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VA (Veteran’s Administration) Chooses Cerner EHR

Posted on June 5, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Some really big news just dropped from the VA Secretary, Dr. David J. Shulkin, that the VA has selected Cerner as their EHR replacement to VistA. You can see the full press release at the bottom of this email which outlines the VA Secretary’s reasoning for going with Cerner and the expedited process.

Without getting too much into the details of government procurement, the VA secretary has decided to use a “Determination and Findings” or “D&F” that allows him to avoid the government requirement for a full and open EHR selection and instead be able to solicit the EHR from Cerner directly. I’m pretty sure this will have many of the VistA and even the Epic people up in arms. We may even see some lawsuits out of it, but I don’t expect they’ll go anywhere. Of course, I think most of the VistA people knew this was coming ever since the VA secretary said they’d be pursuing a commercial EHR.

I think most people in the industry thought that the VA would and should go with Cerner for their EHR once the DoD chose Cerner and has since started implementing the Cerner Millennium EHR in what is now known as MHS GENESIS. The only naysayers suggested that the VA might choose Epic over Cerner just because they wanted to be different. That always seemed like a bit of a stretch to me, but it is government and so you can never know what to expect.

You can read the full press release below, but the reasons for choosing Cerner are pretty clear. The release does say that the VA will have its own instance of Cerner. So, they’ll still have to build interoperability between the DoD implementation of Cerner and the VA implementation of Cerner. This isn’t really a surprise when you think about their unique needs and the size of their implementations. Watch for the Cerner interoperability chart to go through the roof once they start sharing records between the DoD and VA.

I also found it interesting to note that the VA has a lot of community partners who are on other EHR platforms. We’ll see how interoperability goes for them. I expect they’ll likely use the standard interoperability options that are out there today.

The VA Secretary did note the concern of many VistA users when he said that “In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work. And our work will help DoD in turn.” I know many VistA fans who suggested that Cerner and Epic were way behing VistA in many areas and so moving to either commercial EHR would be a frustrating thing for many VA VistA users. We’ll see how well the VA Secretary can incorporate their current IT innovation into Cerner. I expect this will be an extremely hard challenge.

Not being an expert on government procurement, I’m interested to know how the VA will handle the rest of the procurement process. If you remember, the DoD’s massive EHR contract was really led by Leidos and not Cerner. Of the $9 billion contract, there were estimates that Cerner would only see $50-100 million per year of the $9 billion. The VA announcement only talks about a contract with Cerner for their EHR. Will they have to do an open bid process for all the services that Leidos and their rainbow of other partners are providing the Cerner DoD implementation?

Those are some initial high level views on this big announcement. What do you think of the announcement? Any other details I missed? Any other questions you have about it?

VA Press Release on Selection of Cerner EHR:

Today U.S. Secretary of Veterans Affairs Dr. David J. Shulkin announced his decision on the next-generation Electronic Health Record (EHR) system for the Department of Veterans Affairs (VA) at a news briefing at VA headquarters in Washington.

Secretary Shulkin’s full statement is below.

I am here today to announce my decision on the future of the VA’s Electronic Health Record system, otherwise known as EHR.

I wanted to say at the outset that from the day he selected me for this position, the President made clear that we’re going to do things differently for our Veterans, to include in the area of EHR.

I had said previously that I would be making a decision on our EHR by July 1st, and I am honoring that commitment today.

The health and safety of our Veterans is one of our highest national priorities.

Having a Veteran’s complete and accurate health record in a single common EHR system is critical to that care, and to improving patient safety.

Let me say at the outset that I am extremely proud of VA’s longstanding history in IT innovation and in leading the country in advancing the use of EHRs.

  • It was a group of courageous VA clinicians that began this groundbreaking work in the basements of VA’s in the 1970’s that led to the system that we have today, known as the Veterans Health Information Systems and Technology Architecture, or VistA.
  • It has been this system that led to the incredible achievements made by VA clinicians and researchers and resulted in VA’s ability to perform as well or better than the private sector in patient safety and quality of care.

That said, our current VistA system is in need of major modernization to keep pace with the improvements in health information technology and cybersecurity, and software development is not a core competency of VA.

