A Broad New VistA: How Open Source Changes Everything (Peter Levin, Dr. Peter Levin, CTO, Dept. of Veterans Affairs)
A Broad New VistA: How “Open Source” Changes Everything Peter L. LevinSenior Advisor to the Secretary & Chief Technology Officer U.S. Department of Veterans Affairs October 2012
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 President Barack Obama Speech to Disabled American Veterans health records...” Atlanta, August 4, 2010 Page 2
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 Page 3
For example, A contest to create a convenient mobile application that to identify local services such as health clinics, food kitchens, housing services, and Page 4 shelters.
For example: Blue Button Button-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 5
And for very good example: OSEHRA Lower 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 6
Problem Statement Federal 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 Nowhere is this more true than electronic medical records 7
Solution Statement There’s a much better way to do this• Incremental requirements• Interoperable apps / open APIs• Regular customer-facing deliverables• Negotiate features, not time Make it easier, and fairer, for everyone to compete 8
We currently have a contract-driven market• Customers: VA, DoD, IHS• Contractors: T4 and subs, SPECTRUM, TAC-based acquisitions Requirements VA DoD Contractor Code IHS Services: Product Design, Develop, Support 9
OSEHRA enables a product-driven market System OSEHRA Adopter IntegratorCommon codebase: Services:• Version management • Install• APIs • Configure• Testing • Maintain• Collaboration • Support 10
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/ESBall opensource • copy of current version • perpetual license • certification of interoperability • certification of function • documentation USG’s CSB/ESB 12
Use Case #2: adopt commercial code CA’s CSB/ESBall open commercial COTSsource vendor • direct relationship to $ vendor • pre-certified to plug into the codebase • no implied certification of function COTS CSB/ESB 13
Use Case #3: contribute GOTS code CA’s CSB/ESBall open opensource source • capabilities we already have • capabilities we create later • may want to only certify for interoperability • may want to contribute to the codebase GOTS CSB/ESB 14
OSEHRA timeline Pre-launch 2011 2012 July• internal discussion October • 1000 members• market research (IAC) •OSEHRA technical • First delivery operations •“10/1 Project” and March •“Code in Flight” launch • Board of Directors seated •~250 members • More than 750 members August February • OSEHRA launch • Deployment Lockdown • VA initial code contribution • Product development roadshow June • Contract award to tiag April • Custodial Agent RFP March • Custodial Agent RFI 15
Jim Traficant on open source June 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.” 16www.govhealthit.com/news/qa-harris-ceo-jim-traficant-genius-vision-open-source-va-and-dod-iehr
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 Near future: OSEHRA plays more active role in qualification and certification 17
Janus: an open source applicationFuture requirements OSEHRA VA/DoD Janus code Janus code JITC Palo Alto Hawaii VAMC Resource VAMC Group Support MTF 18
Janus presentation layer installed on July 13, 2012 19Dr. 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
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