Why the VA needs IT standardization during time of great transition

The Department of Veterans Affairs (VA) is going through a time of great transformation. Much of this change is being driven by new models of healthcare delivery, the transition to value-based care, new mandates for federal agencies to modernize legacy systems, emerging innovations, as well as the new electronic health record modernization (EHRM) program.

Many of these changes point to the enhanced need to standardize proven technologies and processes to reduce the variance of care across the Veterans Health Administration (VHA), bring about best practices to each VA medical center and ensure that veteran care does not lag during the later facility deployments of the EHRM program.

By putting into place a system to identify and evaluate best of breed IT solutions across the continuum of VA medical care, the VA will be able to further improve patient care at all VA medical facilities and improve the employee experience by streamlining workflow and increasing productivity and efficiency. The VA will also receive the benefit of improved contract provisions and data standardization.

One of the most significant challenges is the transition of specialty health care applications within the current VistA ecosystem in both the short- and long-term as progress is made regarding the migration to the new, commercial-off-the-shelf EHRM. This is an important step in the process over the next 10 years and beyond.

In addition, as medical technologies continue to evolve at an exponential pace, we must ensure that veterans have access to the same quality of care that is delivered in the private sector – the pace of improvements in medical care will not stand still during the deployment of the new VA EHR.

Why the VistA transition is vital

Since its deployment at the VA in 1994, VistA has evolved into a technically complex system comprised of approximately 200 modules that support health care delivery at more than 1,500 sites of care, including each Veterans Affairs Medical Center (VAMC), Community Based Outpatient Clinics (CBOC) and Community Living Centers (CLC), as well as at nearly 300 VA Veteran Centers.

That makes it essential for the VA to establish a process to review these diverse and valuable applications that provide the interface of patient care, and upon which VA medical professionals rely on to offer safe and reliable healthcare for our nation’s veterans.

As the VA transitions to the new EHR, there is also a need for a similar systematic evaluation and transition of the many modules and applications currently integrated within the VistA environment – including the evaluation of critical business intelligence regarding unique VA requirements. This will help with the overall migration to the new EHR and determine which applications will be developed by the EHR contractor.

Many of these VA medical applications are also already compatible with the Cerner EHR platforms in the commercial health care sector and have proven quality measures outcomes and a cost benefit analysis to healthcare systems.

Evaluating and standardizing existing, best of breed, health care applications within the VistA system can lead to a smoother transition to the new EHR for VA health care providers, reduce cost as these systems are already in place and functioning, maximize dollars already spent and mitigate unnecessary risk in an already highly complex transition.

Standardization reduces risk, ensures quality care

As the VA begins to execute its systematic review of healthcare applications that are in use today, this will shine a light on turn-key modules that are tailored for VA workflows, as well as enhance an all-inclusive integration, continuous enhancements, maintenance and customer support. These improve the safety and quality of services and medical care that is delivered to our nation’s veterans now and into the future.

In addition, the VA would benefit from an analysis of alternatives through the best of breed applications available. Thankfully, the current veteran-focused integration process with all solutions being technical reference model (TRM) and enterprise technical architecture (ETA) compliant is helping.

This can be also achieved through applications that offer flexible and extensible systems of engagement; are standardized to enhance efficiencies; maintain clinician productivity; ensure ongoing veterans access to care; and lower total cost of ownership for the VA.

For example, there are commercially proven software applications that enable electronic clinical surveillance for infectious disease prevention and clinical pharmacy, including opiates. This software solution called TheraDoc provides the ability for immediate medical intervention, which currently is challenging due to the VA’s huge and dispersed population of patients – both inpatient and outpatient.

The Miami VA healthcare facility is also using the LiveData PeriOp Manager to help synchronize surgical scheduling, increasing access to care to 1.8 additional cases per day. This solution improves the patient’s journey from surgical consultation through preoperative steps to the scheduled day-of-surgery and discharge.

Both of the commercial systems highlighted above have been integrated into the VA’s current system, VistA, through the expertise of DSS, Inc.


By standardizing modern and proven solutions across all VA medical centers, it is possible to increase veteran access to care, enhance the veteran experience, and improve the VA employee experience. This also reduces risk during deployment of modernization effort – allowing the VA to effectively manage a time of great transition.

Mark Byers is a service-disabled veteran (United States Air Force), as well as the president and co-founder of DSS, Inc. The company has more than 25 years of working with the VHA, and has wide-range of solutions and services being used at VA medical facilities nationwide.

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