OSEHRA 

Open Innovation For Health IT

Conrad Clyburn

Community Development

Arlington, VA

Clyburnc@osehra.org
Custodial Agent

• 501-C-6 Not for Profit Organization

• As a result of agreement between DoD and VA

• Independent Board of Directors

• Operations of an OS Electronic Health Records 

(EHR) Software Development Ecosystem – Membership Organization 

• Developers

• Users

• Vendors and 

• Service providers. 

2

OS

Ecosystem

OS Software

Currency
Open Source Software

Principles

• The freedom 

– to run the software for any 

purpose.

– to study and modify the 

software.

– to copy the software

– to improve the software.

Benefits

• Promote 

– Continuous Refresh of Code

– Continuous Quality Improvement

– Plug and Play Apps Model

– Disciplined Documentation

– Standards

– New Business Models

• Avoid Vendor Lock-in

3

OSEHRA COMMUNITY ACTIVITY
License: Apache 2.0

• The code is protected by copyright.

• The code can be used in closed source projects.

• The code can be included in projects with more restrictive 

licenses.

• Program that use it can be sold and licensed commercially.

• Derivative works need not be released.

• Provides a low entry path for contributors to add to the 

code base.

4
OSEHRA Development Tools

5

Software

Repository

Build, Test

& Package Community

Review

Developers

& Users

Web Site

Git Repositories

Software Quality and

Certification Dashboard

... + Mirrors

Gerrit Code Review Site

Technical 

Journal

Educational Resources
6

GOV (VA, HHS, DoD) OS:

Museum Model 

OSEHRA Activity

Changes and Improvements w/Community Participation Always Current, 

Reusable Components,

Efficient Tools Solution Providers

Improvements

Commercial 

Activity
12/21/2012 7

Certification 

Product Certification

Automated 

Processes 

Meaningful Use

Security and 

Ops 

Certification

Global OS-EHR 

Certification

IT Product

Development

VistA

AHLTA

PHR

Web Services

Mobile Health Plug and Play

One-Stop 

Complete APPs 

Inventory

Production

Platform

Code Repository

Bug-Doc

Version

Control

Configuration

Management

Fully Automatic 

Self-Service

R&D 

Community 

Work Groups

Architecture

Product Def

Concept Dev

VA /DOD/GOV

 Academics

International

PCMH, ACO 

New Delivery 

Models

10,000 

membership

Market

Stimulation

VA/DoD/IHS

NIST/ONC/NIH

Contract Driven

Product Driven

New Comers 

Foreign GOV

OS Inspired

10% Health IT HIT market share

VistA

AHLTA

OSEHRA Functions for Rapid Open Innovations for Health IT OS-Health IT

7
Code Contribution-Acceptance

How does OSEHRA manage the code?

OS Certification

Steady State

Initial

Submission

• Licensing

• Ownership

• Contribution Agreement

• Dependencies to Proprietary

• Apply Apache 2.0

Documentation:

Requirements, Code, Testing

Maintenance, Users Manual, Tutorial,

• Testing, Testing Suites

• S/W Quality Assurance

• Unit Testing

• Functional Testing

8

Performance Testing

Security Testing

FDA Clearance

External to

OSEHRA
Who is in charge?

• Critical Core Issues

– Benevolent Dictator/Oligarchy 

– (Sponsor and a respected community leader)

• Technical Issues

– Meritocracy- Best Solution

– Community Enforcement

• Business Issues_ Emerging Business Models

– Open Competition – Best Service

– It is no longer product driven business

– Android, Apple, Nokia and others as examples
10

2012 Work Groups by OSEHRA Core Functions

Development Strategy by Enabling the Community WG’s

VistA Code

(EHR)

Innovation

Modules

Health IT

Interoperability

iEHR

Certification Product • Meaningful Use 

Certification

• Scheduling Competition

• Certification

• Interoperabili

ty Testing

Product Development • Architecture 

• Code Convergence

• FileMan Convergence

• Drug File/Pharmacy

• Web Services

• Refactoring

• Lab Modules

• Roll and Scroll

• UI Extension

• M-Health

• PHR - Blue Button

• Patient Centered

Care

• Genomics

• Imaging

• Architecture

• VLER

Production Platform • Development Tools

• SKIDS

• Comparison Tools

How to work with OSEHRA?

Join the work groups!

