Frequently Asked Questions (FAQ)
1.0 About the Open Source Electronic Health Record Alliance (OSEHRA)
1.1 What is OSEHRA?
OSEHRA is a non-profit corporation that advances open source electronic health record software and related health information technology to offer the best possible products at the lowest possible costs.
1.2 What is the Mission of OSEHRA?
"Build and support an open source community of users, developers, service providers, and researchers engaged in advancing electronic health record software and related health information technology."
1.3 What does OSEHRA do?
OSEHRA facilitates community-based open source software development, market stimulation and education. It provides a powerful platform and infrastructure repository for software development and distribution. Members of the OSEHRA community openly collaborate on a full range of planning, development, and deployment activities. In support of the community, OSEHRA offers Open Source Software Quality Certification and testing services to improve the quality and usability of submitted code.
1.4 How does OSEHRA operate?
OSEHRA is a 501(c)(6) non-profit corporation. This is a type of non-profit structure often used for professional associations. The members (see 2.0 below) comprise and govern the organization in accordance with the by-laws of the corporation. OSEHRA is funded by a combination of membership dues and income from open source contract work for the Department of Veterans Affairs (VA).
1.5 How did OSEHRA originate?
The Department of Veterans Affairs (VA) Office of Information & Technology (OI&T) is responsible for the development and maintenance of the Veterans Health Information Systems and Technology Architecture (VistA), VA’s electronic health record (EHR). VistA is built from more than 100 discrete applications that together comprise our highly integrated and fully-automated health information system. VistA is the electronic information service that enables clinical care delivery at 152 VA health care facilities and 928 ambulatory care and community-based outpatient clinics worldwide.
By 2010, VA recognized that VistA’s rate of innovation and improvement had slowed substantially, and the codebase was unnecessarily isolated from private sector components, technology, and outcome-improving impact. To address those issues, VA established OSEHRA, the mechanism that to open the aperture to broadly-based public and private sector contributions.
1.6 When did OSEHRA become established?
VA issued a request for proposal (RFP) on April 22, 2011 to competitively select an organization and management team to establish an open source agent as a non-profit independent entity. In June 2011, VA selected the proposal submitted by a consortium led by a small business. A new independent OSEHRA was established as a Delaware registered 501(c)(6) doing business in Arlington, Virginia. Dr. Seong K. Mun was selected as the founding President and CEO; Lieutenant General (US Army, Retired) James Peake, MD, the 16th Secretary of Department of Veterans Affairs, was chosen as the founding Chair of the Board of Directors.
2.0 OSEHRA Membership
2.1 Who can become a member of OSEHRA?
Anyone interested in the advancement of electronic health reconds and health IT.
2.2 What are the different types of membership?
OSEHRA offers Individual, Corporate, and Collaborative Partner memberships:
- Individual Membership
An individual can participate in the OSEHRA community either as an Associate or General Member. Associate Membership is free to any individual; it allows access to web site content and participation in discussion groups, working groups or open source projects. General members have these privileges, plus voting rights in OSEHRA governance and discounts on designated OSEHRA events, including the annual Open Source Summit.
- Corporate Membership
Organizations are encouraged to join and participate in the OSEHRA community. OSEHRA Corporate Members have a voice in the strategic direction of OSEHRA, OSEHRA VistA and open source EHRs. Each corporate member is invited to attend quarterly OSEHRA strategy meetings and to appoint a representative to vote on behalf of the organization at the annual member meeting.
- Collaborative Partnership
In some cases, an organization may not be able to execute the Corporate Membership Agreement for legal reasons (e.g., some Federal government agencies cannot participate as members of a 501(c)(6) organization). The Collaborative Partnership was designed to allow such agencies to participate fully in the OSEHRA community. The only significant difference between this type of membership and Corporate Membership is that Collaborative Partners do not pay dues and do not vote as members of the OSEHRA Corporation.
2.3 How much does membership cost?
Associate Membership does not require dues. The annual dues for General Membership are $90. Annual dues for Corporate Membership vary, based upon the annual revenue of the member’s organization. Collaborative Partners do not pay annual dues.
2.4 Do I have to be a member to join an OSEHRA work group?
2.5 Do I have to be a member to access or submit code?
No. OSEHRA encourages the open source community to collaborate on code. However, further resources may be available to you as a member.
