Turning VistA Into a "Real" Open Source Project

The US Department of Veterans Affairs (VA) is exploring the creation of a "custodial agent" to govern the development of VistA, its popular open source electronic health record (EHR) platform. VistA exists as open source code because it is in the public domain, and a successful ecosystem of VistA-based projects and companies has grown up around it offering EHR services, but without the governance and infrastructure of a "real" open source project.

VistA was developed slowly by the VA, beginning around 1977. In its current form, it consists of more than 100 individual applications handling discrete EHR tasks, including prescriptions, medication dispensing, clinical orders, doctors notes, tracking test results, and many more. It is used by the VA's network of more than 1000 hospitals, clinics, and medical facilities, and is regarded as one of the key factors behind the Veterans Health Administration's top ratings on patient satisfaction and quality of care — regularly beating out Medicare, Medicaid, and private health care services.

In addition to its use by the VA, VistA was adopted as the core of the US Department of Defense's Composite Health Care System (CHCS), the Indian Health System's Resource and Patient Management System (RPMS), Finland's MUSTI Consortium, and a number of non-governmental institutions.

Several open source projects packaging VistA for deployment have developed over the years as well, most designed as commercial products created by system integrators that offer support services and add-ons, such as OpenVistA by Medsphere and vxVistA by DSS. The WorldVistA non-profit organization was established in 2002, and packages its own version, called WorldVistA EHR, in addition to providing discussion forums, documentation, and resources for adopters.