VA's VistA system is world-class but hard to maintain, says IAC's Meagher

The industry group examining how to modernize the legacy VistA electronic health record system at the Veterans Affairs Department is striving to uphold VistA’s strengths while rising above its weaker features, its chairman said today.

“VistA is the best health information system in the world, bar none,” Ed Meagher, who chairs the Industry Advisory Council (IAC) VistA Project, told Federal Computer Week. “At the same time, VistA is very old, very hard to maintain, hard to manage and manipulate, and incredibly expensive to maintain.”

“[All] of those statements are true, so what do you do to modernize it and make it easy to maintain?” Meagher asked. He has formerly served at the VA as deputy assistant secretary for information and technology and currently is director of strategic health initiatives at SRA International Corp.

The VistA Policy industry group was formed in October at the request of Roger Baker, chief information officer of the VA. He wants guidance on how to refresh the architecture for VistA with the goal of possibly deploying the system more broadly to hospitals and physicians' offices. The VA has not decided whether to proceed with such a deployment.

VistA already is being used by some private hospitals; varieties of the VistA software code are available in open-source form at no charge. The IAC VistA Policy group is evaluating how it could be made more widely available in an open-source model, as well as other issues, Meagher said.

The goal is to leverage, as much as possible, the taxpayers’ $8 billion investment in developing VistA over the last 20 years, Meagher said.

“The key is that industry will be making a recommendation to the government, and that does not happen a lot. It is a very powerful thing,” Meagher said. “We have been given a real opportunity.”

The 42-member IAC VistA Project industry group has been meeting weekly since October and its eight subcommittees also have been meeting regularly. Last month, the full group visited the VA Medical Center, in Washington where the members witnessed VistA in action in a clinical care setting and spoke with a chief architect of the software. On Jan. 9, the industry group will meet for a full-day conference with updates from all the subcommittees, Meagher said.

To date, the meetings have been informational, with the goal of educating the membership about VistA and its features and agreeing on definitions and the scope of the workgroup, Meagher said.

Starting Jan. 1, the focus will turn to preparing to make recommendations on whether VistA could be deployed more broadly and outline the most appropriate model and strategy for doing so, and the potential impact on industry and the health care community, he said.

Meagher described the committee members as disparate in their opinions and said he has personally asked each member to rise above his or her company affiliation and represent industry as a whole. “I intend to enforce that,” Meagher said. “It is a good-faith promise.”

VistA provides each military veteran with a digital medical record. The VA began developing and managing the system 25 years ago and uses it at its 153 hospitals and 768 outpatient clinics. The Indian Health Service also uses VistA, and the VA and Defense Department are collaborating on a Virtual Lifetime Electronic Record.

Meagher is hopeful that the format of the VistA Project also will serve as a model to help other federal agencies seeking to update aging IT systems and software. The workgroup has a clear focus but also intends to take lessons learned that could be applied more broadly, he said.

“If we can do this for [VistA], can we do it again for another system?” Meagher asked.