I said recently to Congress that I was committed to getting VA out of the software business, that I didn’t see remaining in that business as benefitting Veterans.  And, because of that, we’re making a decision to move towards a commercial off-the-shelf product.

I have not come to this decision on EHR lightly.

I have reviewed numerous studies, reports and commissions, on this topic, including the recent commission on care report.

  • I’ve spent time talking with clinicians, and I use our legacy VistA system myself as a current practicing VA physician.
  • We have consulted with Chief Information Officers from around the country, and I’ve met personally with CEO’s from leading health systems to get their own thoughts on the best next-generation EHR for VA.
  • We’ve studied reports from management consulting companies and from the GAO and the IG on VA’s IT systems.
  • I can count no fewer than 7 Blue Ribbon Commissions, and a large number of congressional hearings that have called for VA to modernize its approach to IT.

At VA, we know where almost all of our Veteran patients is going to come from — from the DoD, and for this reason, Congress has been urging the VA and DoD for at least 17 years — from all the way back in 2000 — to work more closely on EHR issues.

To date, VA and DoD have not adopted the same EHR system. Instead, VA and DoD have worked together for many years to advance EHR interoperability between their many separate applications — at the cost of several hundred millions of dollars — in an attempt to create a consistent and accurate view of individual medical record information.

While we have established interoperability between VA and DOD for key aspects of the health record, seamless care is fundamentally constrained by ever-changing information sharing standards, separate chains of command, complex governance, separate implementation schedules that must be coordinated to accommodate those changes from separate program offices that have separate funding appropriations, and a host of related complexities requiring constant lifecycle maintenance.

And the bottom line is we still don’t have the ability to trade information seamlessly for our Veteran patients and seamlessly execute a share plan of acre with smooth handoffs.

Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the Departments remain on two different systems.

For these reasons, I have decided that VA will adopt the same EHR system as DoD, now known as MHS GENESIS, which at its core consists of Cerner Millennium.

VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems.

It’s time to move forward, and as Secretary I was not willing to put this decision off any longer.  When DoD went through this acquisition process in 2014 it took far too long.  The entire EHR acquisition process, starting from requirements generation until contract award, took approximately 26 months.

We simply can’t afford to wait that long when it comes to the health of our Veterans.

Because of the urgency and the critical nature of this decision, I have decided that there is a public interest exception to the requirement for full and open competition in this technology acquisition.

Accordingly, under my authority as Secretary of Veterans Affairs, I have signed what is known as a “Determination and Findings,” or D&F, that is a special form of written approval by an authorized official that is required by statute or regulation as a prerequisite to taking certain contract actions.

The D&F notes that there is a public interest exception to the requirement for full and open competition, and determines that the VA may issue a solicitation directly to Cerner Corporation for the acquisition of the EHR system currently being deployed by DoD, for deployment and transition across the VA enterprise in a manner that meets VA needs, and which will enable seamless healthcare to Veterans and qualified beneficiaries.

Additionally we have looked at the need for VA to adopt significant cybersecurity enhancements, and we intend to leverage the architecture, tools and processes that have already been put in place to protect DoD data, to include both physical and virtual separation from commercial clients.

This D&F action is only done in particular circumstances when the public interest demands it, and that’s clearly the case here.  Once again, for the reasons of the health and protection of our Veterans, I have decided that we can’t wait years, as DoD did in its EHR acquisition process, to get our next generation EHR in place.

Let me say what lies ahead, as this is just the beginning of the process.

  • VA has unique needs and many of those are different from the DoD.
  • For this reason, VA will not simply be adopting the identical EHR that DoD uses, but we intend to be on a similar Cerner platform.
  • VA clinicians will be very involved in how this process moves forward and in the implementation of the system.
  • In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work.  And our work will help DoD in turn.
  • Furthermore VA must obtain interoperability with DoD but also with our academic affiliates and community partners, many of whom are on different IT platforms.
  • Therefore we are embarking on creating something that has not been done before — that is an integrated product that, while utilizing the DoD platform, will require a meaningful integration with other vendors to create a system that serves Veterans in the best possible way.
  • This is going to take the cooperation and involvement of many companies and thought leaders, and can serve as a model for the federal government and all of healthcare.

