The Department of Veterans Affairs has laid out a roadmap toward meaningful use certification of its VistA EHR system, with a version that's being updated and improved in the OSEHRA open source community.

The Open Source Electronic Health Record Agent (OSEHRA), a non-profit organization, manages a public/private community formed to modernize VistA for open source and to contribute to the VA-Defense Department’s integrated electronic health record (iEHR).

Certification of the OSEHRA VistA, however, may not be realized until 2014, according to Dr. Theresa Cullen, director of health informatics at the Veterans Health Administration and former CIO at the Indian Health Service. IHS was the first federal agency to receive meaningful use certification of its EHR, which is based on VistA.

VA has formed an internal work group to get the process moving toward certification of VistA.

“We’re in the process. We’ve done modular certification already for about 10 modules," she told Government Health IT at an Oct. 17 OSEHRA conference. VA also will redo the gap analysis it performed two years ago in order to identify any changes in the code, and then release to the open source community the modifications to support certification.

But VistA must incorporate what will be the latest Computerized Patient Record System (CPRS), version 31, the graphical user interface for physicians in VistA that provides a view of the patient’s record, such as physician orders, medications, labs, consults and clinical notifications.

CPRS is on a six-to-eight-month cycle of iterative product improvement. “Version 29 is just going out, and version 30 is planned to have SNOMED and ICD-10. So we can lay the plan for version 31,” she said.

SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) is the standard language designed to capture clinical information during a patient encounter for entry into an EHR. ICD-10 codes must replace ICD-9 in October 2014.

“The issue becomes that I’m certifying to stage 1 of meaningful use, but we’re also doing the analysis for stage 2 at the same time, so theoretically we can do stage 1 and 2 if they’re not in conflict,” Cullen said.

Some vendors have received certification of their EHRs built on some VistA open source modules combined with other commercial applications to create their own health IT products, such as Medsphere. 

The capabilities inherent in meaningful use are “something we all want,” she said. VistA has many of the features, but the preferred language isn’t there yet. But it may not be difficult to add the required functionality, like e-prescribing.

“We have electronic prescribing but not the ability to transmit to an outside pharmacy. But the veterans want that,” she said. “It is all aligning, so committing to meaningful use commits us to get to capabilities that benefit veterans.”  

Robert Kolodner, MD, former national health IT coordinator at the Office of the National Coordinator for Health IT and former VA lead on health IT and VistA as chief health informatics officer, said that ONC and OSEHRA share the priorities of meaningful use.

“VA, DOD and other OSEHRA partners are looking to see how they can meet the needs of involved agencies and make it easier and lower costs to accomplish the things that are part of meaningful use,” he said. Kolodner is currently chief health informatics officer for Open Health Tools.

Kolodner provided an example of another project, the Model Driven Health Tools (MDHT), which started with VA and another open source health IT community. ONC has since adopted it into its Standards & Interoperability Framework to create tools and services to support standards for modeling and health information exchange. Among its uses is in packaging the information in Connect, a representation of the nationwide health information network, and Direct, the secure email protocol, he said. ONC has said that it plans to use MDHT to promote the exchange of information in transitions of care as a patient moves between providers and care settings.

“Here is something that met VA’s needs and is now meeting the nation’s needs, and it is something that can be used by both commercial entities as well as homegrown systems, and it’s not something that has to be a point of competition,” Kolodner said.

If OSEHRA can come out with modules, such as its recently opened contest for a medical scheduling package, and parts of it are open source, commercial companies can also include it.

“It broadens the opportunity for the private sector. It’s a different model, not vendor lock," Kolodner said. "Let’s add innovation and value on top of these things. It’s not just about connecting but really making a difference and democratizing it."