There's no chance that a commercial EHR can replace VistA
When the Department of Veterans Affairs Secretary David Shulkin, MD announced the agency would make a final decision about VistA’s future by July, it seemed the years-long saga over the EHR’s modernization would finally end.
But it’s not that simple.
VistA serves over 1,200 Veterans Health Administration healthcare sites and is seen as a pioneer for many of today’s commercial EHR architectures. Medscape EHR reports from both 2014 and 2016 rank the VA’s computerized record system number one with physicians and in its usefulness as a clinical tool.
The VA, however, has struggled to adapt and maintain the proprietary EHR software, while defining necessary features, functions and workflows. It’s also been in Congress’ line of fire since 2014, when it failed to become interoperable with the Department of Defense’s system in the multi-billion dollar iEHR debacle.
While Congress and other VistA opponents blame the VistA’s failure on age, Medsphere CEO Irv Lichtenwald cut to the chase.
“The commercial options are not new either,” Lichtenwald said. “Epic is the same vintage as VistA and both systems use MUMPS code.”
The difference is that commercial vendors continue to improve base technology while Veterans Affairs VistA has perhaps reached a point of stagnancy despite having access to the same modernizations.
“If the VA were to go with a commercial offering instead of staying with VistA, that commercial offering would not be off-the-shelf,” Lichtenwald said. “Pretending the VA could just pick and use a commercial option without extensive modifications is not reality. Any option will need significant modification to meet VA specifications.”
Chilmark Research founder John Moore echoed these sentiments: “An enterprise COTS software solution of any form - EHR, RCM, ERP - can never fully replace what a custom-built solution can do.”
And it’s highly unlikely that a commercial option would better handle the VA’s volume of patients, Moore explained. “There’s typically a steep learning curve for end users to become accustomed to a new software solution.”
In a potential move to a commercial option, the VA would lose the highly-customized features of VistA, Moore said. But if it were to do so, it would gain a “fully dedicated R&D staff whose business is to develop new features and maintain the solution over the long-haul.”
The real question isn’t whether VistA is the right platform, however, it’s whether the VA wants to be in the software development business moving forward, or not.
Indeed, Secretary Shulkin, other top VA officials and Congress are no doubt keeping a close eye on the Defense Department's progress since deciding not to maintain its proprietary AHLTA EHR and, instead, chose the team of Cerner, Accenture and Leidos the massive modernization contract.
But it’s not a straight comparison, according to Doug Brown, managing partner of Black Book Research.
“The VistA replacement issue is much more political than was the DoD decision,” Brown said. “DoD was mostly a procurement process.”
Black Book, to that end, examined its data to consider how a commercial EHR would address the Trump Administration’s agenda, including improving veterans access to quality care, handling the opioid crisis, improving business processes and fiscal performance as well as innovating within government agencies.
Black Book, in fact, suggested this week that Cerner would be the best EHR to replace VistA, with Allscripts ranking second and Epic third. All three were finalists for the DoD contract.
That might make it tempting to rekindle the iEHR vision of a single integrated electronic health record that spans both DoD and VA only this time based on Cerner’s platform.
If the VA ultimately chooses a commercial EHR, though, is Cerner a shoe-in?
“No,” Chilmark’s Moore said. “But they do have a slight edge.”