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The challenges of developing and maintaining a custom EHR system have proved too great for the Department of Veteran Affairs.
The VA developed its EHR system – VistA – in house; however, it was labor intensive, costly and time consuming to maintain and use. According to VA secretary, David Shulkin, the system is “too complex and too difficult to maneuver”.
A decision needed to be taken on whether to continue to plough money and resources into getting VistA to work as it should, or to call it quits and opt for a new, commercially available system. The VA has more important priorities than software development and has opted for the latter.
Shulkin wants veterans to have more choice about where they receive care. Having an EHR that allows data to be easily shared is essential to ensure veterans get the best medical treatment possible. Yet the VistA system often resulted in care being delayed which had a negative effect on patient outcomes.
The decision to ditch VistA has been a long time coming. The system has been extensively discussed at hearings and last year feedback was sought on the move to a commercially available system.
VistA has been beset with problems, requiring many expensive updates and modifications to be made, yet VistA still has severe limitations. Shulkin has now confirmed the decision to switch to an off-the-shelf EHR system has been made.
Shulkin said at a recent House Committee on Veteran Affairs hearing, “I have come to the conclusion that VA building its own software products and doing its own software development inside is not a good way to pursue this.” Shulkin went on to say, “We need to move towards commercially tested products. If somebody could explain to me why veterans benefit from VA being a good software developer, then maybe I’d change my mind.” The VA will be looking to work with “companies who know how to do this better than we do.”
The VA is likely to choose a FHIR system – the industry interoperability standard – to ensure it has the best possible chance of optimizing health data exchange across multiple providers.
While the decision has been taken to switch to an off-the-shelf EHR system, there are likely to still be challenges ahead. The move is clearly the way forward, but even when a new EHR is chosen, considerable tweaks will be required to get the new EHR to integrate with the VA’s legacy systems.