December 15, 2017

VA VistA Health Information Technology

• VistA Health IT “In the Cloud” (One Billion Users on Two Billion Devices By the Year 2020);

o From VistA Modernization to A New “Civilian VA” in 24 Months;

o One Click Social Networking to Electronic Personal Health Records;

o New Critical Mass of Not-profit Provider Adopters of “VistA in the Cloud” HIT;

o VistA in the Cloud Enterprise Platform (Link, Organize & Operate Provider Network);

o “VistA Cloud Data Services”;

Appendix: Congruence of Government and Project 76 (Nationwide, Not-for-profit Health Service) Goals and Objectives:

“The Department of Veterans Affairs (VA), Office of Information & Technology (OI&T) is responsible for the development and maintenance of the Veterans Health Information Systems and Technology Architecture (VistA), VA’s Electronic Health Record (EHR). VistA is built from more than 100 discrete applications that together comprise VA’s highly integrated and fully-automated health information system and VistA is the electronic information service that enables clinical care delivery at 152 VA health care facilities and 928 ambulatory care and community-based outpatient clinics worldwide. VistA is central to the quality of care VA delivers to Veterans.

Designed by clinicians for clinicians, VistA is patient-centric and embodies the clinical workflow processes that support VA’s model of care. It has enabled measurable improvements in the quality of care VA provides. VistA is stable and reliable; it is available 99.95% of the time and performs well in both large hospital and small office settings.

VA believes that VistA’s rate of innovation and improvement has slowed substantially, and that the “codebase” is unnecessarily isolated from private sector components, technology, and outcome-improving impact. To address this issue, VA is establishing a mechanism that will open the aperture to broader-based public and private sector contributions.

VA believes that the most reliable, most cost effective, and – based on experience – quickest mechanism to re-position this tremendous national asset and to keep pace with innovation is to create a custodial agent based on well-understood open source business models. By doing so, [VA] will provide a transparent mechanism to incorporate new features and capabilities into the source code, provide industry a high fidelity signal of [its] intention and uniform acceptance criteria, and better proliferate those innovations inside our hospital and clinics. VA’s intention is to create a structured, deliberate, and predictable migration path from VA’s custom and proprietary EHR software to an openly architected, modular, and standards-based platform. VA believes that a non-governmental custodian will achieve all these objectives quickly and efficiently…

Specifically, VA believes that a structured, deliberate, and predictable migration from [its] custom and proprietary EHR software to an openly architected, modular, and standards-based platform will achieve five crucial objectives:

It will unleash EHR innovation inside and outside VA.

It will release VA’s captive dependency on any particular component or service and give our clinicians access to the best available tools and solutions.

It will reduce the costs and risks of reliable implementation (and integration) of new functional modules and improve VistA’s capabilities.

It will measurably improve health outcomes for our nation’s Veterans. And

It will enable other providers in the public and private health care system to benefit from, contribute to, and interoperate with this national asset.” (Department of Veterans Affairs, Technology Acquisition Center, Solicitation Number VA118-11-RP-0275 April 22, 2011)

On May 13, 2011 at 4:00 PM EST the VA OI&T, Technology Acquisition Center accepted “Firm Fixed Price” offers from would-be contractors responding to a VA request for proposal (RFP) solicitation number VA118-11-RP-0275, seeking establishment and activation of electronic health record open source Custodial Agent (CA) operations for managing a new open source ecosystem to modernize VistA. “VA views the CA as an independent entity that enables the formation and operation of an active EHR open source community. [VA] foresees the community beginning with the current VistA code and evolving and improving it over time. VA intends to be an active community member and a user of the open source codebase maintained by the CA.

VA will contribute the current FOIA [Freedom of Information Act] version of VistA as the initial code contribution in the establishment of the CA. Thereafter, the CA will manage the evolving EHR open source codebase and VA intends to be both a contributor to, and consumer of the CA’s work product.