3.0 About OSEHRA Software
3.1 What types of software does OSEHRA manage?
There are four types of software that OSEHRA manages:
- FOIA-released public domain VistA.
- A VistA-based electronic health record platform called OSEHRA VistA.
- VistA-related products or software.
- Non-VistA health IT products or software.
3.2 What is VistA?
Veterans Health Information Systems and Technology Architecture (VistA) is the electronic health record (EHR) software that is used to operate Veterans Health Administration (VHA) facilities. VA Enterprise VistA contains all the following resources needed to operate a VA medical center:
- The software code -- written in M (MUMPS) and derivatives such as Caché ObjectScript -- that interacts with the medical centers’ local data stores.
- Data and dictionary elements specific to VA such as internal code sets and identifier roots.
- Licensed commercial software elements that are used within VA to operate certain functions like VA-specific GUIs and diagnostic workstations.
3.3 What is FOIA-released public domain VistA?
FOIA VistA is a version of VA Enterprise VistA that has been “redacted,” i.e., that has VA-specific and licensed commercial software modules removed. This version of VistA is periodically made available for release to the public as legally mandated under the Freedom of Information Act (FOIA, pronounced “foy-uh”). The most recently released version of FOIA VistA is available from the OSEHRA website. FOIA VistA is the baseline on which OSEHRA VistA is built.
3.4 Is FOIA VistA executable?
No. Operation of FOIA VistA requires installation and configuration of the operating system and the MUMPS software environment in which it will run.
3.5 What is OSEHRA VistA?
OSEHRA VistA is described in Section 4.0, “About OSEHRA VistA.”
3.6 What are VistA-related products or software?
Programs, interfaces, and functionalities developed locally at VA medical centers (generally referred to as “Class III code”) and by commercial vendors and community implementers for use within VistA, but not integrated with VA Enterprise VistA. These can be downloaded from the OSEHRA website at OSEHRA Technical Journal and repositories.
3.7 What are non-VistA health IT products or software?
These are programs, interfaces and functionalities developed independently of VistA or any other specific electronic health record implementation. They can be interoperated with VistA for such applications as a personal health record (PHR). These can be downloaded from the OSEHRA website at OSEHRA Technical Journal and repositories.
3.8 Is there a purchase or maintenance charge for OSEHRA software?
No. OSEHRA software is open source (Apache 2.0 licensed) and is freely redistributable, modifiable, and viewable.
3.9 What are the licensing terms of OSEHRA software?
OSEHRA-managed software uses the Apache 2.0 license.
3.10 Is OSEHRA focused only on VistA?
VistA is one of the biggest code bases OSEHRA manages and receives the most attention. However, there are other code submissions that are non-VistA related or written in the M language that are hosted at OSEHRA as well.
4.0 About OSEHRA VistA
4.1 What is OSEHRA VistA?
OSEHRA VistA is an OSEHRA-certified, community-supported, open source electronic health record (EHR) that can be obtained at no cost, configured, customized, and implemented by developers or providers in the healthcare industry. It is based upon, and maintains bi-directional compatibility with, the VistA electronic health record system developed by the Department of Veterans Affairs (VA) but also includes a wide range of enhancements from the community at large.
4.2 Where does OSEHRA VistA software originate?
OSEHRA VistA software consists of contributions from Veterans Affairs (VA) and community contributions from the open source community. The main VA contribution is FOIA VistA, which is obtained by OSEHRA via VA’s Freedom of Information Act (FOIA) website as explained Section 3.3, “What is FOIA VistA?” Additional software contributions may come from information resource management (IRM) departments at individual VA medical centers through VA channels (“Class III code”) and from other OSEHRA members and community developers.
4.3 What does OSEHRA VistA contain?
OSEHRA VistA is based on FOIA VistA, which is described in Section 3.3 “What is FOIA VistA?” It is enhanced by related applications contributed by the open source community, including Fileman 22.2, which features the most recent enhancements to the File Manager software that has powered VistA inside and outside VA since the 1970s. These contributions can be found in the OSEHRA Technical Journal and repositories.
