Open source VistA EHR: On again, off again, partly on again

CMS has released an evaluation of the Veterans Administration electronic health record (EHR) software. From the press release:

The evaluation version will be distributed by qualified vendors and evaluated for usability, effectiveness, implementation and potential for what is known as interoperability, or the ability to communicate, exchange, and use data with other systems and software. As a result of this evaluation, software vendors will be able to further improve the software and develop a version of VistA-Office EHR that is certified in accordance with a process recognized by the Department of Health and Human Services (HHS).

The press release isn’t too exciting and doesn’t promise when the software will be ready for widespread use. It also goes out of its way to point out that the software itself won’t be completely free, and that offices will need all the hardware, support, and maintenance they’d need for any other system.

The communications about the software’s release date have been confusing and not confidence inspiring. See here and here. I don’t expect this EHR to have any substantial impact on adoption or affordability.

September 20, 2005

6 thoughts on “Open source VistA EHR: On again, off again, partly on again”

  1. VistaA might work for some mid-tier hospitals, but the public thinks that private practices will have access to free software. I can not see that an institutionally based EHR system can work in a small physician practice.

    This effort appears to be a political event, devoid of any real benefit.

  2. Streeter, I agree with you that this appears to be a political event. Here’s a quote from the press release that supports your point:

    “The President has set a national goal for most Americans to have an electronic health record within a decade, and CMS is working with providers to make that happen,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process. When fully realized, electronic health record software will help physicians improve health care quality while avoiding unnecessary costs.”

  3. Hi,

    There is a much fuller story here that is being ignored. CMS is being very smart to postpone, because it needs to be good. My name is Fred Trotter and I am the project manager for ClearHealth and I am a medical software activist, mostly regarding the morality of licenses. You can read about that at

    I am working to make ClearHealth (which is the only other live open source practice management system and EHR, besides VistA, that is running practices live in the US) a sister project to OpenVistA which is supported by WorldVistA and MedShere support. You might want to follow the link for WorldVista until you find the hardhats mailing list, which is where you can find up-to-the-second info on VistA.

    It is important to remember that Vista and VistaOffice by extension, are open source projects. They are created by a a team of distributed coders. The Open Source software development method means that it will be ready when its ready. But when its ready it will be good.

    Further it will be possible to use VistA without paying any licensing fees, it will depend of which version of M you decide to use. (there is one you have to pay for, but an excellent open source alternative exists).

    As for paying for support… the current situation with proprietary vendor support is much worse, but because of the open source license there will be competition for support, which means the price will come down. The vendor lock-in that you have with proprietary companies keeps support costs unreasonably high.

    CMS has choosen, I think foolishly, to market their system as “free” as opposed to open source, which is where the real benifit lies. Still more and more people are realizing that open source is the right model for EHR and practice management software. You can read about that at

    Fred Trotter

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