Should VA Sustain Legacy EHR Investment During EHR Implementation?

The Department of Veterans Affairs (VA) should continue investing in its legacy EHR as it conducts its Cerner EHR implementations across Veterans Health Administration (VHA) medical centers, according to an opinion piece by health IT consultant Roger Baker published online by FWC (Federal Computer Week).

VA is three years into its 10-year EHR modernization program (EHRM) to replace parts of its legacy EHR, Vista (Veterans Health Information System and Technology Architecture). However, patient safety issues at the EHR pilot site in Spokane, Washington led the VA to halt any further deployments of the new EHR until at least the rest of the year.

This has created doubt as to whether the decade-long schedule is still viable, according to Baker, who served as VA assistant secretary and CIO from 2009 to 2013.

When VA began its EHRM, it cut back spending on Vista. Baker argued that this will create four major strategic issues for the agency.

First, he noted that since the VA will implement the new EHR at each of its more than 170 medical centers individually and sequentially, the centers that are connected to the new system last will be left using a system that has not been upgraded in over 10 years. Using such outdated technology could put veteran care in jeopardy, Baker noted.

Second, Baker said that the new EHR system only has the capabilities to replace about a third of what Vista currently does.

“The Veterans Health Administration is an unusual healthcare system, and Vista is a unique EHR platform,” Baker wrote. “It reaches far beyond healthcare, and is embedded in countless administrative, financial, and logistical operations at every VHA facility.”

“No commercial EHR will be able to replace this functionality, including critical items specific to veteran care, such as registries (eg, burn pit, prosthetics, embedded shrapnel, PTSD, eye injury, TBI, and others), government specific reimbursement and billing laws, and medical equipment supply and maintenance schedules,” Baker continued.

Third, Baker noted that Vista is the only safety net for national veteran healthcare if the new EHR implementation were to fail or take longer than expected.

“With the EHRM program schedules slipping, and given the government's poor overall track record with huge IT/business modernization programs, VA must plan for a future where Vista remains the primary EHR platform for veteran medical care,” Baker argued.

Last, Baker noted that cutting Vista funding to a minimum is leading valuable health IT employees and contractors to move onto other ventures.

“Vista is large and complex, and has caused the failure of many projects won by low-bid contractors who thought they could ‘figure it out’ and deliver new functionality without having experienced Vista staff on board,” he wrote. “VA's current lack of investment in Vista is causing the most experienced Vista staff – almost by definition its most skilled technologists – to move to other projects.”

Baker called on VA to establish a long-term strategic plan funded by Congress to ensure the viability of Vista.

“The quality of medical care provided our nation's veterans will depend on Vista for the foreseeable future,” Baker wrote.

“Failing to adequately plan for long-term Vista viability will cause veteran care to be impacted at some point, possibly when the expertise to address essential changes no longer exists,” he added. “VA and Congress must act now to avoid the long-term problems that failing to invest in Vista will almost certainly cause.”

Baker said that Vista is a high-performing EHR system.

“Vista's performance as an EHR is unquestioned; it is highly responsive, highly reliable, supports a broader range of medical center functions than any other EHR in existence, and remains one of the most highly rated EHR platforms by clinicians nationwide,” Baker wrote.

This year, Vista will support about 100 million veteran medical encounters, and provide a comprehensive record of medical care for more than nine million veterans, he noted.