Is the VA killing VistA? Say it ain't so

As longer-term readers know, this newsletter has praised the VA's efforts with open-source EMR VistA since we first got started. 

VistA is, in short, a remarkable accomplishment that performs better than virtually every commercial installation available. Every office visit, prescription, and medical procedure is recorded in VistA's database, allowing doctors and nurses to update themselves on a patient's status with just a few keystrokes. In 1995, patient records at VA hospitals were available at the time of a clinical encounter only 60 percent of the time. Today it is 100 percent. Some 96 percent of all prescriptions and medical orders, such as lab tests, are now entered electronically. The national comparison is more like 8 percent.

Despite all this, however, VistA's future may be less promising. While I have heard this second hand, the anecdotal evidence sounds pretty convincing that the VA's world-class VistA EMR system may be dying a slow death. 

According to various sources, including ZDNet Healthcare and Phillip Longman of the New America Foundation, political forces within the VA are causing it to starve Vista:

*  The DoD wants centralized systems to meet its security goals
*  DoD execs are giving favor to AHLTA, the agency's own medical computing system
*  Philosophically, the DoD wants to privatize all government functions

This is leading to some real losses in care coordination, Longman says. While institutions can hook up two hospitals using Vista "in an afternoon," he says, AHLTA and VistA don't interoperate. That's true even though building a Vista/AHLTA interface wouldn't be a big technical deal. According to Longman, however, it wouldn't make a lot of sense to some career DoD people, who have staked their careers to AHLTA.

Now, I don't know about you, but I'm of the "if it ain't broke don't fix it" school. But when it comes to the DoD, that kind of logic may not matter. Sure, why not sacrifice one of the best-performing EMRs anywhere just for the purposes of having centralized control? To a bureaucrat, that's probably a stroke of genius.

Many thanks to ZD's Dana Blankenhorn for the tip on this story. Meanwhile, readers, I encourage you to weigh in--not just with me, but also the VA itself--if there's a chance it will do any good. VistA deserves a better fate than this. - Anne

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