The secretaries of the Veterans Affairs and Defense Departments will meet May 2 to determine their next steps toward developing a single electronic health record for the two agencies, according a senior VA official.

VA Secretary Eric Shinseki and DOD Secretary Robert Gates agreed in March on a commonn technical arcitecture, data and services and exchange standards for the joint system.

But the two departments will move incrementally to a joint electronic health record (EHR) system to avoid disrupting clinicians treating patients at their medical centers, said Roger Baker, VA CIO.

A single electronic health record system has been advocated for years, but its development is finally gaining traction.

Currently, both VA’s VistA and DOD’s AHLTA electronic health record systems have their own large installed base of software applications.

“One of my objectives is to have minimal disruption in the hospitals as we evolve from VistA to the joint EHR system  What I think you will see us do is replace modules, do incremental upgrades,” he said April 28 in a briefing with reporters.

“In five or 10 years, there may not be one line of code left from VistA. And in my ideal world, the users will have no idea that I have made any changes,” he added. 

The joint EHR will include both proprietary and open source software. Many commercial products use open source methods.

VA must accelerate the modernization of VistA, developed initially in the 1970s, even as it is collaborating with DOD on a common EHR. VistA's legacy technical architecture makes it difficult and expensive to maintain and upgrade.

VA is developing an open source track to modernize VistA and will incorporate the approach in the joint EHR, he said.

“Our goals are to bring in as many private sector modules as possible and selecting the same thing to run between VA and DOD so that we end up with a single, common electronic health record system,” Baker said.

“All the work we do with VA on the joint electronic health record firmly incorporates VA’s use of open source as the ‘how’ we will develop. Most of the discussion with the DOD is on the ‘what will we develop.’ There is a large piece of compatibility between those two,” he said.

[See also: Editor's Desk: This week in Government Health IT.]

VA will award a contract in June for what it calls a custodial agent, which is an organization that has experience in establihsing and operating an open source community, of which VA will be just one of the public and private participants, although a very large one.

“To the best of my knowledge, VA and VistA is the first example of a large-scale federal system that is going to use open source as the development method for what we do,” he said.

“Part of what the custodial agent will propose is the mechanism to get the first delivery of code from VA, and from the custodian back to VA for fielding in VA hospitals,” he said.

VA will contribute non-security essential modifications to the product it makes or pays for to the open source custodian.