Should VA opt for a commercial EHR?

VistA is 'in danger of becoming obsolete' and has problems that 'stymie interoperability,' according to a report
By Jack McCarthy
08:57 AM

While the Veteran Affairs Departments homegrown electronic health record system is entrenched at VA outlets around the country, the once cutting-edge EHR appears to be under fire this week.

MITRE Corp. said that the EHR, called the Veterans Health Information Systems and Technology Architecture (VistA), is "in danger of becoming obsolete," within a 4,000-page report it issued late last month.

The report suggested that the Veterans Health Administration CIO, in partnership with the VA CIO, should oversee a comprehensive cost-versus-benefit analysis among commercial off-the-shelf (COTS) EHRs, open source options, and continued in-house custom development of the VistA iteration currently in use.

"The analysis should take into account all the complexities of the VistA architecture and infrastructure and known issues with performance, scalability, extensibility, interoperability, and security," the report said. "It should also address full life-cycle costs, including development time (based on recent delivery trends), availability of development resources, maintenance and licensing costs, and infrastructure costs." 

[Related: How satisfied are you with your EHR? See how that stacks up against our survey.] 

What's more, VA officials are expected to testify this week in front of a congressional committee, defend the system, and oppose suggestions to scrap it in favor of commercial solutions much like what the Defense Department did when it awarded Cerner, Leidos and Accenture the massive contract this summer, Politico reported

"VistA is a great big Buick with whitewall tires and tail fins that gets about 8 miles to the gallon," said Rep. Phil Roe (R-Tenn.), a physician and member of the veterans committee, who noted that the VA is spending 80 percent of its IT budget on maintenance, according to Politico. "It gets you from A to B, but will it last 20 years?"

Another question likely to arise is whether or not VistA will ever be truly interoperable with the commercial EHR DoD announced it would implement this summer. 

MITRE's report said that VistA's problems "stymie interoperability between Veterans Health Administration facilities as well as with DoD and non-VA providers."

The DoD in late July awarded a $4.3 billion contract to the team of Cerner, Leidos and Accenture, which edged out two other teams, one being Epic and IBM, the other consisting of Allscripts, Computer Sciences Corp. and Hewlett-Packard. 

Prior to that DoD and VA were working on a joint electronic health record system, dubbed iEHR, that fizzled out in early 2013. 

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