There in the sky! Not a bird, not a plane, it’s VA’s old VistA system!

Veterans Affairs doesn't dare let its venerable VistA health records system fade away and leave doctors with nothing.

It came up in a hearing. And it came up during a panel discussion of the Association for Federal IRM (AFFIRM) that I happened to moderate. The Department of Veterans Affairs is modernizing its central electronic health care record.

Do I mean the five-year, so far, effort to install an ostensibly commercial product from Cerner-Oracle at all of its facilities? Why no. VA is certainly doing that. But its technology people are also keeping their options open by modernizing the venerable VistA system, the very system the Cerner-Oracle product is supposed to replace.

Some systems never die.

Reginald Cummings, the deputy chief information officer for infrastructure operations explained on the panel, he’s moving VistA to the cloud. That’s significant because the VistA system has traditionally operated as multiple instances, each running separately at each VA facility. More than simply “lifting and shifting” VistA to a cloud, to use the slightly disparaging cloud-talk term, Cummings said, they’re also “containerizing” it. Containerizing refers to a way of packaging an application together with the resources it needs to operate, such as the operating system itself, the storage and interfaces such that it can run in a more secure and portable manner.

In the cloud, any VA facility could, in theory, access any VistA instance more easily than it can now.

As Jory Heckman reported on a recent hearing of the House Veterans Affairs Committee, VA officials offered a simple explanation for why they’re moving VistA to the cloud: They need to keep the darn thing alive for Lord-knows how long it’ll take to get the new product established and trustworthy.

I say trustworthy, because ugly innuendos surfaced at another hearing, before the Senate VA Committee. Sen. Jon Tester of Montana, the chairman, said fatal incidents connected “in some way to their care as delivered by the Oracle-Cerner system.” Whatever that means. It was echoed by Sen. Richard Blumenthal of Connecticut.

It sounds far fetched, although not impossible. The Cerner-Oracle product has had bad inspector general reports. In the realm of medicine, people have died over the centuries because of a million possible medical procedural errors. Anyway, the senators back VA’s plowing ahead with the troubled and expensive project. At least the Democratic ones. A Republican-backed House bill would cancel the Cerner deal.

Tragically comical in this saga is that VA isn’t shoring up VistA for a few months or maybe a year while they spread Cerner-Oracle throughout the department. To the contrary, said Daniel McCune, a VA software executive, VA may need VistA for another 10 years!

When former VA Secretary David Shulkin announced the Cerner award five years ago, I needled him personally that the conversion would take 20 years. He scoffed, and said nah, it’ll be five years. So maybe it’ll be ready in 15 years from the start.

McCune told the House panel that the “lift and shift” nature of the VistA cloud move meant VA would not be updating or modernizing VistA. Like the IRS Master File System, coded a couple of decades even before the VistA system was first cast, you just can’t wring certain functions people want out of 21st century systems from mid-last-century software. The old keeps functioning with new hardware and continuous maintenance, like a B-52 bomber, but it’s a fundamentally legacy system.

So, no, VA officials say they’re not modernizing Vista, merely ensuring a long extension of its expiration date. But by containerizing it and hosting it in a cloud, they’ve acquired the means to avoid sun setting VistA for a long, long  time.

 

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