It is easy to say “I told you so” after the fact of some debacle. The outcome is known, and the causes of the debacle are right there in front of you like the skid marks of a car leading to the wreckage against a wall.
Experts can look at the scene and tell you that speed, or road conditions, or weather or faulty equipment were clearly the causes of the carnage. Or they might point to drugs, or drinking or distracted driving as contributing factors.
But what about before then?
Certainly, all of the above-mentioned causal or contributing factors get talked about but those discussions lack immediacy and urgency, and are speculative about any particular crash or tragedy. No one can say that a particular car will crash at a particular spot, during a particular time period, with a particular set of consequences. If someone did contend that they could predict such a crash they would rightfully be looked at with much skepticism.
But I, and many knowledgeable folks, can predict with a very high degree of certainty that a debacle will occur based on the Veterans Affairs Department’s recent decision to proceed with its highly unusual, sole source, noncompetitive, multi-billions-of-dollars award of a contract to Cerner for a replacement electronic health record (EHR) for its current [Veterans Information Systems and Technology Architecture] system.
The knowledgeable folks I refer to are the experts who built, evolved and maintained VistA for the VA over the past 25 years. They are also the doctors and other clinicians and caregivers who use VistA daily to care for their patients. They are the managers and workers who depend on VistA for the information necessary to manage the care of the millions of veterans who are cared for each year by the VA. These folks have not been asked their opinion about this decision to abandon VistA. If they were, the vast majority, some would say 75 percent to 85 percent, would object.
Their objections would vary from the technical — that the underlying architecture of Cerner will not support the transaction processing requirements of the current VA environment — to the business process requirements. Cerner will not support the VA’s current standard business practices.
Others might point to the Pollyanna-ish estimates about costs, schedule and impacts that will accrue to such a move, to the ability of the VA to achieve its mission.
Still others might point to the sheer technical and managerial complexity of pulling off such a transition even assuming none of the known shortcomings with Cerner and liken the complexity factor to rebuilding a jetliner while in flight.
There are many other predictors of this impending debacle that are widely known throughout the VA, but no one has asked anyone knowledgeable inside the VA about them. There has never been an honest, impartial side-by-side comparison between VistA and any of these commercial EHR’s as to their capabilities to meet the needs of the VA.
This decision to move to Cerner did not come from within the VA. It came through a convergence of the political and financial interests at the Department of Defense, the White House and private sector product and professional services organizations.
It is the fix to the problem that doesn’t exist that if allowed to proceed will break or badly damage the VA’s ability to fulfill its mission. I agree with all of the reasons behind the inevitable failure of this proposed move to Cerner and would add one more. The culture of the VA will not tolerate the degradation of the quality of the medical care provided to our veterans using VistA today caused by the lowest cost, insurance driven, profit based medicine and business practices embedded in Cerner model. Their dedication to the mission and their pride in the “best care anywhere” delivery of medical care to our nation’s warriors will not allow this misguided and ultimately destructive decision to succeed.
This is not a full-throated, blind defense of VistA as it exists today. Much needs to be done to modernize VistA.
I would liken it to the recent decision to extend the life of the U.S. Air Force’s aging B-52 fleet by replacing its engines and modernizing it electronics. The B-52 is a 60-year old aircraft design but it still is the best choice to fulfill its mission. With the modernization efforts it will continue to fulfill its mission for the next 30 years. VistA will do the same.
Edward Francis Meagher, former VA CTO and deputy CIO
Great Falls, Virginia
VA signs long-awaited contract with Cerner for new electronic health record