A Broad New VistA:How “Open Source” Changes Everything

Peter L. Levin

Senior Advisor to the Secretary & Chief Technology Officer

U.S. Department of Veterans Affairs

October 2012

Page 2

The president’s remarks in August 2010

• “…[so] we’re opening this competition to entrepreneurs and academics so the best minds in America can help us develop the technologies to serve our vets…”

• “…Veterans will be able to go to the VA website, click a “blue button,” and download or print your personal health records...”

President Barack ObamaSpeech to Disabled American Veterans

Atlanta, August 4, 2010

Page 3

We’ve created a culture of innovation

• 135 funded projects– Employee competitions– Industry competitions– Special projects– Prizes and challenges

• 6 employee competitions – 10,000 ideas from– 50,000 participants

• 3 industry competitions– 850 industry proposals– Telehealth, housing solutions for

homeless vets, prosthetics, telehealth

For example,

Page 4

A contest to create a convenient mobile application that to identify local services such as health clinics, food kitchens, housing services, and shelters.

Page 5

For example: Blue ButtonButton-easy access to personal health information

• Designed and launched by VA, CMS,

and DoD in October 2010

• VAi2 “Blue Button for All Americans”

contest won by RelayHealth

• Private sector partners– Private health plans

– 3rd party applications

• In March OPM required all federal

carriers to Blue Button-enable their

PHRs

• In June UnitedHealth Group added

Blue Button to its personal health

platform for 4 million patients

Page 6

And for very good example: OSEHRALower TCO, more secure, more competition

• Designed and launched by VA and DoD in October 2011

• One year later, over 1500 members from 150 companies

• Eighteen “infrastructure” components (VistA, AHLTA-Theatre, test harnesses, etc)

• Federal Registry Notice of up-coming Medical Scheduling contest issued October 16, 2012

Problem StatementFederal software acquisition is notoriously slow and error prone

• Encyclopedic requirements• Choose once/choose wisely procurement• Near-zero visibility into development• Epic program slips and cost overruns

7

Nowhere is this more true than electronic medical records

Solution StatementThere’s a much better way to do this

• Incremental requirements• Interoperable apps / open APIs• Regular customer-facing deliverables• Negotiate features, not time

8

Make it easier, and fairer, for everyone to compete

We currently have a contract-driven market

• Customers: VA, DoD, IHS• Contractors: T4 and subs, SPECTRUM, TAC-based acquisitions

VADoDIHS

Contractor

ProductServices:

Design, Develop, Support

Code

Requirements

9

OSEHRA enables aproduct-driven market

10

OSEHRASystem

IntegratorAdopter

Common codebase:• Version management• APIs• Testing• Collaboration

Services:• Install• Configure• Maintain• Support

Open source market

“Government as a customer” market• handles software acquisitions through contracts

Commercial market• gaining familiarity with

open source solutions

“Do it yourself” market• can’t afford commercial apps

11

Use Case #1: adopt an open source module

CA’s CSB/ESB

USG’s CSB/ESB

all open source

• copy of current version• perpetual license• certification of

interoperability• certification of function• documentation

12

Use Case #2: adopt commercial code

CA’s CSB/ESB

CSB/ESB

all open source

• direct relationship to vendor

• pre-certified to plug into the codebase

• no implied certification of function

COTS

COTS

commercial vendor

$

13

Use Case #3: contribute GOTS code

CA’s CSB/ESB

CSB/ESB

all open source

• capabilities we already have• capabilities we create later• may want to only certify for interoperability

• may want to contribute to the codebase

open source

GOTS

14

Pre-launch 2011 2012

OSEHRA timeline

• internal discussion• market research (IAC)

March• Custodial Agent RFI

April• Custodial Agent RFP

June• Contract award to tiag

August• OSEHRA launch• VA initial code contribution

October• OSEHRA technical

operations• “10/1 Project” and • “Code in Flight” launch• ~250 members

February• Deployment Lockdown• Product development roadshow

March• Board of Directors seated• More than 750 members

15

July• 1000 members• First delivery

Jim Traficant on open sourceJune 12, 2012

“We’ve got to enable an ecosystem, an infrastructure, a collaboration between the government and the private sector so we can do full continuity of care, not only between the DoD and the VA, but also when patients go to their hometown hospital or physician and then come back into the VA so that information can flow. Open source is going to provide cost-effective solutions to enable this future state of continuity of care. I think it’s a great vision.”

“It’s this kind of innovation, program execution, and I want to say enterprise architecture – this is the genius of this approach – is not solving problems business by business, region by region, or application by application. Instead they have a holistic view of the architecture, a common way of executing in terms of procurement, a clarity of the desired end state. The DoD and VA are going to set a model that the rest of the country is going to want to follow.”

www.govhealthit.com/news/qa-harris-ceo-jim-traficant-genius-vision-open-source-va-and-dod-iehr

16

JANUS open source: the new model

• Vendor contributed code to OSEHRA in May• VA retrieved code from the custodian in June• Qualified it for safety, security, utility in July

– “go live” was July 13

• VA (or anybody) can now install it

17

Near future: OSEHRA plays more active role in qualification and certification

Janus: an open source application

18

HawaiiResource

Group

OSEHRA

Janus code

JITC

PaloAlto

VAMC

MTF

VAMC

VA/DoD

Future requirements

Support

Janus code

Janus presentation layer installed on July 13, 2012

19

Dr. James Kahn, Chief of Medical Services for VA’s Palo Alto Health Care System demonstrates the first live open source VistA component.

New and next

• Keep assembling open source contributions– Approximately 18 applications from 10 places

• Install open source patient portal– Project led by our Presidential Innovation Fellow

• Position OSEHRA for front line testing– New iEHR components to be certified at OSEHRA

20

For example: a new enterprise-wide appointment scheduling service

Page 21