VA Health Information Technology Sharing

White Paper

(1/1/2003)

The VA and the Veterans Health Administration (VHA) have been actively
engaged in health information and technology sharing for many years. The
following is a brief summary of some of the health information sharing
activities VHA has been engaged in over the past years and some of the
new initiatives getting underway.

**OneVA Health IT Sharing** -- The VA has a long history of information
systems and technology sharing. Since the 1960's the various
administrations and program offices within the VA have worked together
to develop and utilize Department-wide financial, logistics,
administrative, and other support systems. The Veterans Health
Administration (VHA) and its many health care facilities located across
the country make daily use of the VA payroll, accounting,
logistics/inventory, office automation, telecommunications, and many
other centralized systems that have been put in place over time. Over
the years, VHA acquired and implemented a number of information systems
for its own specific uses that have in turn become VA-wide resources,
e.g. VA National Teleconferencing System (VANTS), VA Internet/ Intranet
national web sites, VA Internet Gateways, and the VA Online BBS. Over
the past few years, VHA has also been actively collaborating with the
rest of the Department on a OneVA IT Architecture, OneVA Security, OneVA
Telecommunications WAN, and other high profile initiatives such as the
PCHS contracting vehicle, the CoreFLS and HRLink\$ financial systems
projects, and the OneVA Express Card and VA PKI pilot projects.

With regards to collaboration with other VA administrations and program
offices on health information systems in particular, there have been a
number of noteworthy efforts. These include the development and
implementation of the HINQ, AMIE, AMIE II, IBBA, Gulf War Health
Registry, and the CAPRI systems (see attachment) which primarily involve
the exchange of veterans' information between the Veterans Benefits
Administration (VBA) and Veterans Health Administration (VHA). In
addition, VHA and VBA have also formally collaborated on the delivery of
training and education for their employees using distance-learning
technology. VHA has also participated in the OneVA Master Veteran Record
(MVR) project involving the display of selected veterans' information
pulled from VBA, VHA, and NCA systems. More recently, VHA has developed
a CPRS (View Only) Interface for BVA and VBA and is actively
participating on the VBRS and CAPER projects with VBA, as well as on the
OneVA Registration & Eligibility Project.

**VA/DoD Health IT Sharing** - VA and DoD have a long history of health
information systems sharing activities going back to at least 1984 when
the Department of Defense (DoD) was provided copies of the VA
Decentralized Hospital Computer Program (DHCP) application software. A
test of the DHCP software by DOD at March Air Force Base began in
December 1984. A second test was then scheduled to begin at Fitzsimmons
Army Base in March 1986. The DoD subsequently awarded a multi-year
contract to SAIC to implement a modified version of the VA DHCP system
called the Composite Health Care System (CHCS) at all DoD heath care
facilities around the world.

In 1987, a DHCP system was installed and began to be used to track Air
Force patients at the New Mexico Federal Medical Center, where a sharing
agreement was put in place between the VA and the Air Force. This was
the first of the VA/DoD Joint Venture Sites. An Information Resources
Sharing Executive Coordinating Council was established in November 1988
by the CMD and DoD Assistant Secretary for Health Affairs to develop
action plans addressing the IRM issues at all the VA/DoD Joint Venture
Sites. There are currently seven VA/DoD Joint Ventures Sites. They
include:

> Albuquerque, New Mexico- VISN 18\
> El Paso, Texas - VISN 18\
> Las Vegas, Nevada- VISN 22\
> Anchorage, Alaska - VISN 20\
> Miami (Key West), Florida - VISN 8\
> Honolulu, Hawaii - VISN 21\
> Fairfield (Martinez), California - VISN 21

Today there are over 1000 local sharing agreements between VA/DoD health
care facilities located nearby each other. Many of these have resulted
in the need to share health information between these local facilities.

Based on an April 1991 agreement between the Deputy Secretaries for
Veterans Affairs and Defense, plans were synchronized for the
development of common standards for ensuring interoperability of data
files and systems to improve delivery of services and benefits to
veterans and active duty service members.

