Everybody hates VistA? Not its users

Congress has continually railed on the Veterans’ Affairs EHR for being outdated, but its users say the platform is fast, secure and gets the job done.
By Jessica Davis
01:28 PM
VistA EHR Dr. David Shulkin

As a whole, the healthcare industry has long-since aired its frustrations about clunky electronic health records that take the joy out of medicine. Some providers have gone as far as to say EHRs turn doctors into data entry specialists.

However, when talking with users of the Veterans Affairs’ VistA -- the agency’s EHR and IT system -- the response is the exact opposite. In fact, while Congress has long since dubbed VistA as outdated, VistA users seem completely satisfied with the functionality, speed and security of the system -- among many other positive features.

For starters, annual Medscape EHR Reports consistently rank VistA as the number one EHR over commercial, off-the-shelf vendors.

[Also: Congress presses VA secretary on VistA interoperability, costs]

VistA developers who wrote its code worked directly with physicians to hear their thoughts and opinions about what an ideal system would look like. And even today, IT encourages VistA users to speak up about complaints, suggestions and needs, according to DSS Senior Health Informatics Consultant Deanne Clark.

“When people really look at the history of VA, it has over 20 to 25 years of creating health informatics. It’s elevated the functionality requirements over time,” said Clark. “VA has been working with end users to really understand the software and users.”

[Also: VA hospitals outperform mainstream facilities on readmissions, mortality rates]

“In the VA it was encouraged that if software was seen as a barrier, IT got eyes on the problem very quickly. The culture is ‘let’s fix it and make it better,’” she said.

This supportive culture of identifying user issues and visibility is another reason VistA is so popular. Clark said that the VA’s method doesn’t take away from the usefulness of the system because problems are fixed along the way. The VA identifies what it can do better and uses the software to solve it.

“It stands up over time,” Clark said. “VistA is longitudinal with a focus on best practices, and it’s not tied to reimbursement. The emphasis is care and outcomes.”

Firsthand experience with VistA

To get a better understanding of the user’s point of view, Healthcare IT News spoke with a user who has worked with VistA since its early stages. The long-time user, who wished to remain anonymous, pointed to more than two dozen reasons for VistA’s success.

His biggest point?

“VistA was built by the VA for the people who use it,” he said.

[Also: Not so fast, vendors, fixing VistA is not off the table]

The platform is easily changed to meet needs of patients, specifically veterans with individual needs, down to their area of combat. He said this adaptability makes it easier to support veterans through every step of their care.

VistA is can support up to 2,500 users at a time. There is also 99.5 percent uptime. In fact, there’s a shadow system for VistA used during periods of downtime that allows for seamless care transactions.

And to top it off, one package talks to another. VistA is not just an EHR. The entire IT system runs on VistA, from billing to clinical care. This allows the doctor to see all relevant patient information at once.

A recent Reddit thread shared similar accounts of VistA users with comments that ranged from “it looks like it was coded in 1980, but CPRS sucks way, way less than a lot of commercial products,” to “not the most advanced in the user interface, but at least it was built more for the clinician than the biller.”

While many of these users found the system to be slower than they would like, the consensus was that a commercial vendor would not handle tasks any better.

It’s these factors that have many users concerned: Could a commercial EHR support VA in this same way? And could a private sector vendor fully understand the needs of the veteran? Lastly, can a commercial off-the-shelf EHR handle the VA’s massive size?

“The VA treats a population with greater health issues: more needs and functions than other private sectors patients,” said Clark. There’s trauma, active duty soldiers, mental health, prosthetics and other needs that a general EHR vendor without a military background may not be able to understand.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com

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