The CA is intended to be an independent, central body that fosters the creation and evolution of an open source EHR community. In this role, it defines and performs certification and manages the code repository that provides access to the code base. It provides the forum for maintaining and communicating architecture, product definition, and other aspects of the code base, as well as other functions that help to build and sustain the community. Helping the community achieve consensus among members should be part of the execution of CA responsibilities.” (VA118-11-RP-0275 EHR Electronic Health Record Open Source RFP Custodial Agent Question Answer Q4 421-11_02 April 21, 2011)



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  1. AlxHamiltn says:

    VA cloud pilot could impact 134K medical workers

    August 22, 2011 — 1:43pm ET | By Dan Bowman

    Federal Information Security Management Act FISMA

    Privacy and communications issues surround planned pilot testing of cloud-based tools by the Department of Veterans Affairs that could impact as many as 134,000 VA medical workers. Specifically, the VA wants to move its Microsoft Exchange-based collaboration system to a cloud-based system, according to InformationWeek.

    The issues date back to last December, FierceGovernmentIT reported last month, when doctors and residents at several VA hospitals used GoogleDocs and Yahoo Calendar to manage their workflow. By storing patient information in each application, however, patient information was put at risk, according to Roger Baker, the VA’s chief information officer.

    Baker admitted, though, that such tools were “easier to use and more broadly available.”

    Currently, the VA is in search of an established cloud-based vendor, according to a Federal Business Opportunities notice posted Aug. 11. Ultimately, the VA said its tools need to meet Federal Information Security Management Act (FISMA) standards.

    Once established, the tools will be tested on 5,000 VA doctors and residents, according to the notice. The pilot would expand to 17,000 VA physicians, 36,000 residents and 81,000 other medical personnel if deemed a success.

    Read more: VA cloud pilot could impact 134K medical workers –



  2. AlxHamiltn says:

    The key to health informatics going forward is to be found in re-engineered (open source) VA VistA HIT based personalization, commoditization and standardization of nationwide, not-for-profit medical records and globalized database modeling of health information, on throw-away mobile hardware and telephony hosted in the Cloud. And, as it will represent a non-economic and VERY substantial capital investment as significant as President Eisenhower’s building of the Interstate Highway System, it will need to be the following or another existing non-profit entity that makes the investment that brings that reality for EHR and EMR to life…

  3. AlxHamiltn says:


    Open Source Electronic Health Record Agent Begins Operations

    WASHINGTON (August 30, 2011)- The Department of Veterans Affairs (VA) today announced it has completed an important milestone on its joint path with the Department of Defense (DoD) to create a single electronic health record system for servicemembers and Veterans. OSEHRA, the Open Source Electronic Health Record Agent, has begun operations and will serve as the central governing body of a new open source Electronic Health Record (EHR) community.

    “We developed our open source strategy to engage the public and private sectors in the rapid advancement of our EHR software, which is central to the care we deliver to Veterans and servicemembers and to our joint EHR collaboration with the Department of Defense,” said Secretary of Veterans Affairs Eric K. Shinseki. “With the launch of OSEHRA, we begin the implementation of our strategy and we look forward to the creation of a vibrant open source EHR community.”

    As part of the initiation of OSEHRA operations, VA has contributed its current EHR, known as VistA (Veterans Integrated System Technology Architecture), to seed the effort. OSEHRA will oversee the community of EHR users, developers, and service providers that will deploy, use, and enhance the EHR software.

    Individuals and organizations interested in participating in OSEHRA ( are invited to join through the community website. Established as an independent non-profit corporation during its initial phase of operation, OSEHRA is putting in place the framework and the tools that will enable the public sector, private industry, and academia to collaborate to advance EHR technology.

    Draft documents describing key framework components, such as the design of its code repository and the definition of its software quality certification process, are available on the OSEHRA community website. Community feedback is welcome as the OSEHRA team finalizes these designs in preparation for launch of full technical operations this fall.

    The design of OSEHRA is being led by The Informatics Application Group (tiag) under a contract awarded by VA in June 2011.

    Moving to an open source model invites innovation from the public and private sectors. It is an important element of VA’s strategy to ensure that VA clinicians have the best tools possible, and that Veterans receive the best health care possible.