Also in 1991, one of VBA\'s most ambitious initiative was to have
military medical records sent directly to VA at the time a veteran is
separated from service. This proposal was sent to the Department of
Defense for their consideration. Upon approval for direct receipt of
these records, VBA will be able to greatly enhance its service to
veterans.

During FY 1992, VA continued its focus on initiatives directed at
bringing together and modernizing information systems that are currently
operating independently of one another. In an effort to improve delivery
of services and benefits to veterans and active duty service members, VA
reached agreements with the Department of Defense on the need for and
the transfer of information required to create a Master Veterans Record
which will begin upon enlistment into the military and continue until VA
burial benefits are received.

During FY 1993, an inter-organizational work group led by the Office of
Information Resources Management (OIRM) obtained an agreement on an
overall plan to achieve a Master Veteran Record (MVR). The Master
Veteran Record is intended to improve the flow of service member data
from the Department of Defense (DOD), integrate existing independent
veterans files to achieve a single account for each veteran, and improve
sharing of veteran data with sister civilian agencies. The project's
goal was to begin delivering certain service improvements to veterans as
early as 1994.

1997 - The VA, the National Personnel Records Center (NPRC), and the
Army Reserve Personnel Center undertook a joint effort to improve
information sharing between military service personnel including their
medical records. The Department of Defense (DoD) related \"benchmark\"
study on the redesign of the current information request form (Form
3101) resulted in the elimination of an antiquated batch/tape process
and accelerated responses from the NPRC on service verification
requests.

In 1998, the PacMedNet system which was developed and tested at Tripler
Hospital in Honolulu, Hawaii, successfully shared information between
multiple Composite Health Care System (CHCS) sites and the Department of
Veteran\'s Affairs VISTA System. This interim solution will be placed
into production in 1999.

In addition to the activities recorded above, at the national level
there have also been a number of other major health information system
sharing efforts initiated and/or completed over the past decade. These
include:

-   Interagency Software Integration Laboratory (ISIL)

-   Gulf War Bed Control System

-   Laboratory Data Sharing & Interoperability (LDSI)

-   TRACES Project

-   Federal Healthcare Resource Sharing (FHCRS) database

In 1999, the Government Computer-Based Patient Record (GCPR) Framework
Project was initiated. This was a complex federal healthcare IT
initiative aimed at facilitating the secure electronic exchange of
patient medical information between government health organizations,
i.e. the Department of Defense (DoD), the Indian Health Service of the
Department of Health and Human Services (HHS), and the Department of
Veterans Affairs (VA). The prototype was developed and initial systems
testing was completed in FY 2000. Development and complex testing of the
system continued through FY 2001 and nationwide implementation by the VA
was completed in FY 2002. The system finally placed into production is
now known as the Federal Health Information Exchange (FHIE) System.

More recent VA/DoD health information collaborative opportunities have
been identified and are currently underway or plan to be pursued such
as:

-   Credentialing Systems

-   Scheduling System Replacement

-   FEDS HEAL Program

-   CDR/HDR Projects

-   eHealth

-   Blood Bank Replacement

-   VA/DoD CMOP Project

-   Pharmacy Replacement Project

-   Electronic Clinical Guidelines

-   VA/DoD Joint Architecture/Standards

-   Additional VA/DoD Demo or Joint Venture Sites

There is also an evolving Health***[e]{.underline}***People (Federal)
plan calling for a joint VA and DoD effort to:

-   Improve sharing of health information,

-   Adopt common standards for architecture, data, communications,
    security, technology and software,

-   Seek joint procurements and/or building of applications, where
    appropriate,

-   Seek opportunities for sharing existing systems & technology, and

-   Explore convergence of VA & DoD health information applications
    consistent with mission requirements

# Interagency Health IT Sharing 

***Federal*** -- The level of health information sharing between the VA
and federal government agencies (non-DoD) continues to gather speed. In
the mid-1980's,

the Indian Health Service (IHS) within the Department of Health & Human
Services (HHS) began implementing the VA DHCP/VistA software in their
healthcare facilities across the country. They refer to it as the
Resource & Patient Management System (RPMS). Over the years IHS
programmers have developed a number of innovative software applications
that have been incorporated into VistA, e.g. Health Summary.

