One of the first actions the Veterans Affairs Department has undertaken since launching in August a central body dubbed the "custodial agent" to oversee open source electronic health record projects is to commission a study on how the code for its EHR system could be refactored, VA Chief Information Officer Roger Baker told reporters Nov. 23.

During a monthly call with press, Baker said refactoring of the system, called VistA, won't necessarily replace its MUMPS-written code with a more modern object-oriented language.

"The refactoring is really about restructuring the system into one based on defined interfaces," Baker said, citing data, service bus, application and user interfaces as examples. VistA, as it's written today, "blurs those levels substantially," Baker added. "We need to turn it into more of a modular approach."

The VA has told information technology employees that going forward, projects related to VistA must be done through the department's open source effort. Although new open source capabilities should start moving into production during calendar year 2012, Baker said, the change needed to go from a culture in which everything is internally developed to one in which applications arise through collaboration with outside parties will require a couple of years to implement.

Baker also said an effort to share veterans' medical information among public- and private- sector care providers called the Virtual Lifetime Electronic Record is now underway in the form of 12 pilot programs.

VA will make a decision during 2012 whether to make VLER nationally available, he added.

"At least initially we didn't see as much exchange of information between VA and the private sector as I think we had expected to see. I think we've seen that picking up as we've gotten out to the broader pilots," he said.

For more:
- listen to Roger Baker's Nov. 23 press call
- go to the website for the VA custodial agent, known as the Open Source Electronic Health Record Agent

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