into developing a structure to keep the software current with releases of updates and bug fixes, called the patch stream, emanating from the VA, as well as to incorporate improvements to the software code coming from private sector and public sector users outside the VA.
Dal Molin said he needs to work on a budget to complement a business plan he developed about nine months ago for WorldVistA, but he envisions the organization will be able to sustain itself by charging fees to users and developer/resellers to keep the base software current and compatible with the VA’s VistA system.
Dal Molin said "playing catch up" with the patch stream was one of the challenges WorldVistA faced when it took over much of the development work on the VistA office project. That happened after the CMS announced in September 2005—after a sequence of target release dates came and went—that it was postponing the release of VOE until at least the end of 2006.
In retrospect, the initial decision to not keep VistA Office EHR current with the VA patch stream was, "extremely beyond dumb," Dal Molin said, but some good did come out of the mistake. It led to the creation by pioneer developer Cameron Schlehuber of a software tool to speed the updating of patches. Schlehuber, a WorldVistA member who retired from the VA last year, started working on the VA's initial clinical computer system in 1978.
Keeping the software current, "requires some expertise, so we'll be offering that service to the (VistA) community," Dal Molin said. "I think that's going to be the most valuable (WorldVistA) contribution along with providing a CCHIT-certified version of the software. It's something we can justify going after some revenue for."
Dal Molin said that looking at it from the outside, he was at first no fan of CCHIT certification, but his opinion has changed.
"My initial reaction was, this is dumb and it is going to create a barrier for open source development," he said. "But the whole notion is a good one. You look at the (CCHIT testing) criteria and, really, it's best practices."
Keeping a base of common code and preventing multiple forked, incompatible versions of the VistA software outside the VA will be critical for the success of the open source project, Dal Molin said. "If we don't, we're going to end up with 1,000 VistAs."
Sue Reber, CCHIT communications director, said announcements won't be made until April 30 on those systems that have passed muster and received certification.
"That will be the last for the 2006 criteria," Reber said, "and the last time CCHIT will process applicants for ambulatory EHR systems in batches."
An updated criteria set will be used for subsequent testing with applicants being accepted starting May 1.
"Vendors can apply when they are ready," Reber said. "For ambulatory, there will be not more batch announcements."
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