4.4 Who owns OSEHRA VistA?
VistA was originally developed by VA. Through the Freedom of Information Act (FOIA), an Apache 2.0 Open Source license allows VA Enterprise VistA code to be available to all free of charge through the OSEHRA web site. OSEHRA VistA is another distribution of VistA, licensed under Apache 2.0, which takes in code modules from the community that adds product improvements.
Community contributions are available both for inclusion in VA VistA as well as in VistA versions that are configured, customized, and maintained by other community members.
4.5 What is the difference between OSEHRA VistA and other VistA distributions such as OpenVistA, vxVistA, etc.?
OSEHRA VistA is based on the current version of FOIA VistA as well as contributions from the community that have been certified for open source interoperability as described below in Section 7.0, "About OSEHRA Software Certification".
Community members have agreed to maximize code convergence among various products such as Open VistA, vxVista, etc., that are based on FOIA VistA and may also contain proprietary or open-source extensions. OSEHRA VistA is designed to serve as a common platform for the entire community.
4.6 Is OSEHRA VistA executable?
Operation of OSEHRA VistA requires installation and configuration of the operating system and the MUMPS software environment in which it will run. See Section 6.7 for installation and configuration instructions.
4.7 What can OSEHRA VistA do for my product, service or enterprise?
As an open source electronic health record solution, OSEHRA VistA offers the following advantages to product integrators and implementers:
- Lower life cycle cost
- The reliability of a proven solution
- Reduced risk of obsolescence
- The ability to improve a system without waiting for the next proprietary product release
- A dynamic, free platform for development
- The involvement of developers and integrators in the growing market for installation, customization, and support services
4.8 Can I operate my practice or medical center using OSEHRA VistA?
Generally, no. End users typically require additional functionalities, training, customizations, and maintenance, which are provided by our corporate members.
4.9 Where can I download a copy of OSEHRA VistA?
OSEHRA VistA may be downloaded from the OSEHRA code repository.
5.0 About the OSEHRA Community
5.1 How does OSEHRA work with the Department of Veterans Affairs?
OSEHRA fosters an open ecosystem in which many organizations can equally participate. These organizations include, but are not limited to companies, nonprofits, academic institutions, state government agencies and federal government agencies. Due to fact that VistA was developed by VA and is at the center of the open source ecosystem, the relationship between OSEHRA and VA is very direct. For example, the OSEHRA groups have contributing members from VA who often lead discussions on a variety of issues.
5.2 How does OSEHRA route the code contributions from the open source community to the Department of Veterans Affairs?
The VA has designated OSEHRA to become the host of the Enterprise version of VistA that is deployed at VA facilities. OSEHRA has established workflows by which code contributions from the larger open source community can be tested and certified, and then can be included in the code base.
5.3 How can contributors submit source code to OSEHRA?
OSEHRA has implemented the online OSEHRA Technical Journal that welcomes contributions from all members of the community and makes them freely available to all. All articles fall under the Creative Commons by Attributions License. As a technical journal, it is expected that most articles will include source code, testing code and use case examples to enable readers to get firsthand experience with the software.
5.4 Who can submit to the OSEHRA Technical Journal?
The journal accepts software submissions from any member of the open source community under the Apache 2.0 software licensing terms.
5.5 How are OSEHRA Technical Journal contributions tested and reviewed?
Once articles are submitted to the Journal, they are subject to open and public peer review by members of the community. Peer review is facilitated by the fact that all articles are required to be reproducible, and therefore to include with them all the materials needed to enable a reader to run the software.
5.6 How frequently is the OSEHRA Technical Journal issued?
The Journal works on a continuous cycle. Since it is a fully online publication it is not subject to the restrictions of paper publishing. Therefore, it can accept and review articles on a continuous basis. The Technical Journal can also be used by VA as a catalog from which interesting contributions can be drawn into VA.
5.7 Is OSEHRA geared only towards software developers?
OSEHRA serves the larger community of all involved in adopting and improving open source electronic health records. This includes clinicians, academics, patient advocacy groups and hospital administrators.