The DoD refers to their implementation of the VA DHCP/VistA system at
their healthcare facilities around the world as the Composite Health
Care System (CHCS). The Bureau of Prisons, within the Department of
Justice, also implemented the DHCP/VistA system in the 1980s but
recently replaced it with a COTS product.

The Federal Occupational Health (FOH) within the Public Health System
uses 'M' and some of the VA VistA software for part of their billing
system. There are 200-some clinics nation-wide that provide services to
various departments. They each have a system that runs MSM. Every night
those systems dial up a host and use VA Mailman to send in their data.
The Central host collects the data and bills the departments. FOH have
made data files using the VA FileMan and have written a lot of programs
and reports to go around it. The system also supports access by regional
offices for agreement management and reporting.

In FY 1993, the ***Income Verification Match (IVM) Center*** was
established in Atlanta GA, to conduct the matching of veterans' VA means
tests data contained in the VA VistA system and their Internal Revenue
Service records. This program applies to veterans whose eligibility for
VHA medical care is based on income. In FY 1996, VA had 15 computer
information-matching programs in operation with an estimated real and
cost-avoidance savings of \$527 million. During FY 1996, VA\'s Data
Integrity Board approved a new matching agreement between VA and the
Department of Health and Human Services on behalf of the Administration
for Children and Families, Texas Department of Human Services,
Pennsylvania Department of Public Welfare, Kansas Department of Social
and Rehabilitation Services, and Nebraska Department of Social Services.
The States\' public assistance programs will use the data from this
one-time computer-matching program. VA was also involved with the
Department of Health and Human Services\' Health Care Financing
Administration in collecting statistical information for determining the
value of a computer matching program that identifies and bills
third-party payers of health insurance.

VHA has been an active partner and supporter of several of the Federal
eGov initiatives, e.g. FirstGov, GovBenefits.Gov, USA Services,
e-Vitals, Consolidated Health Informatics (CHI), etc. The goal of the
CHI eGov initiative is to establish Federal health information
interoperability standards as the basis for electronic health data
transfer in all activities and projects and among all Federal agencies
and departments.

The Office of Occupational Safety and Health (OSH) maintains a web site
that provides ready access to patient safety reference materials,
training materials, and up-to-date information for VA employees, other
Federal agencies, and the general public. The Internet address for their
sites is <http://www.va.gov/vasafety> .

Finally, VHA has worked to ensure web links have been established from
the national VA and VHA Internet/Intranet web sites to other Federal
agencies' web sites that offer veterans benefits/programs and vice
versa. In particular, web links to and from all Armed Forces and
National Guard web sites have been put in place.

***State*** -- The following are examples of health information sharing
between the VA and state government agencies.

In 1994, the VA initiated an **Outreach Kiosk Pilot Project** directed
at providing information on VA benefits from locations close to the
veteran population such as shopping malls, military bases, and other
community locations. The outreach kiosks allow veterans to easily access
information on VA benefits in their local communities. Ten vendors
agreed to furnish a total of 24 kiosks to be located around the country.
Representatives at shopping centers and military bases agreed to provide
free space for installation of the kiosks. State and local governments
were also invited to participate at certain kiosk locations. The
Outreach Kiosk Pilot initiative was a prime example of Federal, State,
and local governments working together with the private sector to make a
difference in the lives of veterans and the American people in general.

During FY 1996, VA\'s Data Integrity Board approved new information
systems matching agreements between VA / VHA and the Texas Department of
Human Services, Pennsylvania Department of Public Welfare, Kansas
Department of Social and Rehabilitation Services, and Nebraska
Department of Social Services. The States\' public assistance programs
will use the data from this one-time computer-matching program.