Develop a workgroup!
11

VOLDEMORT Ray Group OSEHR Github Repository

pyVistA Caregraf OSEHR Github Repository

RASR Ray Group OSEHR Github Repository

RPMS Indian Health Services OSEHRA gets it from Pub Site

AHLTA-T DoD OSEHRA Github Repository

Medical Domain Web Services (MDWS) VA OSEHRA Technical Journal

Appointment Postcard / Notification Letter v4.0 VA OSEHRA Technical Journal

Scheduling Package Refactoring API Ray Group OSEHRA Technical Journal

Surgical Quality Workflow Manager (SQWM) Phase 1 VA OSEHRA Technical Journal

Problem List Refactoring Ray Group OSEHRA Technical Journal

Janus 4.0 Hawaii Research Group OSEHRA Technical Journal

HealtheMe – Health and Wellness Management System KRM OSEHRA Technical Journal

Anonymizer Functions Air Force OSEHRA Technical Journal

VistA M Routine Analyzer Ray Group OSEHRA Technical Journal

Computerized Patient Record System v29 VA OSEHRA Technical Journal

Converter from Cache to GT.M VA OSEHRA Technical Journal

EWD: A web application framework for GT.M and Cache M/Gateway Developments Ltd. OSEHRA Technical Journal

Identity Functions - FASC-N Library Air Force OSEHRA Technical Journal

Submitted Codes
Community Based OS Projects I

Gold Disk for VA

• 20 core modules

• OSEHRA Certified

• Code Improvements

• Standardized 

Implementation for the 

Enterprise

• Foundation for Enterprisewide Improvements

Code Conversions

• Code bases managed and 

improved on by many 

organization: VA, IHS, 

Private Sector

• Common Core of converged 

code

• CHCS is VistA Code

• Improve the efficiency of 

code base management
Community Based OS Projects II

AHLTA-Open

• AHLTA Theatre Version

• Rich Collection of Modules 

for Theatre Applications

• Undergoing Preparation for 

OSEHRA Certification

• Will soon be available for 

anyone’s use or commercial 

activities

Common Web Services

• Various approaches in Web 

Services have been 

developed

– JANUS

– MDWS

– EDW

– Others
Community Based OS Projects III

Personal Health Records

• VA developed Blue Button

– Open Source

• KRM Developed HealtheMe

– Open Source

• VA developed MDWS

– Open Source

• Community Based Project 

for Blue Button for America

– Open Source

Mobile Health: Preparation 

• Deployment of mobile 

computing platform

• Theater Application 

• Clinical Trial Application

• VA application

• A Major International 

Android Vendor

• Security Organization
Community Based OS Projects IV

Scheduling Module Competition

• RFI Last January

• Open Source Compatibility

Certification by OSEHRA

• API Applications

• RFP Soon To Be Announced

Other Innovation WG

• Refactoring

– API’s

• Architecture

• Genomics

• Data Warehouse

• Registries

• Imaging
12/21/2012 16

OSEHRA

Corporations Fed Agencies Academics

VistA

RPMS AHLTA

Innovation: 

Refactoring

CL-3, Ext, InFlt

DoD Joint/Common iEHR VA

Open Source iEHR

Notional Open Source Innovation Pathways for iEHR

IHS, NIH, HHS, NIST
OSEHRA Annual Summit

October 17-18, 2012

National Harbor

munsk@oshera.org
2012 Summit and Workshop

• Open Source: Institutionalized Permanently

• Increasing Interests in OS from Many Quarters

• Emerging Vibrant Collaborative Community 

• Diversity of Activities

• Power of Innovation will Overcome the 

Challenges

• Strategic (Collaborative) Priority to Emerge

• Seeking Community (all of us) Roadmap

18

OSEHRA Business 

• OSEHRA is a OS facilitator.

• OSEHRA promotes OS activities.

– New Businesses are Emerging.

– New Markets are Emerging – State Level

• OSEHRA does not compete with its community 

members.

• OSEHRA wants members to make money by 

offering the best services with the best OS 

products.

• OSEHRA lowers barriers of entry and the risks.
21

1,500 Members
Agility and Open Source

Cultural Change

• Agile Acquisition

• Agile Management

• Agile Development

Tools for Agility

• Transparency

– Process

– Products

• Open Development 

Environment

• Real Time Collaboration

• Community Establishment 

and Participation

Open Source Software: 

Currency for Agility

Excellence in PM- Uncompromised

• Disciplined Documentation

• Continuous scrutiny for Quality

• Milestones and Schedule
Open Source in Practice: We are not 

alone!

Hard Ware (Engine) based industry

Cannot keep up with Customer Demands

Cost of software exponentially increasing

Car/Air Craft Companies threatened by

Information and Entertainment Industry:

Apple and Google

Difficult to Manage Version Control

Difficulties in SW support for 20-50 years.

Help!
OSEHRA Strategic Priority

Community Involvement Sought

1. Joint community effort to overcome barriers in 

Open Source: Expand the Market

2. Common Code Base with Modular Capabilities

3. Vibrant Community with more Developers

4. More Software Development Tools and Tests

5. Voluntary Standard Setting Body and Facilitator

24
Innovation Agent

Open Source on the Move

Great Hurdle

25

Open Source Software:

“Persistent Wind of Innovation”

Gen James Peake, MD

Chairman for the Board

Ready for a long run

With OS Community

Join the movement.

Governance

Vision

Process

Tools

IT Infrastructure

Repository
http://www.osehra.org