During most of my career in pathology informatics, controversy has been simmering about VistA (Veterans Information Systems and Technology Architecture) which is the EHR developed by VA technocrats in 1985 (see: VistA). I even served on an NIH committee years ago discussing whether VistA should be terminated with the accompanying mandate that the VA turn to a commercial product. My understanding at that time was that VistA had originally been developed as a "skunkworks" operation within the VA. This was easier than the requirements for other EHRs because there was no patient billing module necessary.
Almost all of the physicians whom I have known who have worked with VistA have admired it in comparison with competing commercial products. However, the days are long gone when a health system, even one as huge as the VA, should be maintaining a home-brew EHR. Attention and time need to be paid to newer technologies that can reduce costs such as telemedicine. Moreover, there has been intense political and lobbying pressure over the years to covert the VA to a commercial EHR. This has often come from members of Congress supporting EHRs developed in their back yards. This pressure won't stop under Trump.
The story gets even more complicated because of long-standing controversy about the integration of VistA with a military EHR which makes perfect sense. However, even the various military branches may not see eye-to-eye on this issue. A comprehensive article was recently published about VistA (see: A 40-year 'conspiracy' at the VA). Below is a short excerpt from it. Read the whole article if you are interested.
VistA had become a victim of the factors that led to its strength. Its distributed development resulted in a thousand flowers blooming, each one a different species, and in the foggy ruins of time no one could identify the people who wrote the code or how it could be amended. Managing all of those applications across a 167-hospital national system, some said, was a nightmare—more than half of the VA’s $4 billion annual IT budget goes to maintaining existing software. Under its current tentative plans, the VA will continue to update VistA’s interface through 2018. After that, the VA is likely to swap out VistA for a commercial EHR. The speculation is that bid would go to Leidos and Cerner—if their current partnership with the DOD continues to move along on schedule. Some believe the fix is in already, because a number of Leidos IT specialists already work inside the VA. At least two other big EHR vendors, Epic and Allscripts, say they’ll also bid to take over the VA’s EHR duties. This is bitter fruit for many VistA fans. Some still say the system could be fixed for $200 million a year—the cost of a medium-sized hospital system’s EHR installation....
Replacing VistA could be a colossal task—the military is spending $4.3 billion to switch to a Cerner EHR by the end of 2022, and Baker has estimated it could cost the VA $16 billion to rip and replace VistA. To maintain the functions that doctors like about it would require intricately lacing together new and existing software. Pitching all the good old stuff because it’s too old and complex to integrate with a new EHR would be tremendously wasteful and frustrating to doctors. A decision on whether to switch to a commercial system has been set for July 1. Some, including former CIO Baker, think the VA should wait until at least September, at which point the IT world will have a clearer picture of how the military’s implementation of a Cerner EHR is progressing.
An EHR vendor can expect decades of revenue from the government and the military once a foot is inserted in the federal contract door. Hence the attraction of such a contract that will amount to many billions of dollars. There will also be plenty of aggravation and bad press involved. All of this VistA story is curious, however, because federal agencies are typically not known for their skills in innovation. The VA IT specialists developed a great product early but politics and time have combined to make it increasingly obsolete. The story perhaps could have been much different.