Also, VHA has also shared its VistA healthcare information system
software with the following state healthcare systems.

-   VistA / DC Government - The Veterans Health Administration (VHA) and
    the District of Columbia (DC) government have reached an agreement
    on technology transfer with regards to the VistA / CPRS system. VHA
    is providing the latest version of VistA / CPRS software, technical
    and user manuals, all updates and patches to the VHA software, and
    limited third level help desk support. The DC applied for and
    received a grant from the Department of Commerce for contractor
    support to install the VHA system in three DC outpatient clinics.
    They are anticipating being able to report significant strides in
    delivery of health care at these sites, which they hope will lead to
    additional funding to install CPRS in all of their other sites.

-   Washington State Psychiatric Hospital System - The three state
    psychiatric hospitals in Washington state have been using VistA/DHCP
    software since 1993. They are using the following modules: Reg/ADT,
    Dietary, Lab (including OE/RR), Engineering, Mental Health (although
    greatly modified locally), and Incident Reporting. Their intention
    is to also use Police & Security, Social Work, and Nursing in the
    next 12 months - FY 2001.

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-   Western State Hospital: Tacoma (Ft. Steilacoom)

-   Child Study & Treatment Center, Tacoma

-   Eastern State Hospital, Spokane

Several other state healthcare organizations have also approached the VA
about use of the VistA software, including Texas and Oklahoma. In
particular, there are 147 State Veterans Homes in 47 states that have
the potential of utilizing the VistA system in some capacity.

Finally, VHA has also worked to establish web links from its national
Internet/Intranet web sites to both the State Health Departments and the
State Departments of Veterans Affairs and vice versa.

***Tribal*** -- In 1984, the Indian Health Service (IHS) began
implementing the VA DHCP/VistA software in its healthcare facilities
across the country. They refer to it as the Resource & Patient
Management System (RPMS). Over the years IHS programmers have developed
a number of innovative software applications that have in turn been
incorporated into the VA VistA system, e.g. Health Summary.

VHA has recently been working to establish web links from the national
VA Internet/Intranet web sites to the Tribal (Native American) Veterans
web sites and vice versa. There are over 190,000 Native American
veterans.

# Non-Government Organizations (NGO) Health IT Sharing -- 

There are a number of companies in the private sector that have obtained
copies of the public domain version of the VistA software suite from the
VA. They in turn have tailored portions of the VA software for numerous
customers and provide training, ongoing support for the systems, and
other related consulting services. Examples of some of these companies
include:

-   EDS - They provide extensive MUMPS software development and support
    services to the VA for their VistA Systems. EDS provides similar
    services to other companies in the healthcare industry.

-   Pioneer Data Systems -- This is a small \'M\' technology training
    and consulting company which has installed VistA or portions of it
    (e.g. Kernel, FileMan) in a number of companies across the country
    including a project to install an adaptation of VistA for a group of
    pharmacies in Minneapolis, MN.

-   Sea Island Systems -- This company has installed VistA or portions
    of VistA (e.g. Kernel, FileMan) in a number of private companies,
    government agencies, and independent laboratories around the
    country. Examples of clients/projects include:

    -   Abbott Laboratories Interface point-of-care glucometer
        instruments to VistA Laboratory Information System (LIS).

    -   Diagnostic Products Corporation Interface DPC Cirrus Immulite
        intrument to VistA LIS, using ASTM 1381 and 1394 standards.

    -   Harvard Health de Mexico Assist with installation and
        configuration of VistA platinum system.

    -   Kimpath Labs, Inc. Assist with installation and configuration of
        VistA Laboratory System.

    -   NextRx Corporation Develop HL7 interface between VistA Unit Dose
        Pharmacy system and NextRx.

    -   Sumter Regional Hospital to install and support patient
        scheduling and surgery information systems.