Once again, I want to thank the President for his incredible commitment to helping our Veterans and his support for our team here at the VA as we undertake this important work.

This is an exciting new phase for VA, DOD, and for the country.  Our mission is too important not to get this right and we will.

$11 Billion DoD EHR Contract

Posted on May 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Nextgov has a great article up which outlines many of the details of the soon to be bid out Healthcare Management Systems Modernization contract. I’d prefer to call it the DoD EHR Contract or AHLTA replacement contract. Certainly there’s more to it than EHR, but that will be the core of the contract and the big name EHR vendors will all be involved.

Here’s a section of the article which gives you an idea of the size of the contract:

The DHMSM contract’s estimated lifecycle value is approximately $11 billion and would include initial operating capabilities by 2017 and full functionality by 2023, according to Dr. Jonathan Woodson, assistant secretary of Defense for health affairs, who testified in February before the House Appropriations Committee’s defense panel.

Even in Washington, $11 billion is a lot of money, and it would surely rank among the largest IT-related contracts in government. What’s unique about this effort is that the Pentagon wants a single contractor to lead the integration of a commercial electronic health records system to cover its nearly 10 million beneficiaries and large assortment of health care facilities worldwide. Defense is one of the largest health care providers in the country, on par in size with the Veterans Affairs Department and private sector leaders like Kaiser Permanente.

The article also states that they want to issue a contract with one vendor. We’ll see how that plays out. I’ve seen some rumors out there about who will be bidding. No doubt it will be a combination of the usual government contractors and EHR consultant companies together with EHR vendors like Epic and Cerner.

What’s going to be really interesting is the VA and its Vista EHR (Vista Evolution) is said to be bidding on the contract as well. We’ll see if they’re the only Vista bid or if others join in as well.

Here’s another great insight into the DoD EHR Contract:

Major data gaps in patient records occur when health care is delivered to beneficiaries outside the DOD network, and today approximately half of DOD’s 9.8 million beneficiaries receive their health care outside the network.

This was an obvious complaint of the AHLTA system. The DoD and VA couldn’t even get their EHR systems to be interoperable. I’m not optimistic that interoperability will be obtainable even under this new contract. That includes DoD to VA interoperability, let alone trying to connect with the care the DoD beneficiaries receive outside the DoD network.

I realize that nothing with the DoD health system is simple. Its an enormous system with all sorts of crazy government regulations. However, I’d hope for $11 billion, we could do better than we’re doing for our veterans.

At HIMSS, I talked with a largely military EHR vendor. They told me that they were close to being able to exchange records between different locations. That’s right. At HIMSS 2014 the amazing breakthrough was that 2 locations with the same EHR software were close to being able to exchange data.

DoD, VA Spent Bulk of 2012 iEHR Budget on Support Contracts

Posted on November 27, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The VA and DoD’s iEHR project may or may not come together, but it seems clear that at least one party is getting ahead — the vendors the agencies retained to support the project.

A new report from the Interagency Program Office concludes that the two agencies spent more than $300 million funding support contracts for iEHR work in 2012.  The IPO’s job is  to modernize the Military Health System’s EMR software.

DoD and the VA have been working to build a joint integrated EMR, known as the iEHR, since 2009. The idea is to build an EMR which allows every service member to have and maintain a single personal electronic health record through their career and lifetime.

However, to say the project has been troubled is an understatement, with changes of strategy riddling the effort throughout its lifespan.

In February, for example, the iEHR project was halted, with officials electing to make their current EMR systems more interoperable.

A few months later, DoD Secretary Chuck Hagel wrote a memo stating that the agency will consider a commercial EMR system. Most recently, the DoD asked 27 EMR vendors to provide demos of possible EMR replacements.

Most recently, the DoD announced that it was looking for contractors that can support its current EMR, AHLTA, through 2018.

