Time for VA to admit the EHR system is a failure, revert back to VistA

Five years ago, I wrote an article, “Let the record show I told you so about VA.” This was in reference to the Department of Veterans Affairs’ decision to replace the current electronic health record (EHR), VistA, with a commercial, off-the-shelf EHR product. I made the bold statement, “But I, and many knowledgeable folks, can predict with a very high degree of certainty that a debacle will occur…”

I don’t bring this up to brag or claim prescience (well maybe a little) but to point out that this was obvious to anyone who knew anything about the VA, its culture, the underlying technologies and the sheer improbability of success of a poorly planned, massive rip-and-replace project of this scale and dimension.

Well, the debacle has occurred as predicted. After five plus years, the deaths of at least four veterans, harm to hundreds of veterans, the up to 50% reduction in productivity at the five VA medical centers where this live trial was imposed and the documented crushing burden placed on clinicians and staff at these facilities and the wasteful expenditure of nearly $10 billion, the VA finally admitted that they were performing a “program reset” and stopping work on future deployments of the new EHR, noting that “the new EHR was not meeting expectations.”

As government debacles go, this one is right up there with some of the most egregious ones in scale and scope. But it leaps into the realm of legendary and calamitous with the deaths and harm to veterans and the spirit breaking workload and morale crushing burden placed on VA clinicians and staff.

Now would be the time for the VA to stop using words like “reset” and “strategic review” to describe abject failure and to announce that this whole program has been a failure and that it is over, done, finished. Two and a half years after this system was initiated at the first test site at the Spokane, Washington, VA Medical Center, this system is still unreliable, error prone, slow and subject to total failure.

Many hours of complete downtime and uncounted days of system degradation are still the norm, not the exception. There is simply no justification for continuing to put veterans lives and health at risk, or to continue to expose long suffering clinicians and staff to the crushing burden imposed on them by this program. That alone is more than enough to compel the VA to put an end to this disaster without mentioning the estimate of the Institute for Defense Analysis that it will take more than $50 billion to complete this program. All of that should be enough without mentioning the fact that all this money and all this effort will only end up replacing some 50% of the required functionality that VistA provides today and that at some point the other functions will have to be recreated, reintegrated, and paid for.

In another article I wrote over two years ago, I pointed out that despite all evidence to the contrary the Secretary of the VA was doubling down on this fiasco with yet another “updated plan to move forward” and predicted with even more certainty that this updated plan was doomed to failure as hard data was beginning to trickle in from the first “go-live” site at the Mann-Grandstaff VA Medical Center in Spokane, Washington. The VA was in possession of a scathing survey conducted with 833 clinicians and staff at Mann-Grandstaff, documenting a horrendous working environment and a morale crushing workload and yet they ignored it.

In any rational, ethical, or moral environment this should have meant the immediate halt to this misbegotten and untested system implementation on human beings, but it wasn’t. After admitting that this system wasn’t ready for any future deployments, they paradoxically announced that they would continue to use this failed system on veterans and staff.

The false premise that this entire program was based on, the fact that VA’s VistA system was old and needed to be replaced, and this new EHR was the best way to facilitate data sharing between DoD and the VA have been widely refuted. The VA’s current false premise for continuing to use this flawed system on veterans is that it would be “very, very difficult” to revert to VistA. This is simply and demonstrably not true. The process that was used to convert these five facilities from VistA to the failed systems can simply be reversed, checked for accuracy and then implemented on the same platform that the remaining 155 VA medical centers are using safely and reliably today.

The irrationality of the VA’s stated decision to continue with a program this flawed and without any identifiable benefits or even hopeful signs begs the question of Why? Some suggest that it is the result of the “sunk cost” fallacy where huge costs that have been expended cloud the judgment and encourage the faulty notion that if only a few more dollars or a few more months were allocated there would be some miraculous turn around. Others proffer that the motivation is the “too big to fail” mentality based on concerns for the complexity of unraveling contracts, policies and personnel issues. A third theory involves political motivations and lobbying pressures to continue this doomed program.

I think it is all of these and at least one more. I think it is ego driven. Most of the current VA leadership has been actively engaged in pounding this politically inspired square peg into the VA’s round hole for years now with the resultant splinters, cracks and deformities seen as signs of progress. It is human folly to hope that continued smashing on the square and the total disregard of the damage to the round hole will result in a successful outcome. Additionally, it is very hard to admit poor judgment, failed plans and bad decisions especially when these failures have resulted in such grievous outcomes. Difficult as all of this maybe it is not a justification for continuing to harm veterans, inflict suffering on dedicated clinicians and staff, and spend good money after bad to avoid admitting something that should be obvious to any responsible, ethical and moral human being. Continuing to use this failed system implies that four deaths and hundreds of cases of veteran harm are acceptable costs to avoid having to admit a conspicuous and lethal mistake that was obvious from the beginning. How many additional deaths and how much harm to how many veterans will it take before VA leadership lives up to its’ responsibilities “to care for those who have borne the battle” and to its oath to “first do no harm?”

The leadership of the VA must stop putting veteran’s health at risk and revert to VistA.

Edward Meagher retired after 24 years in government, 26 years in the private sector and four years in the U.S Air Force. He served for seven years as the deputy assistant secretary and deputy CIO at the Department of Veterans Affairs. Meagher divides his time between his own executive consultancy, VETEGIC, LLC and extensive involvement with several veteran focused organizations including his own Service Member Support (SMS) Foundation.

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