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VA May Drop VistA For Commercial EHR

Posted on July 12, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

It’s beginning to look like the famed VistA EHR may be shelved by the Department of Veterans Affairs, probably to be replaced by a commercial EHR rollout. If so, it could spell the end of the VA’s involvement in the highly-rated open source platform, which has been in use for 40 years. It will be interesting to see how the commercial EHR companies that support Vista would be impacted by this decision.

The first rumblings were heard in March, when VA CIO LaVerne Council  suggested that the VA wasn’t committed to VistA. Now Council, who supervises the agency’s $4 billion IT budget, sounds a bit more resolved. “I have a lot of respect for VistA but it’s a 40-year-old product,” Council told Politico. “Looking at what technology can do today that it couldn’t do then — it can do a lot.”

Her comments were echoed by VA undersecretary for health David Shulkin, who last month told a Senate hearing that the agency is likely to replace VistA with commercial software.

Apparently, the agency will leave VistA in place through 2018. At that point, the agency expects to begin creating a cloud-based platform which may include VistA elements at its core, Politico reports. Council told the hearing that VA IT leaders expect to work with the ONC, as well as the Department of Defense, in building its new digital health platform.

Particularly given its history, which includes some serious fumbles, it’s hardly surprising that some Senate members were critical of the VA’s plans. For example, Sen. Patty Murray said that she was still disappointed with the agency’s 2013 decision back to call of plans for an EHR that integrated fully with the DoD. And Sen. Richard Blumenthal expressed frustration as well. “The decades of unsuccessful attempts to establish an electronic health record system that is compatible across the VA in DoD has caused hundreds of millions of taxpayer dollars to be wasted,” he told the committee.

Now, the question is what commercial system the VA will select. While all the enterprise EHR vendors would seem to have a shot, it seems to me that Cerner is a likely bet. One major reason to anticipate such a move is that Cerner and its partners recently won the $4.3 billion contract to roll out a new health IT platform for the DoD.

Not only that, as I noted in a post earlier this year, the buzz around the deal suggested that Cerner won the DoD contract because it was seen as more open than Epic. I am taking no position on whether there’s any truth to this belief, nor how widespread such gossip may be. But if policymakers or politicians do see Cerner as more interoperability-friendly, that will certainly boost the odds that the VA will choose Cerner as partner.

Of course, any EHR selection process can take crazy turns, and when you grow in politics the process can even crazier. So obviously, no one knows what the VA will do. In fact, given their battles with the DoD maybe they’ll go with Epic just to be different. But if I were a Cerner marketer I’d like my odds.

VA Hospitals Had Big EMR, BCMA Implementation Problems, Study Says

Posted on April 12, 2012 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study done at a group of seven VA hospitals has concluded the hospitals rolled out their EMRs with far too little planning, leading to problems that tied staff members and clinicians in knots.

The study, which was published in the American Journal of Managed Care, drew on interviews with doctors, IT staffers, nurses, pharmacists and managers.  The interviews were done several years after the VA had implemented its computerized patient record system (CPRS) and its bar code medication administration system (BCMA).

The respondents told interviewees that for most of them, the new technology created big difficulties. Many of the interviewees didn’t start out familiar with computer use, making the inevitable workflow disruption even worse than in other hospitals.

BCMA was a particualrly sore spot for the VA clinicians and staff, as it was phased in more rapidly and with little training for users.  Staff members at the hospitals essentially had to implement and use the system on their own, according to a story appearing in Information Week.

As if this wasn’t challenging enough, the hospitals ran into major issues in selecting and rolling out hardware to support these new technologies.

For one thing, some of the hospitals had little idea how to  build a wireless network capable of supporting the myriad of computer cards in use at their facility. In some cases, they faced major connectivity problems after failing to test the wireless systems prior to rollout of CPRS and BCMA.  Other hospitals in the seven had great difficulty figuring out how many computer terminal to order.

As I read the situation, the hospitals’ BCMA rollout led to the biggest problems and greatest possibility for harm.  All seven of the hospitals reported having major BCMA issues, including miscoded medications, empty unit-dose packages being delivered items not scanning.

Perhaps even worse, nurses sometimes had to cut the ID bands off of patient wrists just to scan them, or scan from extra wristbands in patient charts. “At some VA hospitals, staff were implicitly or explicitly permitted to use various workarounds with BCMA, such as…doing all scanning after medication administration,” the magazine reports, quoting the research report.

Not only that, many workarounds remained in place years after the BCMA rollout — a testimony, if there ever was one, to getting things right the first time.

Apparently, according to IW, BCMA is at stage 5 in the maturity scale HIMSS Analytics has established for measuring the maturity of a hospital EMR rollout. HIMSS says that 8.4 percent of hospitals are at this stage.

The thing is, a maturity scale shows its own weakness when you can laud a hospital for getting there even if their implementation has disrupted workflow greatly and even put patients at risk.  And I’m not aware of any ratings scale from HIMSS (or a similar entity) that grades quality of execution.

Do you know of other ratings systems for hospital EMR rollouts that do more to adjust for poor planning or implementation problems?  If you do, I’d love to hear about them.  This story is pretty scary.