In addition to its own systems, one of the significant products it investigated is VistA,” according to the NHS report. The VistA system, it said, was created in the 1980s by clinicians and software engineers from the ground up, and “has become renowned across the world.”
More recently, the VA has recognized the potential benefits to itself and others of developing a global community of users to develop VistA, the NHS report said, a reference to the VA's creation of a not-for-profit, open source custodial agent, OSEHRA, to more rapidly update the VistA system.
NHS England has visited the Veterans Health Administration to undertake deeper analysis of the product and capability for it to be used within the NHS, the report said. “We are now undertaking an initial assessment of product capability and the necessary customization that would be required to make it fit for use as part of NHS VistA.”
The NHS is “looking to adopt some of the ethos behind its creation and potentially part, or all, of the technical product, in combination with others, to generate 'NHS VistA.'”
The 52-page NHS document, “Safer Hospitals, Safer Wards/Achieving an Integrated Digital Care Record,” said the effort will be backed by some money in a $394 million technology fund announced by the nation's health secretary in May to ensure “the rapid progression to digital records.”
“I met visitors from the U.K. on a couple of occasions within the last month,” said Dr. Seong Ki Mun, president of OSEHRA. “There was a group of visitors to the VA and to HHS as well. They did a lot of due diligence. They were very, very interested.
“There are some people in the U.K. government that are very, very strong on open source,” he said. “We expect to provide an OSHERA-certified version for those projects.'
The visitors also “showed a lot of interest” in the Blue Button project, he said. Blue Button was initiated by the VA to enable patients to view, download or transmit electronic copies of their medical records. Mun also said there has been global interest in an open source version of the VA's patient portal, developed by West Virginian Keith McCall, called HealtheMe, now in the OSEHRA portfolio.
Mun said it's unclear yet how the NHS VistA project might translate into jobs for U.S. developers with VistA expertise. “It's entirely possible,” he said. “There is expertise in Europe as well,” so, “who will actually do the work, I don't know.”
“We did offer them, if they're interested in downloading the code, help in getting it up and running,” Mun said. “Having more people use VistA means there will be more expertise and more people trained in the VistA code.
Mun said it's highly likely that any improvements done to VistA by the NHS would enhance the code based use by all VistA-equipped providers. Mun said he stressed to his English visitors the benefits of fully participating in and contributing to the developing open source community and that whatever is done be done in the Apache II license. That's the most flexible open source license, allowing relicensing any improvements as proprietary code, requiring subsequent users to pay the developer royalties. But, Mun said, “generally, it's in everybody's best interest to stay with Apache II. Then the software becomes a living, breathing organism.”
The announcement was greeted with cheers from Joseph Dal Molin, chairman of World VistA, a not-for-profit corporation formed in 2002 to promote the use of an open source version of VistA outside the VA. He said he was delighted to read the new NHS guidance document.
“The NHS has, in my opinion, set the bar for a sensible and pragmatic approach to making open source solutions and open innovation part of a refreshing approach to health IT,” said Dal Molin, the Toronto-based president of an IT consulting firm, e-cology Corp., who served as a technical adviser on the installation of VistA at hospitals in Jordan. “It is very exciting that the NHS is seriously investigating the creation of an NHS VistA, especially given the deep understanding of the clinician-led process that created VistA and the patient-focused ethos that has driven VistA's evolution.”
Follow Joseph Conn on Twitter: @MHJConn