Why VA Should Keep Vista Healthy
The Department of Veterans Affairs has begun a three-year program to replace parts of its legacy electronic health record, Vista (Veterans Health Information System and Technology Architecture), with a commercial system designed and built by Cerner Corporation. The results of the initial pilot site for the new EHR, in Spokane, Wash., Led VA Secretary Denis McDonough to suspend any further deployment of the new EHR for at least the remainder of 2021. This created significant doubt as to whether Whether the original ten-year EHR Modernization Program (EHR) schedule remains viable.
Today, like every day for over 30 years, Vista supports medical care for veterans seen in VA. This year, Vista will support approximately 100 million veteran medical visits and provide comprehensive medical care records to over 9 million veterans. Vista’s performance as a DSE is unmistakable; It is highly responsive, highly reliable, supports a wider range of clinic functions than any other EHR in existence, and remains one of the top clinician-rated EHR platforms nationwide. The quality of care provided to veterans in facilities that continue to rely on Vista remains good, and VA physicians continue to believe Vista is an aid, not a hindrance, to their patient care efforts.
So there is no such thing as a âhot platformâ forcing VA to take risks in its Vista replacement program. To protect the quality of veteran medical care, the new EHR should only replace Vista in VA facilities when quality of care metrics show veterans will receive better medical care in facilities using the new EHR than when Vista was used.
This âcrossing pointâ of the quality of care is inevitable. Private sector investment in commercial EHRs has eclipsed comparable government spending for over 20 years. In addition, with every attempt by AV to replace Vista since 2000 has been accompanied by a multi-year moratorium on additional investment, as the government seeks to minimize spending on a product being replaced. Such a moratorium has been in place for three years, since the announcement of the new EHR program.
But the moratorium on other investments in Vista put in place three years ago creates at least four major strategic issues for VA, each of which creates the potential to have a major impact on veterans’ medical care if not. not resolved.
First, even in the most optimistic EHRM schedule, Vista will be used for direct veteran medical care for at least seven years. There are over 170 VA medical centers and each of their EHR replacements will be done separately and sequentially, as replacing an EHR in a single hospital is a huge project. One facility will go last, and all veterans seen at that facility (at some point identified by VA as Miami) will have the quality of their medical care dependent on a Vista EHR that has not been improved for more than 10 years. years. It is unclear what VA’s plans are to deal with the mandatory Vista upgrades needed during this period, such as new national medical warrants (for example, recently completed ICD-10 upgrades) or medically urgent system changes (for example, tracking and monitoring opioid prescriptions). But it is clear that VA recklessly reduced its spending on Vista to an absolute minimum.
Second, the new EHR does not have the capacity to replace about a third of what Vista currently does in VA medical centers. The reality is that the Veterans Health Administration is an unusual health care system, and Vista is a unique EHR platform. It goes far beyond healthcare and is integrated into countless administrative, financial and logistical operations at every VHA facility. No commercial EHR will be able to replace this functionality, including critical elements specific to veteran care, such as logs (e.g. burn site, prostheses, built-in shrapnel, PTSD, eye injuries, TBI and others), government-specific reimbursement and billing laws; and medical equipment supply and maintenance schedules. In fact, being built around managing the revenue cycle as much as delivering care, none of the dominant commercial EHRs can match Vista’s capabilities to facilitate patient care. To date, the program plan for EHRM has not included the treatment of this feature, meaning that about a third of Vista must be supported well beyond the 10-year period, even if the EHRM stays on schedule.
Third, Vista is the only built-in security for national veteran care in the event of failure of the new EHR program. The quality of medical care provided to our country’s veterans today depends entirely on Vista’s capabilities. With EHRM program schedules slipping and considering the government’s poor overall performance with huge IT / business modernization programs, VA must plan for a future where Vista remains the primary EHR platform for veteran medical care. With the knowledge we have today, this seems to be the most likely case.
Finally, VA quickly loses the knowledge necessary to carry out upgrades to Vista, both at the level of its employees and its contractors. Vista is large and complex, and has caused the failure of many projects won by low-cost contractors who thought they could “figure it out” and deliver new functionality without having experienced Vista staff on board. VA’s current lack of investment in Vista is pushing the most experienced Vista staff – almost by definition their most skilled technologists – to move on to other projects.
For each of these reasons, VA and Congress must invest now to ensure that Vista remains a robust and viable EHR platform until its successful replacement is guaranteed, however long it may take. VA must establish, and Congress should fund, a long-term strategic plan to ensure Vista’s viability and quality veteran medical care, regardless of any current or future replacement plans. This plan should include a realistic assessment of how VA will find and retain the Vista skills and experience necessary for the plan to be successful.
The quality of medical care provided to our nation’s veterans will depend on Vista for the foreseeable future. Failure to adequately plan for Vista’s long-term viability will impact veteran care at some point, perhaps when the expertise to deal with critical changes no longer exists. VA and Congress must act now to avoid the long term problems that failure to invest in Vista will almost certainly cause.
Roger Baker was Assistant Secretary of Veterans Affairs for Information and Technology from 2009 to 2013. Since leaving VA, he has been a consultant for several electronic health records and integration companies doing business with the agency, including Cerner.