The Real Story About COTS for the VA

There has been a tremendous amount of news coverage of recent congressional hearings about the need for the Department of Veterans Affairs to replace its existing electronic health record technology. What's even more remarkable is how one-sided the discussions and the reporting have been. For anyone without a background in healthcare IT, it would seem like a slam dunk that moving to a commercial off the shelf electronic health record solution is the best way forward for the VA.

However, there is another side to the story that needs to be told. EHR solutions proposed by COTS vendors are in fact a very risky, "rip and replace" move for the VA. If adopted, they will cost billions and potentially jeopardize the continuity of care for millions of veterans. The current VA Health Information System is known as the Veterans Health Information Systems Technology Architecture, or VistA, which contains the VA's EHR. Despite proven gains in patient safety and a clear role in pioneering the field of clinical informatics, VistA has become a punching bag in recent years, often blamed for challenges in the delivery of care that have more to do with the volume of need and supply of medical staff, rather than technology.

The truth of the matter is that VistA was designed specifically for the unique needs of the VA with over 150 customized medical applications, which are more complex and focused on longitudinal care over time than episode-of-care-oriented, revenue-driven COTS systems. VistA has been updated and improved repeatedly since the late 1980's, and it can continue evolving to meet the changing IT needs of the VA and veterans...