    # # #

    About OSEHRA

    OSEHRA (Open Source Electronic Health Record Agent) governs an open, collaborative community of users, developers, and researchers engaged in advancing electronic health record technology. For more information, visit

  4. AlxHamiltn says:

    Today’s Top News

    1. VA open source custodial agent opens doors

    By David Perera

    The Veterans Affairs Department officially launched Aug. 30 a central body dubbed the “custodial agent” to oversee open source electronic health record projects.

    The body, now going by the official name of the Open Source Electronic Health Record Agent, or OSEHRA (pronounced “oh- sarah”), is meant to be the first step in creating an open source successor to VA and Defense Department EHRs. Code for the VA system–known as VistA–has long been available as an open source download, but the VA has never before intended to incorporate outside changes to the code.

    The joint DoD and VA successor system, the iEHR, “when we get done, will be in the open source,” VA Chief Information Officer Roger Baker told reporters during an Aug. 30 call.

    The DoD and VA posted online Aug. 22 a special notice encouraging vendors “to develop or modify their potential solutions to fit into an open architecture model.”

    “If they want to be in that category of having the DoD and VA use their standard as a common standard and potentially promulgated across the country, we think a really good way to do that would be to make certain that it’s either in the public domain or in an open source vehicle with appropriate widely-available licensing,” Baker said.

    The iEHR will rely on an enterprise service bus for data portability, Baker also said. The ESB “will be the absolute heart of the EHR, because that’s how all of the various modules will plug together,” he added.

    For more:

    – go to the OSEHRA website

    – listen to the Aug. 30 Roger Baker press call

    Related Articles:

    Spotlight: VA awards contract for iEHR open source custodial agent
    iEHR will be in place 4 to 6 years from now, says Baker
    In North Chicago, a glimpse of the iEHR to come

  5. AlxHamiltn says:

    Public and Intergovernmental Affairs (Department of Veteran Affairs) Press Release

    Health Care Leaders Discuss Next Generation of Quality and Value Metrics

    September 28, 2011

    Health Care Leaders Discuss

    Next Generation of Quality and Value Metrics

    WASHINGTON – Top health care industry leaders from around the country joined for a two-day roundtable discussion about the next generation of health care quality and value metrics. The meeting allowed leaders to compare and contrast how they use metrics to enhance quality of care and value for patients.

    “We greatly appreciate the time, commitment and expertise of these health care leaders, who shared thoughtful and powerful insights on how to better measure quality, safety and performance,” said Secretary of Veterans Affairs Eric K. Shinseki. “I believe strategic partnerships with our health care colleagues, public and private, are invaluable.”

    Harvey V. Fineberg, MD, PhD, president of the Institute of Medicine and former provost of Harvard University, moderated the discussion. The meeting created a dialogue across major health care systems in order to work toward two primary goals: to identify the next generation of performance metrics to assess population health, patient experience and health care value, and to explore opportunities to develop and use these new measures.

    Last year, VA launched its ASPIRE for Quality initiative, aimed at making data and outcome information available to the public in such areas as inpatient and ambulatory care, prevention, and chronic disease. More information on ASPIRE is available at

    Attendees Included:

    · Eric K. Shinseki, Secretary, Department of Veterans Affairs

    · Harvey V. Fineberg, MD, PhD, President of the Institute of Medicine

    · Brian Alexander, MD, MPH, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School

    · Helen Burstin, MD, MPH, Senior Vice President for Performance Measures, National Quality Forum

    · Francis J. Crosson, MD, Senior Fellow, Kaiser Permanente Institute for Health Policy

    · Douglas Eby, MD, MPH, Vice President of Medical Services for Southcentral Foundation, Alaska Native Medical Center

    · Richard J. Gilfillan, MD, Acting Director of the Center for Medicare and Medicaid Innovation

    · Lt. Gen. Charles B. Green, MD, Surgeon General of the Air Force

    · Ashish Jha, MD, MPH, Associate Professor of Health Policy at the Harvard School of Public Health; Associate Professor of Medicine at Harvard Medical School

    · Thomas Lee, MD, Network President, Partners Healthcare System Inc.

