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How VA's Open Source Community is Improving Veteran Health Care

Image via Jeff Cameron Collingwood/



VA is continually evolving the health care we deliver to Veterans, from enhancing treatment for Traumatic Brain Injury and Post-Traumatic Stress Disorder to enabling clinicians and patients to use mobile devices to improve care. The VA Innovation Initiative (VAi2) supports this constructive evolution by tapping the talent and expertise of individuals inside and outside of government for creative solutions and providing a method for new ideas to be evaluated, tested, and deployed.

Nearly all VA health care innovations involve patient health information and the Electronic Health Record (EHR) software that manages it. VA’s EHR, known as VistA, was designed by clinicians for clinicians and is a patient-centric system that embodies the clinical workflow processes that support VA’s models of care. In order to maintain a high rate of innovation in health care, VA must maintain a high rate of innovation with the VistA EHR.

However, VA found that VistA’s rate of improvement had slowed substantially. Its advancement depended on a limited set of VA experts, or on contract development that too often involved narrowly focused, single vendor solutions. The VistA software had grown isolated from the kind of open and collaborative development that was the original source of its outcome-enhancing effectiveness.

Recognizing that an open source software model has unleashed creativity with technologies such as operating systems and databases and broad platforms such as cloud computing, VA sought to apply this innovation-inducing model to EHR software. VAi2 sponsored an effort to create an open source, community-based approach to the enhancement of VistA and other EHR-related software.

This work led to the launch of OSEHRA, an open source custodial agent at the center of a rapidly growing community of developers, clinicians, vendors, universities, and others interested in the use, development, and enhancement of EHRs and Vista in particular. OSEHRA provides the technical infrastructure necessary to efficient collaboration, such as an openly available code repository, a process for certifying code contributions, and tools for running work groups and discussions. But more importantly, OSEHRA provides the catalyst for interested parties, including VA, to gather to develop open and common programming standards, to decide on priorities, to share informant, requirements, and software, and to both encourage convergence on topics where consistency is beneficial and to enable competition in areas where a diversity of implementations benefits the diverse health care community.

Launched about a year ago, the OSEHRA community has grown to over 1,500 members representing more than 150 organizations. It has spurred increased collaboration among the existing members of the VistA community and has drawn new interest from both users and developers attracted by the power that the open source model brings to health IT. Most importantly, the establishment of a robust open source community has already improved the rate at which VA is able to innovate with VistA and applications that enable us to advance the health care we provide to our Vets.

(Image via Jeff Cameron Collingwood/

As Senior Advisor, Mike leads VAi2 programs that tap the expertise of both industry and VA’s employee base to identify, evaluate, and deploy solutions that improve the services that VA provides to Veterans. He is also VA’s liaison to the board of directors of OSEHRA, the governing body of an open source electronic health record community. He has been involved in the commercialization of new products and technology as an executive in both startups and large companies, and as an early stage venture capital investor. Mr. O’Neill received a Bachelor’s and Master’s degree in Electrical Engineering from Virginia Tech.

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