Editor’s note: Dan Johnson, MD is a distinguished member of the FOSS in medicine community. He holds the distinction of writing the earliest known ideas on the subject. Dan reports the following: First, this is not an “announcement,” in the sense of Grand Hoopla. It is news that a door is creaking open: The Wisconsin QIO (Quality Improvement Organization; formerly known as a PRO – Professional Review Organization), MetaStar (formerly known as
WIPRO), has internally committed to sponsoring a proper open-source distribution of VistA Office, the physician-office-ready version of VistA that is being prepared for August 1st release by CMS (the agency formerly known as HCFA).
What does this mean?

Well, let’s start with what does “a proper open-source distribution” mean?

It means — at a minimum —

1 – that all the components needed to run the application are available as open source software.

1a -In this effort, because the intended user base will be physician offices that will not likely be technically sophisticated enough to be
fully self-able to install, train for, and maintain the package, each component must be available in a commercially-supported version.

2 – that there is a mailing list server for user and developer interchange.

3 – that there is a code repository for components.

4 – That the components be *packaged*.

Items 2 through 4 are those that need especially to be taken care of in
this instance. MetaStar has agreed to lead the initial creation of this
distribution.

Next, there are some special needs related to the nature of this project.

VistA, the VA system’s and DOD’s and Indian Health Service’s EHR, is open as in “freely available” but is not being developed collaboratively. VistA Office is an adaptation of IHS templates to the current VistA code; the commitment by CMS is to keep VistA Office current with the VA code base; hence, there is no intent to create a collaboratory for VistA code.

But there is need to collaborate on templates and other enhancements, and for this a collaboratory site needs to be established.

The components of the distribution must be:

• VistA Office ported to Linux
• GT.MThere are two phases of this project.

  Phase I, to begin as soon as VistA Office code is released by CMS, is to
  port VistA Office to Linux and GT.M. I expect that the port will run at
  least on Red Hat Enterprise Linux (commercial support availability) and
  debian (historical base), and likely SUSE Linux as well, if Novell is
  interested.

  Phase II, somewhat more extensive, is to finish the port of CPRS (the
  visual presentation layer for VistA) to WINE, so that a Delphi license
  and Windows clients are not required. Update 5/8/2005: this sentence added: Codeweavers has nearly completed a port of CPRS to WINE; its completion
  awaits additional funding. When this is complete, no Windows clients
  will be needed to use VistA Office.

  This news, you must note, is not an announcement, so specifics (such as
  dates, developers, Internet locations) are not yet known. When these
  are known, the proper announcements will be made. This news is merely a
  declaration of intent.

  What is a QIO?

  The Medicare legislation requires CMS to have a quality-assurance
  process for Medicare recipients. It has fulfilled this requirement by
  promoting and supporting a network of state non-profits. MetaStar is
  the Wisconsin contractor.

  Why MetaStar?

  Dr. Dan Johnson is a long-time spectator and advocate for open source in
  medicine, and happens to be a MetaStar trustee. Also, the current
  MetaStar board chairman, Dr. Bill Annesley, is a urologist who’s rather
  a geek (programmer in pre-medical school life), and understands the
  situation well. And the MetaStar executive staff has been listening with
  interest to the conversation.

  What next?

  It is hoped that the AAFP and the ACP, at least, will permit presentations of this new paradigm for EHR at their annual meetings
  during the next year.