WorldVistA

WorldVistA is an open source implementation of the Veteran Administration's Electronic Health Record system intended for use in health care facilities outside the VA.

Background

The US Veterans Administration developed the most widely distributed electronic health record used in the US, the Veterans Health Information Systems and Technology Architecture (VistA). In an effort to make the system widely available to institutions outside the Veterans Administration health system, the software code was placed in the Public Domain under the Freedom of Information Act.

The foundation for the WorldVistA EHR was formed to extend and collaboratively improve the VistA electronic health record and health information system for use outside of its original setting. It was originally developed as part of the VistA-Office project, a collaborative effort funded by the United States Centers for Medicare and Medicaid Services (CMS), an agency of the US Department of Health and Human Services (DHHS).

WorldVistA EHR VOE/ 1.0 is based on and compatible with the U.S. Department of Veterans Affairs (VA) world-renowned EHR, Veterans Health Information Systems and Technology Architecture (VistA). A fully open-source (GPL v2 licensed) project, WorldVistA has also developed software modules (such as pediatrics, obstetrics, and other functions) not used in the veterans' healthcare setting.

In 2006, WorldVistA EHR VOE/ 1.0 was the only open source EHR that met Certification Commission for Healthcare Information Technology (CCHITSM) ambulatory electronic health record (EHR) criteria, and in January 2008, it was released with full CCHITSM EHR.

As a free product developed in co-operation with the US government, WorldVistA is not marketed in a similar fashion to commercial EHRs.

Core VistA functions

• patient registration
• clinical reminders for chronic disease management
• clinical order entry
• progress note templates
• results reporting

Customizable functions

The structure of WorldVistA is modular, and a wide variety of customization is possible. Because it is fully open source, this can be done without restriction (although CCHIT certification is granted only to the officially maintained package).

• ability to interface to existing practice management / billing systems, lab services and other applications
• scanning and inclusion of scanned documents into the medical record
• prescription finishing and faxing
• clinical quality measure reporting capabilities
• support for disease management, using clinical reminders
• templates for obstetrics/gynecology (OB/GYN) and pediatrics care

Server platforms

For Linux-based servers, WorldVistA server uses the (free open source) Fidelity GT.M MUMPS database, available as an integrated package along with WorldVistA Server. This software is part of the VistA Public Domain software, and does not require licensing.

For Windows-based servers, WorldVistA can be implemented used the commercial Caché MUMPS database, which requires a database license and software from Intersystems Corporation.

For Mac OS-X-based servers, a development effort to port GT.M (and the Server software) to that platform has begun.

Client platforms

The Client software is an implementation of CPRS, which is Windows-based. This allows Windows terminals to access the central server database. This software is part of the VistA Public Domain software, and does not require licensing.

For Linux terminals, CPRS can be run as a Wine package or from within a virtual machine.

A separate (Windows-based) module is available to capture and view vital signs as well as graphing of other clinical data. This is meant to be used on client terminals.

A separate (Windows-based) module allows the scanning, capture and integration of paper documents as part of an individuals medical record. It can also be used to add a variety of non-diagnostic quality images to the medical record. This is meant to be used on client terminals.

Development history

WorldVistA is developed by a series of physicians (and other medical professionals) and software professionals that donate their efforts as volunteers. This group loosely referred to themselves as Hardhats (and continues to do so) before the name of the project was officially changed to WorldVistA.

WorldVistA has developed and distributes a "toaster" version of VistA, which is a self-contained software package that integrates both the MUMPS database (GT.M version) and the VistA software.

In 2009, the self-installing Linux toaster version was enhanced with a GUI-based patient registration module, web interface, and other enhancements, and incorporated into a self-installing package for both Debian/Ubuntu and Red Hat Linux. This freely available version of WorldVistA is known as Astronaut VistA. This version is packaged with both an enhanced GUI as well as a web interface (which allows connection through an intranet or through the Internet). An introduction to this package is here in a PDF slide presentation.

A similar package for Windows-based servers is in alpha (early development) stage.

Grants opportunities to help further development

• NIH grants -- Supported by the American Recovery & Reinvestment Act of 2009 (ARRA), NIH grants can be used efforts to further technology that advances the goals of the NIH
• Robert Woods Johnson Foundation -- This foundation has a goal of helping integrate personal access to electronic health records nationwide, similar to the VA's HealtheVet project.

Adoption

• Clinica Adelante implemented the open source version of VistA for its 30,000 member community health clinic, and has testified before the US Congress regarding its success.
• Oroville Hospital is installing the WorldVistA version into a co-ordinated hospital and clinic system.

External links

• - Home of the WorldVistA EHR
• - a WorldVistA user community
• - Tips for installation of the Astronaut WorldVistA server on Ubuntu/Kubuntu Linux (from Ubuntu Doctors Guild)