All  I can say is that if you’re following all of this you’re way ahead of me. With so many switches in direction, I can’t imagine anything lasting and good coming out of the process. Maybe you have to be military to get it. As for me, I see a strategy process that seems to be governed by something resembling a coin flip.

Buy EHR vs Build EHR

Posted on October 14, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve long had an interest in the topic of when hospitals chose to buy their EHR software versus build their EHR software. In fact, we’ve written multiple times on the subject including Anne Zieger’s piece on “Some Hospitals Still Choosing To Build Own EMR“.

With this as background, I was really intrigued by Dr. Edmund Billings’ blog post looking at how open source EHR is the best of both buy and build worlds. Here’s a good section of his article which frames the debate:

In a Buy vs. Build decision, the key drivers are control and cost. Do you have control over your system at a cost you can afford? The decision calculus then shifts to ownership on two levels: First, can we have true ownership of our solution and make it work ourselves? Second, is the total cost of ownership economically sustainable?

Dr. Billings then goes on to make the case that open source EHR is the best of both worlds. He compares the open source EHR vista to Linux and Red Hat to Medsphere. It’s a pretty app comparison of what Medsphere is trying to do. Dr. Billings does point out that an enterprise EHR is not an operating system (like RedHat/Linux). Although, I find that ironic since I’ve written before about how I think that the EHR is the operating system of healthcare.

One major difference between Linux and VistA is how they’re implemented. Linux could be implemented by an organization on just a server or two while still running all the old servers on something else. Then, over time they could add in more Linux servers. This isn’t the case with VistA. Everyone wants an Enterprise EHR to be implemented across the entire system. I don’t see someone implementing VistA in one department and then growing from there. Maybe we should do it this way, but that’s not what I see happening in the market. They buy an EHR system they can use across their whole organization.

This difference aside, open source does provide an interesting balance between the buy vs build mentality. I wonder why hospital organizations have chosen other EHR vendors over the open source EHR alternatives.

Great Whitepaper Summary of OpenVista Features

Posted on July 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The week after I got my first job implementing EHR, I went into the medical records office where I was shown an article about the government’s decision to open source the Vista EHR software. The HIM manager was drawn by the idea of a free EHR. Of course, the clinic I was working for had already invested hundreds of thousands of dollars on an EHR system. In fact, this is likely what made the HIM manager so interested in the idea of a free EHR. She didn’t know why we’d spent hundreds of thousands of dollars when the government was offering an EHR for free.

What she didn’t understand was that just because the software is free doesn’t mean that the EHR is free. Plus, she (and I at the time) had little understanding of what the Vista EHR software really encompasses. Implementing Vista in that small clinic would have been like taking a sledgehammer to a 2 penny nail. In fact, that might even be underestimating the breadth of what could be done with Vista.

Of course, if we had been in the hospital environment, then we should have definitely considered Vista. However, back then there were a lot of unknowns with how Vista would transition to open source and how it would work in a commercial healthcare environment. 8+ years later, the companies working with the open source EHR is much more mature.

One of the leaders when it comes to implementing Vista in hospitals is a company called Medsphere. Medsphere’s version of Vista is called OpenVista. What’s amazing is the stark contrast in costs between an open source EHR versus many of the proprietary alternatives. No doubt Medsphere and others are benefiting from the billions of dollars the VA spent developing Vista.

For those of you not familiar with Medsphere and OpenVista, check out this whitepaper summary of OpenVista. It’s a really great summary of the capabilities of the software and what Medsphere has done to improve on the Vista software.

I’m sure there are still many hospital CIOs that aren’t brave enough to choose an open source EHR when “know one gets fired for buying Epic.” Although, I think it’s a big mistake when hospital CIOs don’t even consider the open source EHR options. When you see the breadth and depth of what’s available in Vista, it’s definitely worth considering.

Plus, since it’s open source, you can still develop custom additions to the software without worrying whether your EHR vendor will let you create a deep connection to the EHR software. I see an open source EHR software as a great option for those hospitals that are use to developing custom applications in house, but also see how a commercial vendor has expertise that they don’t have in house.

What are your thoughts on Vista as a hospital EHR?

