VA scan­dal could fuel drive to re­place VistA EHR

Modern Healthcare - - NEWS - By Joseph Conn

Will em­ployee abuse of the Vet­er­ans Af­fairs Depart­ment’s VistA elec­tronic health-record sys­tem give a po­lit­i­cal boost to the pri­vate sec­tor’s long-stand­ing drive to re­place VistA with a commercial, off-the-shelf EHR sys­tem, even though the VistA sys­tem was not at fault?

“There is no road kill that vul­tures won’t go af­ter,” said Dr. Harry Green­spun, se­nior ad­viser on health­care trans­for­ma­tion and tech­nol­ogy with the Deloitte Cen­ter for Health­care So­lu­tions. He is sure the VA’s cur­rent woes will re-en­er­gize that push for a commercial EHR sys­tem.

VistA is used in the VA’s 152 hos­pi­tals and 990 out­pa­tient clin­ics. In March, the VA’s Of­fice of In­spec­tor Gen­eral blamed long pa­tient wait­ing times on “a con­vo­luted sched­ul­ing process,” not soft­ware glitches. The of­fice found that for more than a decade, some VA em­ploy­ees have mis­used the VistA sys­tem to es­sen­tially lie about how long vet­er­ans had to wait for med­i­cal ap­point­ments. The OIG noted, how­ever, that for new en­rollees, VA staff print out paper copies of ba­sic pa­tient en­roll­ment in­for­ma­tion that then has to be re-en­tered into a VistA mod­ule for sched­ul­ing ap­point­ments. That sug­gests sys­temic prob­lems with in­ter­op­er­abil­ity.

The VistA sched­ul­ing mod­ule was ini­tially de­vel­oped in the 1980s and has un­der­gone mul­ti­ple up­grades. Last year, the VA spon­sored a con­test in which 41 de­vel­op­ers vied to come up with a re­place­ment sys­tem for the sched­ul­ing mod­ule. A col­lab­o­ra­tion of firms, in­clud­ing MedRed, won the $1.8 mil­lion top prize in Septem­ber. But Dr. Wil­liam Smith, CEO of MedRed, said the VA has not moved for­ward with any re­place­ment sys­tem. On May 30, the VA is­sued a pro­cure­ment no­tice to be­gin ac­quir­ing a new sched­ul­ing sys­tem. Green­spun said a pow­er­ful mo­tive for EHR de­vel­op­ers to push the VA to buy a commercial sys­tem is that most large pri­vate health­care providers al­ready have bought or up­graded their clin­i­cal IT sys­tems un­der the federal EHR in­cen­tive pay­ment pro­gram. “There are just not that many big deals left,” he said. A con­tract to re­place VistA “would dwarf any other (health IT) de­ploy­ment.”

Rep­re­sen­ta­tives of Epic Sys­tems, Cerner and Allscripts de­clined to com­ment on their po­ten­tial in­ter­est in a VistA re­place­ment con­tract.

Seong Ki Mun, pres­i­dent of the Open Source EHR Al­liance, des­ig­nated by the VA to over­see fu­ture up­grades to the VistA sys­tem, said he is not ex­pect­ing the re­cent tur­moil at the VA to change the agency’s course on im­prov­ing rather than re­plac­ing VistA. “There has to be some sort of con­gres­sional ac­tion to change the di­rec­tion,” Mun said. “That’s not in the pic­ture.”

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