A Different VistA for the NHS?

I've written quite a lot about Microsoft's ill-fated Vista in Open Enterprise, but nothing so far about another VistA:

Electronic Health Record systems (EHR) are essential to improving health quality and managing health care delivery, whether in a large health system, hospital, or primary care clinic. The U.S. Department of Veterans Affairs (VA) has developed and continues to maintain a robust EHR known as VistA - the Veterans Health Information Systems and Technology Architecture. This system was designed and developed to support a high-quality medical care environment for the military veterans in the United States. The VistA system is in production today at hundreds of VA medical centers and outpatient clinics across the country.

VistA has a proven track record of supporting a large variety of clinical settings and medical care delivery systems. Facilities range from small clinics that provide solely outpatient care to large medical centers with significant inpatient populations and their associated specialties, such as surgical care or dermatology. These systems focus on clinically relevant record keeping that improves patient care by improving clinical and administrative decision-making. Versions of this system are in active use in the U.S. Department of Defense Military Health System, the U.S. Department of Health and Human Services Indian Health Service, and internationally as well, e.g., Mexico - Instituto Mexicano del Seguro Social, Berlin Heart Institute of Germany, and National Cancer Institute of Cairo University in Egypt.

The costs associated with the acquisition and support of an EHR can be a barrier to improving the quality of health care provided by limiting the availability of timely and accurate access to electronic patient information. Part of the solution is to lower the cost of acquiring an EHR by using a software stack consisting of open-source, free software such as VistA. VistA is public domain and freely available through the US Freedom of Information Act (FOIA).

Because VistA is public domain software, there have been a range of derivatives, some free software, some proprietary. This has led to a certain fragmentation of the VistA ecosystem, and also means that its relevance to the wider free software world has been limited. No longer: one of the main proprietary versions is going open source:

DSS, Inc. the leading developer of enhancements to VistA, the VA’s award winning electronic health record, announced it will open source the code for its vxVista an enhanced version of VistA designed for the commercial market. In this major development, DSS, Inc. has effectively removed the greatest obstacle to collaboration in the VistA community by providing their enhanced version of VistA under a commercially friendly open source license that can be used to unite the VistA community.


As an integral part of its actions, DSS, Inc. has joined the Open Health Tools (OHT) Foundation. Open Health Tools is the leading umbrella non-profit organization for open source projects in healthcare. Skip McGaughey, Executive Director of Open Health Tools said “We are very excited about DSS joining OHT and making such a significant contribution.” McGaughey added, “The VistA technology has been used by millions of people and has established the benchmark for the industry.”


vxVistA will be released under the Eclipse Public License (EPL). The Open Health Tools (OHT) Foundation is modeled after the Eclipse Foundation , one the most successful open source projects today. Using the Eclipse Public License all members of the “VistA community”, including competitors, will be able to use vxVistA as the core framework for their products and innovations.


In addition to being released under the Eclipse Public License, vxVistA's framework will follow that of the Eclipse Foundation. Companies will be able to collaborate to build products by programming and packaging plug-ins, modules and extensions to vxVistA's core framework.

Aside from the general importance of this move for Eclipse, open source, and free software in healthcare, there is a particular reason why this could be big news for the UK.

As I noted earlier last year, the Open Health Tools Foundation mentioned above was actually co-founded by a group of organisations including NHS Connecting for Health. This latest move of DSS should strengthen the OHT Foundation enormously, and make VistA even more attractive to healthcare providers around the world - including the NHS. Could this be the straw that finally broke the proprietary camel's back in UK healthcare? What will be the NHS's, er, view?

Copyright © 2009 IDG Communications, Inc.

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