5.8 I am a U.S. government employee. How do I work with or contribute to OSEHRA?
Just as any other individuals, U.S. government employees are welcome and encouraged to participate in OSEHRA activities. There are two main avenues of participation. First, as an employee of the federal government, you can start by verifying the regulation and practices of your specific agency and become familiar with the processes used to participate in open source projects. At the present time, many federal agencies have been involved with hundreds of open source projects, and it should be relatively easy to follow the example of your colleagues on how to participate. A second avenue, is of course, to participate as an individual, if you would prefer to do so, independent of your activities as an employee of the federal government.
5.9 How do I get involved (Developers, Clinicians, HIT management, Academics, Patient Advocates… All)?
The quickest way to get involved is to become a member of OSEHRA. All OSEHRA community members are encouraged to join any of the numerous existing groups, or to propose new groups. Currently OSEHRA hosts over 20 groups, including: Architecture, Certification, Code Convergence, Development Tools, Education, Genomics, Patient Centered Care, and others.
5.10 What types of activities do OSEHRA groups engage on?
The groups are divided into discussion groups, working groups, and open source project groups. Discussion groups provide forums for exchanging ideas of common interest, mainly via blog postings. Working groups typically have specific objectives and action items to achieve and conduct scheduled conference calls, many of them weekly, moderated by the group chair. Open source project groups provide tools and forums for members to collaborate on open source software development.
5.11 How can I join the a group?
All of the groups are open to OSEHRA members. Work group participants are encouraged to post to associated discussion pages, wikis, and blogs. Participation in work groups is also open to the public.
5.12 How do I contribute code to the OSEHRA open source ecosystem?
There are two main avenues for contributing code. The choice depends on the size and nature of the code contribution. For large or self-contained contributions, the Technical Journal is used. For small patches and bug fixes, we use the Gerrit code review system.
5.13 How do I contribute code to the OSEHRA Technical Journal?
First we suggest that you get in touch with us by sending us an e-mail to firstname.lastname@example.org or calling us at +1 (571) 858-3061. We will work with you to make the contributing process seamless and easy. In the case of the Technical Journal, you would include your source code along with the documentation describing its nature, motivation and use. The combined submission will then be openly reviewed and improved by community members. You will also be asked to sign a code contribution agreement that includes terms of software license of Apache 2.0.
5.14 How do I contribute code to the OSEHRA Gerrit system?
In the case of Gerrit, you can directly create an account, and start submitting patches and bug fixes, as well as participating in the review process to improve code that others have contributed. See Gerrit Code Review System for an in-depth discussion and detailed instructions.
5.15 Should I create an OSEHRA account before I contribute source code?
We recommend that contributions be shared with the larger community. As OSEHRA is all-inclusive, community members are encouraged to create a member account to facilitate this process.
5.16 Who can review the source code contributions to OSEHRA?
Any OSEHRA members can participate in the review. As an open source community, OSEHRA encourages those with ideas or code to actively participate by submitting or by helping with the evaluation and improvement of submissions from other members of our community.
5.17 Where can I find the latest OSEHRA news?
The OSEHRA website is the main source of news and updates on the many activities that take place in the OSEHRA community. You can subscribe to the groups of your interest and follow up on their activities. Even without subscribing to the groups, you can also follow up on the many blogs that are posted by participant members. Regular updates are found at http://www.osehra.org/most_recent.
6.0 About the OSEHRA Development Environment
6.1 What development tools are available?
OSEHRA has put significant time and effort into ensuring that a modern VistA development environment is available. Such efforts include the creation of an automated cross reference tool, an automated testing framework, code review, repositories (with associated repository management tools) and a test dashboard. An overview of VistA resources is available here.
Additionally, there is a development tools discussion group where more tools are available.
6.2 Are tests required?
Tests are not required for code submission but are required for OSEHRA certification. The certification page outlines the kinds of tests required for certification.
6.3 How do I write OSEHRA tests used for OSEHRA certification?
OSEHRA has a series of webinars that will explain how to write functional tests, unit tests, and web-based tests. Each programming language normally has its own unit test framework that can be integrated into the OSEHRA testing framework. OSEHRA currently supports Munit, Delphi, and Python based unit test suites as well as Selenium and PExpect based Functional tests. Other tools and languages can also be supported in the future.
6.4 What license do I have to use to contribute to OSEHRA?
OSEHRA will only accept submissions whose licensing is compatible with the Apache 2.0 license. A full license overview is located at our licensing page.
