“We're still working through the details,” Kolodner said of his specific new duties. “It's all about personal-centered health and improving the health of individuals worldwide. We're looking at innovative ways to collaborate and establishing sort of a hybrid open-source technology.”
Last month, Kolodner announced in an e-mail to friends and colleagues that Sept. 22 was his final day as a federal government employee, closing out a public service career that spanned more than three decades.
A graduate of Yale medical school, Kolodner, a psychiatrist, began his 28-year tenure with the Veterans Affairs Administration in 1978 in Atlanta, where he also served as a member of the medical faculty of Emory University. Kolodner came to the VA just as work was getting under way on designing from scratch an electronic health-record system for the sprawling, government-run integrated healthcare system.
And here's where the homecoming part kicks in. The collaborative, decentralized and distributed model of software development used in those early days at the VA was in many ways akin to open-source development methods popularized in the private sector.
If Kolodner wasn't precisely in at the beginning of IT development at the VA, which began in late 1977, according to a history of the system, his arrival the following year was early enough that he knew and collaborated with many of the founders. In his own right, during his long career at the VA, Kolodner was a clinical IT leader, serving in 1983 as chairman of the Mental Health Special Interest Users Group, in 1989 as co-chairman of the interdisciplinary Clinical Record Special Interest Users group, and in 1991 as chairman of the Clinical Application Requirements Group, according to his biography.
Kolodner transferred to Washington in 1993 and worked in various national IT leadership positions, culminating as the VA's chief medical information officer.
Kolodner was a true VA IT “pioneer,” according to Tom Munnecke, one of the earliest programmers to work on what would become the Decentralized Hospital Computer Program, and later renamed VistA.
By going to work for a not-for-profit, Munnecke said, Kolodner “is taking a cut in pay compared to working for a Beltway bandit,” but, “he's very dedicated.”
“He's not a super technical person; he's an M.D.,” Munnecke said. “He wasn't doing programming, but I think this is bigger than one person anyway. One of his skills is he's able to work with bureaucracies and had the patience to do that. I didn't, and I respect him for that.”
Kolodner's people skills will serve him well at Open Health Tools, Munnecke predicts. “He's very good about reaching out to other people. I think he'll be great in that.”
Would there be someone better?
“Linus Torvalds,” Munnecke said, referring to the founder of the Linux operating system development effort, arguably the premier open-source program.
At a 2008 reunion of early VA programmers, Munnecke handed Kolodner an upgraded, VIP replacement of a membership card Kolodner had received much earlier as a member of the storied “Underground Railroad.” According to VA lore, the name was adopted by a group of founding VA developers and clinicians who clandestinely kept the distributed development method alive at the VA when it was being suppressed in the early 1980s by Washington, which favored a centralized approach to IT procurement and development.
One hallmark of the underground effort was adherence to commonly shared standards and core systems upon which a number of modular applications were created to meet the specific needs of clinicians at the local hospitals and clinics.
A second, innovative feature of the early IT work at the VA was an iterative development process in which the code for a plethora of modular software applications was banged out with clinicians and developers working in close, sometimes daily contact with each other to solve specific clinical problems.
Using common standards enabled locally developed modules, once debugged and ready for “prime time,” to be shared throughout the VA system with those hospitals wanting and needing to use them. Currently, the VistA system is comprised of more than 100 interoperable modules built on a common core.
After several years of battling the top-down development strategy pushed by Washington, the insurgents won, and in 1982 work on the Decentralized Hospital Computer Program became the official IT development strategy at the VA. The DHCP system would be renamed VistA in 1994. Use of the innovative, localized and iterative development scheme has waxed and waned at the VA, and so has internal and congressional pressure to contract out work on the VA's multibillion-dollar IT systems. Localized innovation at the VA could see resurgence with current VA leadership, however.
“It's in good hands,” Kolodner said, pointing out that Roger Baker, the VA's assistant secretary for information and technology, has a background in open-source development.
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