US Veterans Association picks Cerner to replace VistA EHR
- 6 June 2017
The US Department of Veterans Affairs agency will replace its ageing electronic health record system, called VistA, by adopting the same Cerner platform as the US Department of Defense.
The decision came with news that the VA had decided for public interest reasons to set aside usual competitive procurement rules and instead directly solicit Cerner to acquire the DoD’s EHR system.
The VA, which has been the champion of open source EHR development for over 30 years, will now move to the same vendor as DoD, VA Secretary David Shulkin said in a statement.
Shulkin had first hinted in March that the VA would move from in-house EHR development to a commercial product, noting the software development business “is not a core competency for the agency”.
Announcing the decision on Monday President Trump said that the choice of a new EHR, will fix the agency’s data sharing ‘once and for all’.
“The records will now be able to follow the veteran when they leave service, meaning faster and far better quality care. This is one of the biggest wins for our veterans in decades and I congratulate Secretary Shulkin for making this very important decision,” Trump said.
The decision to move to Cerner forms part of ongoing effort by the VA to modernise its healthcare IT system, and a government drive for closer integration between DoD and the VA.
The US DoD awarded a contract to Leidos and Cerner for its healthcare facilities, which after delays, began roll-out earlier this year to the Military Health System, with full roll-out scheduled to be completed by 2022.
Significant efforts and investment have already been channelled into enabling interoperability between the DoD and Veterans Health Administration, but these are not felt to go far enough in integrating patient care, “the bottom line is we still don’t have the ability to trade information seamlessly for our Veteran patients and seamlessly execute a shared plan of care with smooth handoffs,” said Shulkin.
“Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the Departments remain on two different systems,” said Shulkin. “For these reasons, I have decided that VA will adopt the same EHR system as DoD, now known as MHS GENESIS, which at its core consists of Cerner Millennium,” Shulkin wrote.
He explained that usual procurement rules had been set aside to avoid a lengthy procurement, which for the Military Health System had taken 24-months: “For the reasons of the health and protection of our veterans, I have decided that we can’t wait years, as DoD did in its EHR acquisition process, to get our next generation EHR in place.”
By the VA adopting the same Cerner EHR system as DoD all patient data will reside in one common system and enable seamless care between the departments, Shulkin said.
Because the VA has different needs to the DoD, particularly the need to share information with a range of other healthcare organisations running on different systems, the agency will not adopt an identical version of the Cerner EHR used by DoD.
The open source Veterans Health Information Systems and Technology Architecture (VistA), has been developed since in the 1970s. VistA currently serves more than 1,200 healthcare sites of the Veterans Health Administration throughout the US, but was been judged by the DoD to be outdated and unable to meet changing needs.
Shulkin praised the huge achievements of the VA in developing VistA, and benefits this had brought to many patients, and noted: “In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work.”
“That said, our current VistA system is in need of major modernisation to keep pace with the improvements in health information technology and cybersecurity, and software development is not a core competency of VA.”
He added: “We have consulted with Chief Information Officers from around the country, and I’ve met personally with CEO’s from leading health systems to get their own thoughts on the best next-generation EHR for VA.
“I can count no fewer than 7 Blue Ribbon Commissions, and a large number of congressional hearings that have called for VA to modernise its approach to IT”.
Press Conference of VA Secretary David Shulkin, MD, explaining the decision to switch from VistA to Cerner
11 Comments
This is integration not interoperability, the ability of same brand systems to exchange information is nice, but as others point out that resolves a technical interconnect and one would expect it also addresses semantic exchange, however as also pointed out does this meet interoperability at a technical, semantic and business layer for other people interacting with VA and DOD?
I do not wish to detract from what is being attempted, simply integration is a component of interoperability, but do not mistake it for interoperability which is far more inclusive and powerful.
Must be game over for open source then?
Interoperability must be just too hard.
Cerner and/or Epic are clearly the way to go.
Em, no. I don’t think so.
With due respect to the Cerner employee here and the good stuff they do, the fact that expensive interoperability efforts have been used to justify a move like this speaks volumes of the current state of interoperability across healthcare, as well as the state of the health IT market.
The easy answer may be to go shopping for IBM (a la, no one ever got fired for buying IBM, strike that, make that Cerner) but some of us see beyond that type of logic.
There is another way..
https://www.digitalhealth.net/2017/03/48-bids-open-digital-platform-challenge-fund/
I’ve got to agree with Cerner employee – this isn’t some conspiracy theory that all tracks back to Trump. The VA have been working on how to better interoperate with DoD Military Health Services a couple of decades. This has been coming a while.
People may not agree with the decision to go with Cerner but it’s a perfectly rational decision for ensuring better interoperability between VA and DoD – albeit interoperability of the standardised system kind. The announcement makes clear that VA will still have a load of interoperability challenges working with a range of partners other than DoD though.
And on pricing, rather than low-ball, surely a danger of skipping a tender process is whether this is actually more likely to result in higher prices than a competitive procurement. Either way it’s a big win for Cerner and the beginning of the end of a golden era for VisTa as the flag-carrier for open source EHR/EPR developments.
I agree Jon, however what it does show is how it is difficult to get organisations to exchange information when it goes against the business model of the organisation.
Here we have the open source EHR unable to fully integrate with the Cerner application, so what happens the open source is dropped and the Cerner product is taken, one could ask if this was this a cute business strategy?
We suffer same issues in the NHS, we are asking competitor organisations to share information when fundamentally the business models sometimes clash and it is not in the interest of the companies to collaborate fully with each other, couple of examples would be the MiG/DocMan/MESH/structured messages debate in primary care and then you have the EPR’s systems and information flows around the STP’s never mind nationally, try and get an updated from a ED department in Essex if your attending your home A&E in Newcastle and suffering follow up pain from an accident you had only days earlier.
We need national standards initially which are coming, more importantly we need national drive on ensuring suppliers exchange information freely otherwise i feel our paper free local hospitals will be sending emails to each other manually when a patient is treated elsewhere!
I’m not sure it’s interoperability, Cerner has been quite open with it’s interfacing, it’s the only supplier with anything like GPConnect Tranche 2.
However from what I know of the internal configuration of VistA, it sounds like it has all the complexity on UK interop mis-mash and some extra. Much of it’s internal coding probably hasn’t been updated to latest mumps standards (pre mid 90’s?), so even comparing it to TrakCare (modern mumps) would be difficult. You’re going to struggle getting developers and other IT support staff.
You wonder if CERNER low-balled this to displace the best example of a complete OS system where by all accounts everything worked and it was cheap and efficient to administer – shame it was all in MUMPS.
Will be interesting to see the procurement documents around this.
Lowballed? The financials haven’t been negotiated yet. Stop talking our of your rear, please.
Why shame on MUMPS it can be EPIC!
I wonder how many shares Trump and/or his family have in Cerner?
We’ve been anticipating VA deal long before Trump became the President.
Here – http://investors.morningstar.com/ownership/shareholders-overview.html?t=CERN®ion=usa&culture=en-US&ownerCountry=USA
Comments are closed.