VA unveils plans to certify VistA for meaningful use

The Department of Veterans Affairs has laid out a roadmap toward meaningful use certification of its VistA EHR system, with a version that's being updated and improved in the OSEHRA open source community.

The Open Source Electronic Health Record Agent (OSEHRA), a non-profit organization, manages a public/private community formed to modernize VistA for open source and to contribute to the VA-Defense Department’s integrated electronic health record (iEHR).

Certification of the OSEHRA VistA, however, may not be realized until 2014, according to Dr. Theresa Cullen, director of health informatics at the Veterans Health Administration and former CIO at the Indian Health Service. IHS was the first federal agency to receive meaningful use certification of its EHR, which is based on VistA.

VA has formed an internal work group to get the process moving toward certification of VistA.

“We’re in the process. We’ve done modular certification already for about 10 modules," she told Government Health IT at an Oct. 17 OSEHRA conference. VA also will redo the gap analysis it performed two years ago in order to identify any changes in the code, and then release to the open source community the modifications to support certification.

But VistA must incorporate what will be the latest Computerized Patient Record System (CPRS), version 31, the graphical user interface for physicians in VistA that provides a view of the patient’s record, such as physician orders, medications, labs, consults and clinical notifications.

CPRS is on a six-to-eight-month cycle of iterative product improvement. “Version 29 is just going out, and version 30 is planned to have SNOMED and ICD-10. So we can lay the plan for version 31,” she said.

SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) is the standard language designed to capture clinical information during a patient encounter for entry into an EHR. ICD-10 codes must replace ICD-9 in October 2014.

“The issue becomes that I’m certifying to stage 1 of meaningful use, but we’re also doing the analysis for stage 2 at the same time, so theoretically we can do stage 1 and 2 if they’re not in conflict,” Cullen said.

Some vendors have received certification of their EHRs built on some VistA open source modules combined with other commercial applications to create their own health IT products, such as Medsphere. 

The capabilities inherent in meaningful use are “something we all want,” she said. VistA has many of the features, but the preferred language isn’t there yet. But it may not be difficult to add the required functionality, like e-prescribing.