VistA’s long, contentious history helps explain its demise

As officials at the Department of Veterans Affairs look to scrap the system’s legacy electronic medical records system for a commercial EHR, a look back at the system’s history shows a program that was ahead of its time but often met with resistance.

To hear lawmakers talk about VistA in its current form, one might think the system has lost a step to private EHR vendors that have populated the market. In congressional hearings, representatives have repeatedly criticized the VA for its inability to keep pace with modernized medicine and the high costs tied to maintaining and updating the medical records infrastructure. Earlier this month, the new VA secretary, David Shulkin, said the VA is ditching VistA for a commercial option.

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But purists say VistA is still one of the premier EHR systems, and many lamented the system’s long, tumultuous history dating back to the 1970s, according to a Politico article that details the complex history of VistA. In its infancy, when IT gurus were piecing together VistA using the earliest computer models, developers were often met with outright resistance from government leaders.

Those developers persevered, but the same factors that ultimately made VistA so innovative and user-friendly have also fueled its eventual demise. The system was pieced together by a handful of rogue developers. Once those developers moved on, updating the original code proved difficult.

Others pointed to mismanagement fueled by bureaucratic oversight. Lack of funding pushed the system’s original developers to the private sector, and updating the system was rife with management failures that stifled innovation.

“Modern management techniques killed it,” one former senior VA official told Politico. “We always wondered whether it was a plot to help the private vendors. But whether it was or not, it had that effect.”

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Others said the switch to a commercial EHR will be just as expensive and cumbersome, particularly if officials try to integrate the many elements of VistA that physicians find useful.

The VA has engaged in a slow but steady push to modernize its IT systems, particularly its scheduling software.

RELATED: VA's slow but steady push to modernize its technology

Last week, Jennifer Lee, M.D., deputy undersecretary for health policy and services, said the VA is piloting a commercial scheduling system in Boise, Idaho, but noted that full integration is still years away.