In open-source software development, consensus is crucial.
With multiple programmers writing software code on their own or for different companies, without obtaining consensus on whose code to use, an open-source project will fork into multiple rivulets of code, which results in duplication of effort and incompatibility.
The programmers and representatives of companies gathered for the WorldVistA community meeting last week in Tempe, Ariz., spent much of the session talking about ways to reach consensus on a sustainable open-source development model. Their goal is to make the VistA clinical software system developed by the Veterans Affairs Department a viable alternative to proprietary software currently dominating the healthcare information technology market.
Copies of the VAs VistA system are available free of charge under the Freedom of Information Act, but the software needs modification for use outside the VA, tasks typically performed by vendors or consultants. Currently, there are two versions of VistA or VistA-related code available from the government for use in the private sector under the Freedom of Information Act. Maybe a half-dozen other VistA versions have been developed by for-profit and not-for-profit organizations.
For WorldVistA, a not-for-profit organization whose members emphatically want to prevent any further forking of the core VistA code, the stakes are high and there is no time to waste.
Right now, its Balkanizing, said Frederick "Rick" Marshall, a WorldVistA founder and past president. We cant continue to do this much longer or we wont be able to talk to one another.
Marshall, a former VA programmer, led a brainstorming session on how to maintain the VistA software development lifecycle outside the VA. It was one of several formal community meeting panels and many informal discussions that centered on how to best structure a collaborative that will distribute needed work and open-source community resources.
President-elect Barack Obama campaigned with a pledge to spend $10 billion a year for five years on health IT, and more recently has called for including HIT support in the economic stimulus package he wants passed by Congress as soon as he takes office.
At least one legislative proposal introduced last fall, by Rep. Pete Stark (D-Calif.), called for a special set-aside for developing an open-source health IT alternative much like the one used in the VA. The bill prompted a rapid, negative response from the Healthcare Information and Management Systems Society.
Meanwhile, a federal official speaking at the conference said 60% of some 1,300 community health centers are looking to implement health IT. Johanna Barraza-Cannon, director of the division of health information technology policy within the Health Information Technology Office at HHS Health Resources and Services Administration, said the total cost of those systems varies, based on how much the software itself costs, but said $300 million would be a fair estimate.
The high cost of health IT systems is an oft-reported barrier to adoption for any healthcare organization, but it becomes particularly problematic for safety net providers. HRSA handed out $19 million in IT grants last year, including planning grants that helped federally qualified health centers select an EHR system.
There is still a great deal of unmet demand in the safety net community, Barraza-Cannon said. When were asked for money, we cant fund all the requests, but you also have to ask if theyre ready. So its not just who wants the money, but whos ready.
Barraza-Cannon said a good number of the proposed IT projects are shovel ready, that is, could start when funds become available. HRSA, she said, is ready to ramp up grant oversight operations should more federal funds become available.
We have contract officers, we have the financial mechanism, Barraza-Cannon said. Were familiar with dealing with that type of pressure. What keeps me up at night is: How do we connect high tech with economic development (with) workforce challenges? This is the next frontier of job creation.
Last week, Ignacio Valdes, a physician who runs the LinuxMedNews blog, and Fred Trotter, who also blogs about open-source healthcare software, wrote that developer DSS, Juno Beach, Fla., would offer substantial portions of its vxVistA iteration of the VAs software as open source. DSS officials confirmed the report.
Weve been looking at this over the last couple of years of how to enter the open-source community without shooting ourselves in the foot, said Hugh Creedon, vxVista operations manager for DSS. We attended the Open Health Tools board meeting last month in San Jose Calif.," he said, and they gave us some insight on how we could proceed in a way that made sense to us.
DSS will release the software sometime next year on the Open Health Tools open-source community Web site under the Eclipse Public License, with the goal being before the annual HIMSS convention in April, according to Deanne Clark, vxVistA product manager. The release will include software modules developed by DSS or modifications to existing VistA modules for prescription writing and group notes for mental-health record keeping. The release will not be the complete software package that has been tested and certified by the Certification Commission for Healthcare Information Technology, according to a posting on the Open Health Tools Web site. Clark said the release also will not include proprietary modules developed by DSS and licensed to the VA for dentistry, mental health and release of information.
Those are things we cant release and charge the VA for, Clark said.
If DSS goes forward with its plan, it will join Medsphere Systems Corp., Carlsbad, Calif., as a for-profit VistA developer releasing significant sections of its code for open-source development. In addition to these two corporate entities, several other for-profit companies are selling versions of VistA; the Indian Health Service also has a system based on VistA that is available under the Freedom of Information Act, and the not-for-profit WorldVistA organization has its own version of VistA it is offering to the public as open-source software.
The WorldVistA EHR is offered under the GNU General Public License, which is not compatible with the Eclipse license, according to Ray Anthracite, a Washington-based lawyer who led a presentation at the meeting on source-code management.
Anthracite, a WorldVistA member, said although the GPL and Eclipse open-source licenses are very similar, the fact that theyre almost compatible gets you nowhere.
It would be nice if we could exchange code back and forth and use code from both licenses, but, Anthracite said, such code swapping would be unlawful without further agreement between the parties.
Still, WorldVistA Chairman Matthew King, a physician who is chief medical officer at Clinica Adelante, Sunrise, Ariz., was pleased with the movement by DSS and understands that the company must come to see there is greater value in collaboration than in retaining an income stream from site licenses. Clinica Adelante has installed WorldVistA EHR in a HRSA-funded pilot.
DSS gets a lot of their business from the VA, King said. We are glad to see them taking steps and acknowledging the value of going open source. Were closely aligned enough to collaborate in some arenas. Maybe well never collaborate in all, but its a great start. So, I applaud the fact that theyre taking steps to release code.What do you think? To submit a letter to YOUR VIEWS, click here. Please include your name, title, company and hometown. Health IT Strategist reserves the right to edit all submissions.
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