6.5 Why does OSEHRA require that code contributions be licensed using Apache 2.0?
The Apache 2.0 license provides these ideal combinations:
- it is a legally well-written license
- it is very permissive
- it encourages participation of businesses
- it discourages litigation
- it defines implicit terms for contribution
- and it provides clarity for the terms and conditions of participation.
This license allows participants in the community to readily use OSEHRA open source submissions without impact on their existing source code or commercialization strategies. While we recognize that other open source communities prefer a reciprocal license, we believe that additional constraints imposed by such licenses work against adoption by the broadest possible community.
6.6 Where do I find a catalog of contributed software?
A list of all software modules received from VA and from the open source community is available at the OSEHRA Technical Journal.
6.7 How do I create a VistA development environment?
The fastest way to get a VistA development environment running is to use Vagrant. Vagrant is an automated development virtual machine provisioner. OSEHRA has scripts in the VistA repository that will create an Ubuntu LTS Virtual Machine (VM) and install and do a basic configuration of VistA. Documentation for setting up a vagrant instance is available. Also available is a longer form document that will walk you through the options for testing and installing VistA.
6.8 How do clinicians provide input on the OSEHRA VistA development process?
Clinicians can provide input into the OSEHRA VistA development process by participating in the work groups that either have ongoing development projects or are devising plans for solutions to a specific issue. Work groups that may be of interest to clinicians include Genomics, Immunization, Imaging, Patient-Centered Care and Portability, and Reminders. To join the appropriate work group, you must first become a member of OSEHRA. Once you are a member, we encourage you to find groups in which to participate.
7.1 What is software certification?
Essentially, certification is the imprimatur used to differentiate code that has been subjected to and has passed a software quality review. This review indicates that the code meets standards consistent with the open source release of high quality software. It is not a substitute for integration and Software Quality Assurance (SQA) testing for sites marketing or releasing products based on the open source code.
7.2 Is all software certified?
Not all software is certified, and not all contributions are meant to reach the certified state. OSEHRA provides a marketplace where developers can contribute and exchange code and ideas. Certification is the mark that a specific code has reached a level of maturity and quality which makes it desirable for broader adoption and dissemination.
7.3 Who certifies the OSEHRA software?
Final application of the OSEHRA certification mark is always a function of an OSEHRA designee after a certification review. However, the process of certification allows and encourages community participation. Community members are encouraged to visit the OSEHRA Certification Standards and OSEHRA Process Plan documentation for more details on certification and the specific steps a community reviewer or OSEHRA Designee is asked to perform.
7.4 How does my software become OSEHRA Certified?
Software becomes certified after it has been selected for certification and has undergone a formal review by the community and by an OSEHRA Designee. A full explanation of the OSEHRA certification process, the standards that must be met, and the process of certification can be found in the OSEHRA Certification Standards and OSEHRA Process Plan documentation.
7.5 How is software selected for certification?
Any software submitted to the OSEHRA Technical Journal (OTJ) or bug fixes submitted for Gerrit review can become candidates for certification. Depending upon the size and scope of the submission, certification can be an expensive process requiring sponsorship. The choice of when to carry out a certification is made based on the completeness of the submission, community pull, business development goals, and resources available. Positive peer reviews for an OTJ submission, or positive Gerrit reviews for bug submissions are encouraged as they are both good indications of community interest and give a good indication of certifiability; however, given a sufficiently critical business case, certification can begin.
7.6 Where do I find a catalog of OSEHRA certified software?
Certification status of software that has been contributed to OSEHRA is contained in these code lists.
8.0 Communicating with OSEHRA
8.1 Where can I post questions?
If you have a general question about OSEHRA such as membership, governance, etc, please send an email to email@example.com.
If the question is technical, we encourage you to use the OSEHRA work groups. Join OSHERA at the membership page, join an appropriate group on the Groups Page, and then use the Wiki utilities to post your question as a discussion. An email will be sent to all members of the group and your question should be answered in a timely manner.
8.2 Whom do I contact regarding:
- Code and technical journal submission statuses
- Participation in OSEHRA events (Summit, etc.)
- Website issues
For any of the above issues, please send an email to firstname.lastname@example.org.