VA scandal could fuel drive to replace VistA EHR

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.”