It's been fascinating to see this deal for perhaps the largest government IT project in history get "negotiated" and now signed. Thank you, Mr. HIStalk, for giving us the opportunity to play armchair quarterback on this one.
From a macro level, there is some logic in the DOD and VA being on the same system. There will be a few efficiencies gained from having shared Master Patient Indexes, fewer interfaces, common reporting solutions, and leadership on both sides sharing lessons learned, etc.
However, those efficiencies are dwarfed by the enormous costs of implementing both projects at the same time. The DOD and VA will be competing for consultants, Cerner's resources, and probably more funding at the same time. Waiting would have been an extremely prudent move for the VA, especially to give the DOD time to work out the kinks exposed in their recent scathing process review.
Finally, there is the issue of acting secretary Wilke signing a contract that he may not legally be authorized to sign as an interim leader... perhaps if his new presidential appointment goes through, it will be a non-issue, but for now, it was an unnecessarily hasty move, that gives critics grounds to sue.
In 5-10 years time, a modern EHR will be based on a cloud-first technology and won't look anything like the Epic/Cerner etc versions we have put into American health care over the last 10 years. Those are based on pre-cloud/web technology (although much lipstick has been applied).
The cutting edge of the EHR world is getting FHIR, app stores, and data integration--not to mention bringing in data from genomics, sensors, the environment and more, and using blockchain technology for data integration and storage. But those technologies are not mature enough yet, and there aren't any major vendors really representing that cutting edge who cold take on a project of the VA's scale
So right now, before that tech revolution is a bit further along, is the worst time to buy an EHR. If the VA installation goes well, in 10 years it'll be state of the art from 20 years ago. And the rest of health care will be ripping out all the systems put in between 2005 & 2015, and putting in new ones.
So the best option was to do nothing, leave VISTA as is and defer this decision for 5 years
It's been fascinating to see this deal for perhaps the largest government IT project in history get "negotiated" and now signed. Thank you, Mr. HIStalk, for giving us the opportunity to play armchair quarterback on this one.
From a macro level, there is some logic in the DOD and VA being on the same system. There will be a few efficiencies gained from having shared Master Patient Indexes, fewer interfaces, common reporting solutions, and leadership on both sides sharing lessons learned, etc.
However, those efficiencies are dwarfed by the enormous costs of implementing both projects at the same time. The DOD and VA will be competing for consultants, Cerner's resources, and probably more funding at the same time. Waiting would have been an extremely prudent move for the VA, especially to give the DOD time to work out the kinks exposed in their recent scathing process review.
Finally, there is the issue of acting secretary Wilke signing a contract that he may not legally be authorized to sign as an interim leader... perhaps if his new presidential appointment goes through, it will be a non-issue, but for now, it was an unnecessarily hasty move, that gives critics grounds to sue.
In 5-10 years time, a modern EHR will be based on a cloud-first technology and won't look anything like the Epic/Cerner etc versions we have put into American health care over the last 10 years. Those are based on pre-cloud/web technology (although much lipstick has been applied).
The cutting edge of the EHR world is getting FHIR, app stores, and data integration--not to mention bringing in data from genomics, sensors, the environment and more, and using blockchain technology for data integration and storage. But those technologies are not mature enough yet, and there aren't any major vendors really representing that cutting edge who cold take on a project of the VA's scale
So right now, before that tech revolution is a bit further along, is the worst time to buy an EHR. If the VA installation goes well, in 10 years it'll be state of the art from 20 years ago. And the rest of health care will be ripping out all the systems put in between 2005 & 2015, and putting in new ones.
So the best option was to do nothing, leave VISTA as is and defer this decision for 5 years