    · Elizabeth A McGlynn, PhD, Director of the Kaiser Permanente Center for Effectiveness and Safety Research

    · David B. Pryor, MD, Chief Medical Officer, Ascension Health

    · Stephen Swensen, MD, Mayo Clinic Director of Quality

    · Robert Petzel, MD, VA Under Secretary for Health

    · Robert Jesse, MD, PhD, VA Principal Deputy Under Secretary for Health

    · William E. Duncan, MD, PhD, VA Associate Deputy Under Secretary for Health for Quality and Safety

    · Peter Almenoff, MD, VA Assistant Deputy Under Secretary for Health for Quality and Safety

    # # #

  6. AlxHamiltn says:


    Top News

    DHS picks CGI to provide cloud Web services

    Interior to start over for cloud email with a RFI

    VA to slow-roll use of smartphones, tablets on network

    Thursday – 9/29/2011, 6:58am ET

    By Jason Miller

    Jason Miller, executive editor, Federal News Radio

    The Veterans Affairs Department is on track to open up its network to employees using smartphone and tablet devices starting Monday. But Roger Baker, VA’s assistant secretary for information technology and chief information officer, tried to tamp down the excitement — at least for a little while.

    “We may have set some level of expectations from our users they all will be able to go out and get one next Monday, but the fact is there still will be a bar set for the performance of your duties,” said Baker during his weekly call with reporters about VA’s data breach report. “And if not, then like anything else, it’s an investment.”

    Still, VA expects to issue about 1,000 devices — mostly Apple iPhones and iPads — over the next year.

    “We will limit growth initially to make certain there is actually a bona fide business requirement for the mobile device before the government acquires the device and provides it to the individual,” Baker said. “We also will require a trade in. In other words, you can’t acquire one of the new mobile devices unless you give up your BlackBerry or your laptop. In other words, if you were a mobile user before, you have a pretty good case why you would want to be a mobile user with a different device going forward.”

    Baker wouldn’t confirm Apple is the product of choice, but he said earlier this yearit would be the popular devices.

    Currently, 17,000 VA employees have BlackBerry devices, and Baker said his office will pay close attention to how the first 1,000 employees with new smartphones and tablets are meeting the agency’s mission goals.

    “At this introduction point, it’s not going to have dramatic effect,” Baker said. “For what you can do with it right now, it’s only somewhat more useable than the other mobile devices we’ve had in our infrastructure. It will have the same level of encryption, but you will be able to access our information gateway that is more view-able.”

    How to pay for devices?

    Over the next few days, Baker said there still are a couple of issues he’s wrestling with and that may be one reason for the slower rollout.

    Baker said he has to figure out where the money comes from to pay for the smartphone or tablet devices. But the way VA classifies laptops is an example of why the decision is complicated, he said.

    “We actually classify laptops as either medical equipment or IT equipment depending on what the use will be,” he said. “About 25 percent to a third of the laptops owned at VA are actually medical equipment and about 75 percent, then, are IT equipment. We’ve had to go through and look at — for everything we buy — the purpose for it. If it’s medical, then it’s bought out of the medical appropriation. If it’s IT, then it’s bought out of the IT appropriation.”

    Baker says he will make that decision this week. Currently VA has not set up an enterprisewide contract to buy smartphone or tablet devices.

    While the initial roll out will be slow, Baker expects both the demand and the devices’ usefulness to increase over the next year.

    VA also plans to set up an apps store to host internally and externally developed software.

    “Right now there are a number of apps relative to medical care that are in various stages of development,” Baker said. “None of them yet are ready for roll out across the enterprise. They have to do with everything from a version of CPRS, our clinician interface, that’s built specifically for mobile devices to things that allow clinicians to look at various statistics for either their facility or their portfolio of patients.”

    Baker said the plan for an apps store is part of the reason VA recently decided to take its electronic health record, VISTA, to open source.