CA Hospital Adds CPOE To VistA Implementation

Posted on July 1, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s still rare these days to see a private hospital roll out open source EMR VistA, despite VistA’s excellent reputation. But one such hospital has not only implemented VistA, it’s added CPOE to its VistA rollout.

The facility in question is Oroville (CA) Hospital, which spent three years self-implementing the VA platform. Oroville has spent seven years developing a paper-based order set system, and has now converted its order sets from paper to electronic.

For a year the medical staff at Oroville had been using paper order sets and the VistA EMR, but that arrangement was getting old, so the transition was a happy one, according to Dr. Matthew Fine, the hospital’s chief medical officer, who’s quoted in a press statement.

“After a whole year of using paper and electronic charts the staff was chomping at the bit to go live and the anticipation outweighed the fear… so turning on CPOE was almost a welcomed event. The inadvertent strategy of having hybrid charts seems to have been a good way to make full conversion to EHR/CPOE more palatable,” Dr. Fine said.

To make the CPOE transition, the Oroville staff created a mechanism for systematically converting order sets to an electronic format, the press release notes. Each order set, once transformed, was reviewed by a relevant group of physicians along with 20-odd additional staff including department/section heads, nurses, pharmacists, nutritionists, lab staff and anyone else who might be carrying out the orders in the order sets.

Since go-live in October of last year, electronic order volume has mounted, and now 80 percent of orders are electronic. The hospital’s goal is for 100 percent of orders to be electronic, but it has hit a stumbling block in that it has been unable to adapt VistA’s original CP Flowsheet module.

For that reason, Oroville will have to create its own CPOE solution for several areas of the hospital, including outpatient surgery and the PACU.

DoD Official Says Agency *Might* Select VistA Derivative

Posted on June 20, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While it appears to be an outside shot, it’s possible that the Department of Defense might still consider a derivative of the VistA EMR for its VA EMR integration project, though a straight ahead VistA implementation sounds like it may be out of the question.

At a briefing by DoD, Under Secretary for Acquisition, Technology and Logistics Frank Kendall said that while using and modernizing VistA was a “reasonable decision” for VA, it’s necessarily as bright an idea for the DoD.

After doing market research, DoD technology leaders have decided that they’ll consider a mix of competing commercial products as well as Vista-based systems, and have taken in about 20 pitches from EMR vendors.

“Three of them were from VistA-based approaches, and the rest were from other approaches,” Kendall said. “So we think we have a rich field to pick from, and we can make a best value determination for DoD.”

When asked how much the DoD’s next EMR move is going to cost, Kendall did a bit of a bob and weave, saying that seamlessly integrated data is funded in the ’13 and ’14 budgets, without naming a number for those projects or long-term costs.

OK folks. You know what?  This whole thing really ticks me off — how about you?

I don’t know why the DoD is so dismissive of VistA, but despite its colossal failures with AHLTA and the death of the iEHR project, people there still seem to think they should pursue their own course rather than go with what’s been working at the VA.

And as an American taxpayer, much less a health IT analyst, I’m really tired of hearing the leadership at DoD justify their shaky moves in the EMR arena.

Come on, Mr. Kendall. Why won’t you be more specific about the costs of your health IT initiative?  Perhaps it’s because VistA-based products could cost 10 times less than, say, an Epic installation and you don’t want annoying editors like me bugging you about it?

Apparently even blistering critiques by your colleagues haven’t moved leaders like you off of your entrenched commercial approach to EMR integration.  I guess it’ll take a memo from on high — apparently one from President Obama doesn’t suffice — to get the generalissimos of HIT at the DoD to try something that might work.

W. VA. Rolls Out Enhancements To VistA

Posted on May 7, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Officials with the West Virginia bureau of behavior health and health facilities are putting some finishing touches on VistA installations cutting across the state, adding computerized laboratory information to a six-year-old implementation.

West Virginia officials have implemented Vista in seven communities, Modern Healthcare reports. Facilities include an acute-care hospital, two psychiatric hospitals, four long-term care hospitals, a nursing home and two ambulatory care clinics.  The facilities are all connected to a central database in Charleston via T1 lines.

