VA gets VistA certified as modular EHR

The Veterans Affairs Department—as part of an effort to show that it's keeping up with commercial electronic health-record system developers—has had its VistA EHR system tested and certified as a modular EHR under the terms of the federal EHR certification program.

The VA does not participate in the federal EHR incentive payment programs under Medicare and Medicaid, which require hospitals, physicians and other eligible professionals to use independently tested and certified health IT systems. But a VA official said in October that the giant healthcare organization—with more than 150 hospitals and more than 700 outpatient clinics—plans to have VistA tested and certified anyway to demonstrate that it is staying on par with other systems.

The immediate impact of ONC authorization of VistA on a growing community of commercial and not-for-profit developers of VistA derivative EHRs and their users is more symbolic than substantive. Four developers—commercial firms Medsphere Systems and DSS; the not-for-profit WorldVistA; and the Indian Health Service, an arm of HHS—all have tested and certified versions of VistA. Thus far, more than 70 healthcare organizations have used these ONC-approved VistA derivatives to meet Stage 1 meaningful-use criteria and receive payment under the Medicare EHR incentive payment program, federal records show.

Notice of the testing and certification was posted on the Certified Health IT Product List, a public website kept by HHS' Office of the National Coordinator for Health Information Technology. The VA also had tested and certified its MyHealtheVet personal health-record system as an EHR module.

Looking at the ONC's website, which features a checklist of the VistA functions remaining to be tested before VistA can be certified as a "complete EHR," the VA still has a way to go, said Dr. Nancy Anthracite, president and chief medical officer of WorldVistA.

"They picked up the stuff that can be done easily, and now they're working on the stuff that can't be done so easily," Anthracite said. "We'd like to work cooperatively with them. We've sort of pointed them at what we did and we hope that they choose to consider working with us."

Historically, the VA has been reluctant to accept additions or improvements to its own VistA version from developers outside the VA, with the notable exception of the Indian Health Service, with which the VA has had a longstanding and close collaboration. But in 2011, the VA launched a not-for-profit organization to oversee an open-source development program for VistA improvements.

"We are actually having some conversation, between DSS, Medsphere, WorldVistA, the IHS and the VA about working together," Anthracite said. "I think there are barriers within the VA that are legal issues that there isn't an open and free conversation yet, but we're hoping that will come in the near future."

According to a VA statement, for the next two years Vista will stand pat at its current level of testing and certification as a modular EHR, with certification to 20 inpatient criteria in the 2011 Edition of ONC testing and certification standards. The 2011 Edition are the standards developers have used to build systems for use in Stage 1 used of the Medicare EHR incentive payment program.

As the federal EHR incentive payment program moves in 2014 to stricter Stage 2 meaningful-use criteria and EHR vendors face a more-stringent set of testing and certification standards, the VA will upgrade its VistA testing and certification, the VA said. The ONC released the final specifications for those tougher, 2014 edition EHR standards this month.