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Veterans Affairs
how all-encompassing VistA is as a hospital automation system.
It supports [and] enforces so many of the medical processes in every VHA hospital and goes far beyond what a commercial EHR product does.” ROGER BAKER
Pressure for change is coming from inside the agency as well. The VA Com- mission on Care recently recommend- ed a major restructuring of IT at the agency, including adding a CIO at the Veterans Health Administration with a direct line to the VA CIO. The commis- sion’s June 30 report also calls for VA to acquire a “comprehensive, commer- cial off‐the‐shelf information technology solution to include clinical, operational and financial systems.”
But pivoting away from VistA, the agency’s homegrown electronic health record system, would be a major shift for the VA.
All-encompassing IT
Former VA CIO Roger Baker said VistA is the only EHR designed by doctors, not technologists.
“That is the real power of VistA, and it remains the real power of VistA,” he added.
The system, rooted in 1970s code, is designed to assist doctors in their daily work. Providers at the various VA medi- cal facilities nationwide customize it for their specific needs.
“Most people don’t realize how all- encompassing VistA is as a hospital automation system,” said Baker, who left the agency in 2013. “It supports [and] enforces so many of the medical processes in every VHA hospital and goes far beyond what a commercial EHR product does.”
One downside, however, is that mod- ern “third-party software is difficult to integrate into VistA, and there are many parts of VistA that third-party products just can’t replace,” he added.
VistA also has a broad user base outside VA. And although that fact is unlikely to influence the department’s decisions to any large degree, it does speak to the platform’s value.
The Open Source Electronic Health Record Alliance gives outside hospi- tals and health care systems commer- cial access to the VistA software. At an OSEHRA conference in late June, attendees praised VistA and expressed concern that the VA’s commitment to
the platform might be waning.
Nancy Anthracite, an OSEHRA group leader, said “lots of lobbyists” are trying to move VA to a commercial product. But the real problem, in her opinion,
lies in the agency.
“The people who have just arrived
into the VA don’t know about VistA,... what they’ve got and why it would be hard to shift from it,” she said, adding that it would be “very, very expen- sive” to tailor a commercial product to accommodate all the functionality that VA medical facilities need.
Feras Kamal, CEO and co-founder of Electronic Health Solutions, started implementing VistA at medical facili- ties in Jordan in 2007. Almost 100 sites are using it now, he added, and it has proven to be a cost-effective and attrac- tive solution for the country.
“VistA is solid,” Kamal told FCW. “It has all the safety measures and other features [and] it easily can be enhanced and taken to a different level. But taking it out and going commercial is going to be really difficult, even within the VA.”
Baker said that as integral as it has been to the department, the 40-year-old system might be coming to the end of its life as more and more doctors prefer newer commercial products.
“It puts OI&T in a very difficult posi- tion,” he said, adding that both com- mercial and in-house options have their drawbacks. “And a lot depends on” the Defense Department.
DOD is in the midst of implementing a new EHR system under its Defense Healthcare Management System Mod- ernization (DHMSM) program. The Pentagon is making a $4.3 billion bet that a commercial system from Cerner and Leidos can support the needs of the sprawling Military Health System.
“If DOD can successfully implement DHMSM, then VA should be looking at implementing that same product,” Baker said. “If DOD fails, it may be essential that VA have a still vital VistA as a fallback. As far as the dollars go, the investment in VistA remains rela- tively small compared to the cost of replacing [it].”
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