The Department of Veterans Affairs is at work on the next generation of VistA, its 20-plus year-old electronic medical record system, which is often praised by users but considered a headache to planners working to bring VA health systems fully into the Internet age.

The new system - dubbed Aviva - is designed to be Web-enabled, modular and capable of easily exchanging health records with other EMRs and organizations using standards built for the Nationwide Health Information Network (NHIN).

In contrast, the current version of VistA resides on tens of thousands of computers, is difficult to upgrade and presents obstacles to VA plans to share information with other agencies and heath organizations, according to its chief technology officer.

"Effectively what we are trying to do is replace a tin can on a string with a cell phone system," said Peter Levin, the VA's CTO, who described Aviva at a March 8 meeting of a Health IT Standards Committee workgroup.

It is difficult for VA to exchange data with external partners, the aim of its Virtual Lifetime Electronic Record (VLER) project with the Kaiser Permanente and the Defense Department to provide better care for veterans who get treatment from the three organizations, he said.

Additionally, any changes or bug fixes planned for VistA must be made on each of the thousands of computers across the VA system.

"Being current is what is eluding us right now to be able to fix bugs quickly, to be able to accelerate our release cycle and be able to plug into other components," Levin told the panel.

Levin said that while VistA's user interface "is arguably the best in any electronic medical record," it is "difficult to learn and the information is not as intuitive as it could be." The programming environment of the current system is also "outdated and difficult to maintain," he said.

In developing Aviva, Levin said the VA wants to build a platform that can "scale with our veterans' population" and accommodate "in a modular, perhaps open source, framework multiple development teams" that could install their applications into the system's backbone platform.

Yet Levin emphasized that VistA would remain a key component of Aviva. "I wouldn't be surprised if it ultimately subsumes (VistA)," he said.

VA's most important initial goal is making its EMR system interoperable with other systems and agencies, Levin said.

"All we really care about is data interoperability or data interoperability first," Levin said. "We can exchange business rules later. If we can have some kind of convergence of the user layer, that's great. But right now I am focused on data."

Ultimately, VA wants to segment the kaleidoscope of data, business rules and lines of MUMPS code into a presentation layer "that protects the user from changes that take place behind the curtain."

In making it interoperable, Levin said, VA would "segregate the presentation layer of VistA and attach it to the nationwide health information network."