-   MedSphere VistA Systems - One of the goals of Medsphere Systems
    Corporation [www.medsphere.com](http://www.medsphere.com/) is to
    take the VistA code base to the private sector. An important part of
    their core strategy is to leverage the open-source model to reduce
    costs at technology layers where traditional providers allocate
    significant budgetary resources. MedSphere can provide VistA
    expertise in the initial configuration, setup, and deployment of
    VistA to integrated delivery networks, hospitals, clinics and
    physician offices. They offer the solution in either a hosted or
    in-house model and charge a monthly subscription fee for support,
    maintenance, and value-added services. MedSphere\'s goal is to
    provide an affordable, proven, and turn-key solution that makes it
    easier to provide better care. Clients include hospitals in American
    Samoa and South America. Medsphere is currently engaged with
    WorldVistA and other developers on the porting over of the March
    2002 FOIA release of VistA to run on GT.M on Linux.

-   Informatix Laboratories Corp. -- This company has developed a number
    of software applications specifically designed for hospitals and
    health centers utilizing the Indian Health Service RPMS or
    Department of Veterans Affairs (VISTA/DHCP) computer software. These
    include Accounts Receivable, Pharmacy, Managed Care/Contract Care,
    and other modules. \[Recently bid to install VistA in several
    hospitals in Albania\]

-   M Systems Plus - This is a small software consulting company that
    uses M technologies including both the VA & FileMan internally at M
    Systems Plus, Inc. for most of their commercial systems development.
    Historically, they have developed a complete travel (cruise booking)
    system for American Express Travel Related Services using the VistA
    software. This endeavor was written up in the \'M COMPUTING\'
    publication. They have also developed systems for the TV & appliance
    repair industry, schools, etc.

-   LaFond Systems -- This is a small company providing contract
    programming, application development, system administration and
    support services using Internet and M / Cache technologies. Clients
    include:

    -   Physicians Health Services

    -   First Options Health Plan

    -   Community Health Plan

-   Metro Computer System - Metro Computer Systems, Inc. installed CPRS
    at Metro Internal Medicine in Raleigh, NC. Metro Internal Medicine
    has been using CPRS for 19 months now. The clinic is using Progress
    Notes, entering vitals, writing outpatient medication orders,
    entering problem list, entering encounters through PCE. They are
    also using Registration and Scheduling. Checking in and Checking out
    of the patient is also done. MCS Inc. is determined to install the
    FOIA VISTA Systems to all interested private doctor\'s offices and
    all private medical hospitals. They are installing from Kernel,FM,
    MAS, Laboratory, Pharmacy, CPRS, Radiology, Surgery, and all other
    software included in FOIA VISTA. MCS tries to make as little
    modification as possible to VISTA when installing it.

-   VistA Hardhats - An organization and web site dedicated to fostering
    a virtual community for the worldwide users of the VISTA (DHCP)
    software. Copies of public domain and OpenSource versions of the
    VistA software can be downloaded from this site along with other
    software tools. [www.hardhats.org](http://www.hardhats.org/)

-   VHA has recently been working to establish web links from the
    national VA Internet/Intranet web sites to the Veterans Service
    Organizations (VSO) web sites and vice versa. VHA has also
    established web links to and from all of the 107 Affiliated Medical
    Schools across the country.

-   VHA is also actively participating in national and international
    Standards Organizations, e.g. HL7, ASTM, OMG, ANSI, HISB, and US TAG
    ISO.

-   Global/International Health IT Sharing - Over the year the public
    domain version of the VA VistA software has been acquired and
    implemented by organizations around the world. The system has been
    translated into various foreign languages such as German, Finnish,
    French, Spanish, Arabic, and Portuguese. The following are some
    examples of where the VA VistA software is used.

    -   VistA Finland @ University of Kuopio - The University of Kuopio,
        Finland, has ordered Vista public domain software regularly
        (i.e. FileMan, MailMan, Kernel and Broker) and has modified it
        for the Finnish environment (language, character set, date
        format). This modified version is widely used in Finnish
        hospitals. The Student Administration System, Publication System
        and many minor systems in our university (University of Kuopio)
        is based on Finnish version of FileMan, MailMan, Kernel and
        Broker. The VA VistA software technology is used extensively
        within the MUSTI Hospital Information System in Finland.

