Guest Commentary: Tom Munnecke on VistA Lessons Learned

I fear that many of the lessons learned from the development of the Veterans Health Information Systems and Technology Architecture aren't sufficiently counted in planning tomorrow's VistA.

As one of the original designers of the Department of Veterans Affairs' VistA system, I watch with interest department efforts to create a next generation electronic health record.

I fear that many of the lessons learned from the development of the Veterans Health Information Systems and Technology Architecture aren't sufficiently counted in planning tomorrow's VistA.

To begin with, we need to recognize how well VistA works. Given other large-scale government information technology efforts, this might even be considered miraculous. The billions spent on the Defense Department's AHLTA (it might as well stand for "Ah Heck, Let's Do it Again") have led to a system which is so bad that it is one of the leading complaints cited by doctors when they leave military service. And here we come to a first lesson learned: Evolutionary development.

In contrast to DoD's "break and replace" development strategy, VistA has been under continuous evolution over the past 32 years. There have been thousands of errors made in the evolution of VistA, but generally they have been caught in the early stages. Like biological evolution, there VistA progressed by a series of small steps--even with people working on similar ideas in different parts of the country. VistA never started with a vision of the one correct way to the perfect EHR. Rather, it was a process of discovery, searching and amplifying what worked.

Secondly, our design philosophy was to get something that was "good enough" out in the user's hands, and then make it better. Rather than writing elaborate specifications, we wanted to introduce iterative generations of software.