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VA to DoD: Adopt VistA for sake of seamless EHR integration

By Kyle Murphy, PhD

- The task of integrating the EHR systems used by the Departments of Veterans Affairs and Defense (VA, DoD) has turned into a debate about the merits of the VA’s Veterans Health Information System Technology Architecture (VistA) ever since the two agencies informed Congress in February that they would be scrapping the joint integrated EHR (iEHR) in favor of simply making their current systems interoperable.

The problem with this approach, however, is that the DoD doesn’t know what it’s system will be — that, the department hasn’t chosen an EHR system in the wake of its decision “to seek out commercial solutions,” reports Jared Serbu of Federal News Radio. And now the VA is making a strong case for VistA to be that system, which is proving to be an uphill battle.

“The organization strongly believes VistA is the tool DoD can use to their best benefit. But they have to embrace that on their own. If you force-feed it, it will never happen,” the VA’s Acting Assistant Secretary for Information and Technology Stephen Warren told reporters Wednesday. “We believe they’ll come to that conclusion, but we have to give them that opportunity.”

Despite its relationship with the DoD and its obvious affinity for VistA, the VA has already met with resistance from its sister agency.  During a hearing last month before the House Committee on Veterans’ Affairs, the Assistant Secretary of Defense for Health Affairs at the DoD Jonathan Woodson expressed the department’s hesitation in using the solution. “As good as VistA is, it isn’t one system,” he argued in reference to the EHR system’s variation as a result of its open-source nature.

Although information about the DoD’s selection of an EHR system isn’t anticipated until the next week or two, the DoD’s skepticism and resistance relative to VistA doesn’t make it likely that a simple resolution to integrating the two health systems and their EHRs is within reach.

It’s a prospect that Warren is acutely aware of. “The more complex a system is, the more moving parts it has, the more dependent systems there are, all of that adds up to a higher probability of failure,” he explained. “One piece will fail somewhere along the way.”

Having both departments on the same system seems an obvious choice, and this is precisely the case that Warren and the VA are making to DoD:

Running a single system ensures you’re looking at the same record. You don’t have to worry about translating data or staging it, or making sure it’s moving across various systems correctly. It’s in one place, it has one source, it has one use. There’s tremendous value there, and that’s why we think VistA is the path we should go down. But I need to make sure that I respect my colleagues across the river to make sure that’s what they need to do to meet their business needs.

While VistA by no means represent a panacea — it would still need to be implemented and adopted across all the DoD’s sites — it would appear to be the most logical move. But as the partnership between the VA and DoD has shown, it’s not safe to expect anything other than the unexpected.



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