    -   VistA Egypt - The Cairo Health Organization, under the Egyptian
        Ministry of Health, has implemented an Arabic version of the VA
        VistA health information system at four of its large hospitals.
        This was sponsored by the U.S. AID agency and the prime
        contractor employed was Maximus. VistA modules implemented
        include: ADT, Pharmacy, and Laboratory.

    -   VistA Pakistan - VistA was installed in the Shaukat Khanum
        Memorial Cancer Hospital in Lahore Pakistan in 1997. Admission,
        Discharge, Transfer (ADT), Scheduling, the KERNEL (Public Domain
        Version), and VA FileMan were implemented. Locally developed
        applications, Laboratory, and OutPatient Pharmacy modules were
        also developed and implemented. The system was recently replaced
        by a commercial (COTS) system.

    -   VistA Nigeria - University Teaching Hospital - The VA VistA
        software (i.e. FileMan, MailMan and the Kernel) has been
        modified for the Nigerian environment (date format, character
        set). Staff from the University of Kuopio in Finland have
        partnered with Nigeria to jointly produce a Hospital Information
        System using the public domain Admission-Discharge-Transfer
        package of the U.S. Department of Veterans Affairs (then
        Veterans Administration, VA) as a basis. The system has been in
        operation in one of the hospital units of the Obafemi Awolowo
        University Teaching Hospitals since January 1991 and in the
        other hospital unit since January 1995. The software technology
        is the same as in the MUSTI Hospital Information System in
        Finland. The Nigeria National Health Plan of 1996 aims at the
        majority of the over twenty teaching and specialist hospitals
        having a computer-based Hospital Information System by the
        year 2001. This software used in the Obafemi Awolowo University
        Teaching Hospitals in Nigeria will soon be sold to their
        customers.

-   National Cancer Institute of Egypt - In 1990 a Project was launched
    to implement a HMIS at the National Cancer Institute, Cairo
    University (NCI-CU). NCI-CU is the leading Cancer centre in Egypt,
    delivering cancer care for about 12,000 new cancer cases every year,
    more than half free of charge. They are now upgrading all system
    modules to the current versions and using CPRS and plan to use
    Imaging also. DHCP (VISTA) was adopted as the Health Information
    System. Customization and Arabization of many parts of VISTA was
    achieved inhouse, with cooperation from VA staff and the University
    of Wurzburg Germany. Applications customized, converted to Arabic
    and used included: Registration, ADT, Surgery, Lab, Pharmacy,
    Radiology, Record Tracking, Nursing, Engineering, and a test of the
    Imaging module.

    -   LBJ Tropical Medicine Hospital - Mele Corporation has recently
        installed VISTA in American Samoa at the LBJ Tropical Medicine
        Hospital. The company also provides professional services and
        support to DoD/VA's telemedicine program in Honolulu, Hawaii.

    -   Post Doctoral Training in VistA - VISTA is used as basis for
        postdoctoral training in Medical Informatics at the Akademie
        fuer Aerztliche Fortbildung in Bad Nauheim (State of Hessen,
        Germany). The training is over one year.

    -   German Heart Institute - The German Heart Institute
        (www.DHZB.de) in Berlin specializes in cardio-thoracic surgery
        and cardiology. In 1992 it started adding DHCP modules to its
        existing M-based Hospital Information System. The VA KERNEL
        became the framework for its Hospital Information System. The
        hospital is now running Lab, Record Tracking, Parts of Blood
        Bank, and Anatomic Pathology, in addition to
        internally-developed applications using FileMan and ScreenMan.
        Latest developments include GUI-applications.

-   Composite Health Care System (CHCS I) - CHCS I is the Composite
    Health Care System installed at most DoD health care facilities
    around the world primarily supported by SAIC. Much of the CHCS
    system is based on VA VistA software.