    Email and information viewing

    In the meantime, Baker said users will be able to use the smartphone and tablet devices for two main functions: secure email and information viewing.

    “We know the email client uses FIPS 140-2 encryption. The other side is visibility, being able to view information through an information viewer from that device so no storage of information on the device,” he said. “We are being very careful not to increase our information breach exposure as we roll these things out. And frankly, that simple fact has been why it has taken so long to get to this point to be able to say that.”

    Baker said VA is paying close attention to ensuring the best security features are in place.

    “The email client has an encrypted tunnel as it exchanges information with the server,” he said. “So we made a decision relative to what email client you can use. We are making decisions relative to whether or not we will allow 3G as an access method. The major thing we are doing is deciding we are going to utilize a mobile device manager (MDM) that will enforce policies throughout VA.”

    He said if a user wants to download an unencrypted email client on to the device, the MDM would block the user from access VA data until the email client was removed.

    VA also will have strict rules for downloading apps to the device from iTunes or other libraries, Baker added.

    “We will control what software is allowed to run on these devices that are allowed to access the VA network,” he said. “Information protection is a priority in utilizing these devices. We can’t let information protection get away from us.”

  7. AlxHamiltn says:

    Healthcare Business News

    Tricare reports data breach affecting 4.9 million patients

    By Joseph Conn
    Posted: September 29, 2011 – 5:45 pm ET
    Tags: Data security, Electronic Health Records (EHR), Information Technology, Military Health, Patient privacy

    The records of about 4.9 million Military Health System patients have been breached by a contractor for the military’s Tricare Management Activity insurance carrier, according to a Tricare statement (PDF).

    Tricare reports data breach affecting 4.9 million patients

    The breach by Science Applications International Corp., McLean, Va., was reported to Tricare on Sept. 14 and involved backup tapes of a military electronic health-record system that was in use from 1992 through Sept. 7, 2011, according to the statement.

    The breached records, affecting patients who received care at San Antonio-area military treatment facilities “may include Social Security numbers, addresses and phone numbers, and some personal health data such as clinical notes, laboratory tests and prescriptions,” Tricare noted. The data includes prescriptions and results of laboratory work performed in the San Antonio area even if the patient did not receive treatment there, according to the statement. No financial information, such as credit-card or bank-account numbers, was contained in the records.

    If the current estimate of the number of affected individuals holds, the Tricare breach would top the list as the largest of the 330 most serious security breaches reported to the Office for Civil Rights at HHS since September 2009.

    “I know that an employee at SAIC reported the tapes (as) stolen,” said Austin Camacho, chief of public affairs at Tricare.

    SAIC spokesman Vernon Guidry confirmed the tapes were taken from an employee’s car while being physically transferred to an off-site storage facility in the San Antonio area as part of a routine backup operation. Guidry said the theft was being investigated by San Antonio police and U.S. Defense Department investigators.

    According to the San Antonio Police Department report, the tapes were burglarized about 8 a.m. The incident was not reported to police until nearly 4 p.m. the following day.

    Guidry said some of the personal information was encrypted, but he declined to estimate how much had been encryption-protected.

    Tricare described the risk of harm to individuals as low, stating that “retrieving the data on the tapes would require knowledge of and access to specific hardware and software and knowledge of the system and data structure.”

    SAIC has set up a toll-free call-center number for concerned individuals in the U.S.: (855) 366-0140. Those dialing from abroad can place a collect call to (952) 556-8312. Information about avoiding identity theft is available at the Federal Trade Commission’s website.

    SAIC, one of the nation’s largest defense information technology and national security contractors, also has a long history with military health IT. In 1988, SAIC was awarded a $1.01 billion, eight-year contract to modify a clinical IT system developed by the U.S. Veterans Affairs Department for Defense Department use. The resulting EHR, called the Consolidated Health Care System, was fully installed by about 1994 and remains in use at military hospitals. SAIC recently won an IT support services contract with Tricare lasting up to four years and valued at up to $53 million.

    Read more: Tricare reports data breach affecting 4.9 million patients – Healthcare business news and research | Modern Healthcare

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