What's Up with VistA? I'm glad you asked.

VistA (Veterans Health Information System and Technology Architecture) is the VA's home-grown electronic medical record (EMR). You can read about its complex history at this web site as well as its adoption over the years by other federal agencies (see: VistA & Federal Agencies). There has been some movement in recent months to replace it, despite its history of success, with a proprietary system (see: Why are reformers destroying Veterans’ health computer system?).

I have covered Dr. Scott Shreeve in previous notes. He lectured on the topic of Health 2.0 at Lab InfoTech Summit 2008. Scott has a tight connection to VistA as a co-founder, with his brother Steve, of Medsphere that Mr. HIStalk described in the following way in an interview of Scott: Medsphere is the un-cola of the industry, the little company whose patch of beach is to bring a commercialized version of the VA's acclaimed VistA system to the hospital masses, offering a less-expensive alternative to that majority of hospitals unable to afford what the big boys are peddling. 

Here's Scott's version of what he would like to happen with VistA (see: Act III: VistA Will Find a Way):

The VA and DoD could agree to leverage the current investment, build on a growing international community of users, and burgeoning army of private sector VistA companies who could embrace, extend, and dramatically improve upon the core VistA offering. I am confident that the open source community, powered by private sector financing, could come up with a far more elegant, cost-effective, and realistic interoperability/ replacement solution than anything that the VA and DoD could come up with. There is NO DOWNSIDE to throwing this problem over the proverbial open source fence and letting the community chew on it (any warm body within the VA/DoD should realize that this will shut up the community as well!). You can even continue to waste hundreds of millions of dollars in parallel (which you will probably do anyway). Again, no downside.

Mr. HIStalk provides below his usually correct opinion about this whole VistA controversy:

Scott Shreeve weighs in on the apparent DoD-led conniving to dump VistA in favor of vendor applications. Given that DoD has given big consulting firms billions of dollars to develop its AHLTA system, you can bet that lobbyists are whispering in a lot of political ears to make VA follow the big bucks model, which unfortunately trumps any consideration of VistA’s superior track record. The VA has made some boneheaded and ego-driven IT mistakes, but VistA isn’t one of them.

Scott more recently has even more to say about HealtheVet (see: Dude! The $100M VistA Open Source Opportunity), which is the current VistA modernization project and quotes an article covering GAO oversight of the project (see: GAO: VA’s HealtheVet needs plans).

“Although VA has made progress on its $11 billion HealtheVet initiative, it has also experienced significant delays, and NONE of the associated development projects have been completed. Moreover, VA is proceeding with this complex initiative without a project management plan and validated cost estimates to coordinate and guide the effort. At the same time, a governance structure for HealtheVet has not yet been established, and key leadership positions that are responsible for providing day-to-day oversight have not been permanently staffed. Further, several IT governance boards with oversight responsibility for HealtheVet have not yet performed essential reviews of HealtheVet projects to gauge progress and funding requirements and the department lacks a time frame for doing so. Until the department takes the necessary actions to fully address these matters, it will face the risk that HealtheVet may experience cost overruns and continued schedule slippages, and may not achieve the outcome it intends to achieve.”

I hope that all of this is now clear in your minds. And believe me, this issue is not going to go away quickly. Now is a good time to come up to speed.