The state has been working on contract with Medsphere Systems Corp. to install a VistA version known as FOIA VistA, a version in the public domain that can be obtained freely from the VA under the Freedom of Information Act, Modern Healthcare notes.

Though VistA itself is free, the state has spent heavily on installing it across the seven sites.  Since FY 2005, West Virginia has paid Medsphere $8.4 million for system implementation, development and support, and is contracted to pay the vendor $939,800 this year for support.

In addition to paying Medsphere a monthly fee for systems support, the state pays licensing fees to InterSystems, developer of Cache, a version of the MUMPS database and programming language. It also licenses Keane’s financial system, which interfaces with VistA.

West Virginia began looking at a common infrastructure for all of its facilities when HIPAA passed back in 1996, noting that the idea behind it was portability and accountability. Now state officials are glad they moved ahead. “It’s expensive,” but “in terms of satisfaction, I think we’d all agree it was well worth it,” deputy commissioner for administration Craig Richards told the magazine.

What Would It Take To Get More Hospitals On VistA?

Posted on January 22, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Recently, we shared the story of of a California community hospital that decided to bypass big vendors like Cerner and Epic and go for a VistA installation instead. While Oroville Hospital ended up spending $10 million on its VistA implementation, that turned out to be about half of what it would have spent on Cerner and its big-vendor cousins. Then, to boot, Oroville got a $5 million Meaningful Use payout.

Yes, without a doubt, Oroville had a different experience when it went with VistA than it would have if it hired on Epic and had armies of be-suited consultants descend onto its campus. Any open source project faces the risk that the fervor and volunteer labor that makes up the backbone of its ongoing development efforts.

But given how much flexibility hospitals get out of the deal, and how much they save, it seems to me that you’d still expect to see more VistA projects being mounted.  What would it take? Here’s a few ideas:

*  Get a CCHIT-certified VistA product out there:  Right now, hospitals don’t have such a choice. The only reason Oroville got its instance certified was thanks to special help from World VistA.

* Have more happy talk stories on how VistA can really work appear in serious business publications like Forbes:   Arguably, peer pressure is a major reason hospitals stick to a short list of popular solutions.  More coverage of VistA successes in major pubs creates its own buzz which may encourage IT leaders to reconsider their existing plans.

* VistA consulting firms need to become more common:  Right new there are a few firms, like Medsphere, that will walk hospitals through the VistA installation process. But what if, say, Accenture had a division devoted to VistA support?

There’s not a lot you can do if a hospital CEO is determined to buy Epic or Meditech or Cerner. But if they want to consider VistA, there’s a lot the industry could do to help.

VA Plans Baseline Repository for VistA

Posted on December 28, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Right now, there are 133 instances of the VA’s popular VistA software operating across the U.S. In an effort to create some harmony, the VA has set plans to create a special separate repository for its Gold Disk version of VistA which developers can use as a baseline.

According to Healthcare IT News, the VA is also planning a software testing platform, open source dev standards and documentation of open source community outreach planning.

The idea behind the VA’s move is to attract more developers and code contributions to VistA, which despite its popularity is getting a bit long in the tooth at more than 30 years old, HIN reports.

VistA is already being renovated by the community managed by the Open Source Electronic Health Record Agent (OSEHRA), a not-for profit created by a previously standing contract between the agency and The Applications Informatics Group.

The group is working to create a minimum baseline standard for VistA code behind 20 key modules. To do that, OSEHRA’s working with VA’s internal development team to clean up the code and leverage what works.

Meanwhile, OSEHRA is working as a custodial agent is to certify open source code for integration into the VistA code base and to make sure complimentary software contributions will work with VistA.

According to estimates cited by HIN, OSEHRA should cost less than $10 million per year, while replacing VistA with an existing commercial EMR could cost about $16 billion. (Yeah, there’s a no-brainer for you.)

In any event, the big idea behind all of the VA’s VistA efforts is to get things moving quickly and bring on the innovation.  It’s hard to argue that this is a good idea. Whether OSEHRA itself is the right vehicle to guide and channel this innovation is anybody’s guess, but if it can harness the explosive creative force that is the open source community, watch out!