A Veterans Affairs requested VistA Modernization Report is now available. The good news: it prominently features and recommends open source and discusses the prospect of VA VistA as a national standard. The bad news is that it appears to be progressive while actually being regressive from current and past VA experience and practice.
The reports thesis is to open the door wide for both open source and proprietary EHR software. That sounds good until one realizes that much of VA’s undeniable success has been directly because of its sound decision to largely exclude proprietary EHR software. On the few occasions it has deviated from this it has caused large and expensive problems.
Among the reports issues, it calls the GNU General Public License ‘restrictive’. Restrictive of what? Restrictive of the ability of proprietary vendors to establish and maintain vendor lock-in at the great expense of taxpayers and patients? The report at times treats open source and proprietary EHR software as equals instead of proprietary EHR software as a destructive invasive species. The report probably understates the number of private sector VistA deployments as measured by the 2008 AMIA Open Source White Paper. Finally, it makes the common error of subdividing open source vs commercial when open source is certainly commercial. They probably mean open source vs. proprietary.
Other troublesome questions unanswered by the report are:
- What about existing private sector VistA open source efforts and advances?
- Who will make key architecture decisions?
- Who will make the licensing decision?
- Timetable for achieving all of this?
- Joel on Software Architecture Astronauts, much?
As above the report recommends massive reengineering of an already functioning system. Ask the British how their similar Larenzo project is going. Answer? It is now twelve years late.
Overall this report appears to be progressive in its embrace of open source when in reality it is highly regressive by its inclusion of proprietary EHR software and a massive re-engineering approach instead of limited refactoring. The UK experience has shown that this approach can be disastrous. The VA’s VistA EHR is successful because it consciously eliminated proprietary EHR software to a large degree. The report attempts a utopian picture of open source and proprietary EHR software standing shoulder to shoulder and singing kumbaya. This is a highly unlikely scenario that would greatly jeopardize and fly in the face of VA’s long open source software history and track record of success.