    -   Church Convention Management System - The Catholic and Lutheran
        church have big conventions taking place every other year in a
        different city in Germany. Attendance for these Five-Day-Events
        is normally more than 100,000 people. Both organizations have
        adopted VISTA based software for the management of registration,
        accommodation, exhibition planning, billing and event
        management. They will have a joint convention in Berlin 2003
        that will be supported by the VISTA software.

    -   TVD-Verlag - TVD-Verlag in Düsseldorf is a small publishing
        house in Germany that has developed a complete application for
        the management of music rights (lyrics and music) based on the
        VISTA Toolset (KERNEL, FileMan).

    -   The Pacific Telehealth & Technology Hui conducts research,
        develops prototypes, demonstrates, tests, evaluates, validates,
        then disseminates and institutionalizes telehealth applications
        in support of the health and medical needs of beneficiaries in
        the Pacific. The Hui then works to make these technologies and
        systems available to other federal, public, and private
        organizations through its emerging technology transfer program.
        The LBJ Tropical Medical Center in American Samoa and the
        Pacific Telehealth and Technology Hui have initiated a project
        to install specific modules of the VA\'s VistA clinical
        information system at the LBJ TMC that are appropriate to their
        needs. Since the population of American Samoa includes a
        significant segment of veterans, the VAM&ROC Honolulu identified
        a need to have the capability to collect and track information
        on the veterans\' healthcare needs and services. In addition to
        Samoa, there are veterans living in many other island nations in
        the Pacific that are also interested in using the VA VistA
        system.

VHA is also monitoring the growing global movement toward Open Source
software. This includes the activities of the Open Source Health Care
Software Alliance, WorldVistA, the Spirit Project, MedSphere, etc.

-   The Open Source Health Care Alliance
    [www.oshca.org](http://www.oshca.org/) is a collaborative forum to
    promote and facilitate the development and use of open source
    software in healthcare. OSHCA is a community of people in the health
    care and informatics industries that promotes the open source
    software concept in health care. OSHCA helps policy makers,
    commercial enterprises, and users take advantage of the benefits of
    open source. (Link to [www.oshca.org](http://www.oshca.org/) ) In
    the public and private healthcare sectors, Open Source software is
    just now emerging as a significant trend with hundreds of health
    care open source software applications in development
    internationally and many applications being successfully deployed in
    domestic United States health care market segments. The recent
    growth of the Open Source software movement has been fueled by the
    World Wide Web and Internet technology, which allows for global
    collaboration in the development of complex software and operating
    systems (e.g., Apache, Linux, etc.) and numerous applications across
    all industries.

-   WorldVistA [www.worldvista.org](http://www.worldvista.org/) is a
    non-profit organization incorporated in California with the mission
    of furthering the cause of affordable health care information
    technology worldwide. Current efforts are targeted to championing
    the use of the Department of Veterans Affairs (VA) health
    information system in healthcare organizations external to the VA.
    This VA health information system is known as VistA and is a suite
    of clinical software applications available in the public domain.
    Part of what WorldVistA hopes to achieve is to act as a coordination
    point for work on the public domain VistA software done outside the
    VA, to ensure that all such software changes are available under an
    appropriate open-source license, and to feed bug fixes and
    enhancements back to the VA for consideration for inclusion in the
    VA\'s VistA system. The goal is to help establish an open source
    community of interest associated with the VistA system and to help
    bring together a critical mass of needed developers and users.

In FY 2002, VHA began to analyze the benefits and risks of using the
Federal Health Information Exchange (FHIE) framework to exchange
patient-specific electronic medical records with regional networks,
particularly in Indianapolis and Santa Barbara. As approximately 40% of
veterans treated in VHA facilities receive some of their medical care
from non-VA providers, the ability to quickly and safely share records
will benefit both the veteran and the medical facility. This is part of
the long range VA Health*e*People strategy.

Finally, VHA is also actively participating in national and
international Standards Organizations, e.g. HL7, ASTM, OMG, ANSI, HISB,
and US TAG ISO.