VHA terminates COTS program

The Veterans Health Administration this month pulled the plug on a program that integrated commercially available products with an agency-developed system that manages patient information.

VHA canceled the Hybrid Open Systems Technology (HOST) program, which it started in the early 1990s to give VHA medical centers money and guidance in integrating commercial products into an older, proprietary system used to record and manage information on patient visits and billing. That older system, called the Veterans Health Information Systems and Technology Architecture (VISTA), and its predecessor system, the Decentralized Hospital Computer Program (DHCP), were built specifically to meet VHA's needs.

By granting medical centers money to experiment with combining commercial computer systems with VISTA, VHA leaders hoped to jump-start an interest in commercial off-the-shelf (COTS) products and to find products that could be rolled out to VHA's hundreds of medical centers, said Maureen Coyle, HOST director.

But as VHA has reorganized in the past few years into a confederacy of 22 semiautonomous health networks and as more VHA leaders at the networks and at VHA headquarters realized the potential of COTS technology, the program outlived its usefulness, said Coyle, who could not estimate how much money was invested in the HOST program.

"The philosophy of HOST is now ingrained in the entire [Office of the Chief Information Officer]...so you don't need a separate program office anymore," Coyle said. "That's it. [Using more commercially available technology] is now a part of the way we do business."

Some VHA employees, however, are concerned that HOST has been canceled. "Who's doing the prioritizing [of commercial-proprietary] projects now?" asked Joseph Lerschen, chief of clinical support services at the VA medical center in Iron Mountain, Mich., where HOST money was used for a project that may allow the center to use commercial software to attach medical images from pathology exams to the VISTA database. "Now what are they going to do?... Who's going to risk giving you the funding now?"

The Department of Veterans Affairs and the Defense Department are developing standards for computerization and electronic sharing of patient records. Standardization, according to observers, should make it easier for organizations such as the VA to integrate commercial products with existing systems for managing patient information. Those products could run the gamut from software that will alert doctors of potential drug interactions to software for merging X-rays with text-based records.

The Government Computer-based Patient Record program (G-CPR) should allow DOD, VA and the Indian Health Service to share patient information more easily. The program will be challenging because agencies will try to create an information technology bridge between the agencies' existing systems rather than build from scratch a multiagency system. "Tying [together] two systems is extremely difficult," said Christine Malcolm, vice president of business development in Computer Science Corp.'s health care group.

None of the projects HOST funded led to a national rollout of a commercial product that would add extra functionality to VISTA. "Health care is a very local issue, and the idea that you could find one COTS product, standardize it and then use it nationally is difficult in today's environment," said Elizabeth Smith, director of health care business development at Electronic Data Systems Corp.'s Government Division.