VA and OSEHRA Respond to DoD's EHR RFI

The US Department of Veterans Affairs (VA) has just submitted a proposal to the Department of Defense for the Military Health System to migrate from its dysfunctional Electronic Health Record system (EHR) to the world-renowned EHR developed by the VA, VistA. The proposal was submitted in response to a Request for Proposal from DoD requesting advince on how to replace their current systems with a fully functional EHR.

The VA drafted the proposal in collaboration with the open source VistA community, including members of World VistA, Hard Hats, and the Open Source Electronic Health Record Agent (OSEHRA) organization. The full text of the proposal is found here.

This is a very hot topic in Washington today. Yesterday, the House Committee on Veterans’ Affairs held a hearing on the status of the iEHR effort. The hearing took a turn, however as Congressmen started grilling the DoD represetives over their failure to just simply implement VistA.  Assistant Secretary of Defense for health affairs, Jonathan Woodson, MD, promised the panel that DoD would look at the proposal submitted by the VA, together with the proposals of proprietary EHR vendors, and make a decision by the end of March.

This whole issue was examined by veteran journalist Joe Conn in an excellent article in Modern Healthcare titled DoD Should Make Right Decision and Adopt VistA. Conn points out "The military, meanwhile, is still working on multiple iterations of its own EHRs . None of them are comparable to VistA, or fully interoperable with it, in large part because the military has always gone at it the wrong way—top-down instead of bottom up, says programmer Tom Munnecke, who worked on early versions of both the VA's and the military's EHR systems."

Open Health News has also written an extensive analysis of the problems with the DoD approach to their EHR that can be read in this article. Over the past twenty years DoD has spent over $10 billion to develop an EHR. It has suffered several spectacular failures and the current system, AHLTA, is dysfunctional and passionately hated by all the users. In contrast, VA's VistA is widely considered the world's best hospital-based EHR and has been in use by 100% of all VA medical facilities for almost 20 years. In the past few years, more that 50 private and State hospitals in the US have successfully implemented VistA at a fraction of the time, effort and cost compared to proprietary EHR implementations.

Interestingly enough, the greatest impetus for change in the DoD's failed approach to its EHR implementation is the arrival of Chuck Hagel as Secretary of Defense. As detailed by Tom Munnecke in a blog post titled "Chuck Hagel – One of the Fathers of VistA," Hagel, Deputy Director of the VA in the early 80's, played a key role in the decision to implement VistA across the VA. Speaking at the recently concluded VistA Community conference in Sacramento, CA, VA CIO Roger Baker told the audience during his presentation that everybody at DoD had read Munnecke's blog post.

The full text of the VA's response to the DoD RFI is found here. It is an excellent proposal. We will have more to say as the story unfolds.