VA Strategic Missteps re: Health IT Systems
SuperStar
I have been watching some of the steps VA has taken over this past
year with regards to management of health IT systems that I would
consider to be major strategic missteps. The following are some
informal observations.
VA reorganized and centralized its IT resources under the VA Office of
Information & Technology (OIT). Rather than centralizing selected
corporate wide functions and resources (e.g. planning, policy,
security), the VA went further and centralized IT development and
operations resources of all administrations under OIT. Rather than
following best practices that have emerged and are being followed by
many other organizations with regards to decentralizing management of
these type of resources to the business side of the house, the VA
chose to pursue an approach that was widely used in the past but which
are no longer strongly advocated. The expected result will be a loss
of innovation, lack of responsiveness to business needs, and a
tendency to lose its leadership position in the healthcare industry,
especially with regards to health IT systems.
The VA Office of Information & Technology (OIT) recently chose to
award a contract to Cerner to replace the VistA laboratory module.
This seems to be part of a pattern of steps being taken to unplug
VistA software modules over time and replace them with commercial off
the shelf (COTS) products. This strategy leads to a system composed of
a mix of multiple, costly commercial systems that will all need to be
interfaced - an approach that many private sector hospitals have put
in place and been roundly criticized for following. The VA has
consistently been praised for the tightly integrated VistA software
modules that are written in the same language, use the same database,
and require no extensive interface solutions. This appears to run
contrary to recommended best practices in health IT.
The VA Office of Information & Technology (OIT) has begun to
centralize its hospital information systems at four regional
processing centers. Unfortunately, one of these centers recently went
down basically disabling all the VA healthcare facilities on the west
coast, Hawaii, and Pacific Islands. While on the surface this was an
unfortunate incident and centralizing IT systems seems cost effective,
that may in fact be way off base. If you think of centralizing data
that will simply be viewed by users, like a personal health record
(PHR), this makes sense. However, if you use a different analogy and
realize that hospitals are very similar to factories, and hospital
information systems are interfaced to laboratory equipment, radiology
x-ray and MRI systems, pharmacy Rx dispensing units, bed control, and
food handling systems this makes no sense. Patient care at a hospital
is handled in a very systematic way, with patients moving down a
production line with specialized components put in place to serve the
needs of the patient and healthcare provider - much like a healthcare
'factory'. Ford or GM would not centralize the operation of its
information systems and equipment located in a factory that make up
the line used to produce and/or care for their product - cars.
Similarly, centralizing a hospital system being used in the minute to
minute care of a patient as they move through the hospital makes no
sense. You can centralize a PHR or EHR data repositories to view data,
but not a heavy duty industrial automated system being used in patient
care.
Finally, the VA Office of Information & Technology (OIT) has begun to
disengage from its health IT partnering activities with the larger
'open' VistA community that has grown quite large. This unfortunately
leads to an inability of the VA and the federal government to tap into
the knowledge and development resources that community is willing to
make freely available to the VA. Given the continual change to
healthcare and health IT systems, this is a potentially great loss. It
slows down innovation, ability to rapidly change, increases costs, and
harms efforts to help the country to move towards interoperable EHR
systems and health information exchange (HIE) networks.
If I could think of four strategies I would think the VA would
absolutely choose to avoid, the new OIT management team has chosen to
pursue all four.
iva...@hal-pc.org
going to do. I challenged Paul Tibbits, VA deputy CIO for enterprise
development at his HIMSS talk in March when he presented
unintelligible gibberish for centralization of VA health IT and
belittlement of what software engineers do. His only acknowledgment
when I pointed out that this had not worked in the past was that the
cycle was towards centralization for now and that it would probably go
back to decentralization in the future and 'it depends on what your
definition of works is'?!?? In all my life it was a first for me to
get up in the middle of a talk and leave in anger after being
presented with the senseless destruction that was to come.
-- IV
K.S. Bhaskar
There are people who work at the VA and who contribute to this forum
and we don't want to drive them away. *Any* political discussion in a
forum they participate in can jeopardize their position at the VA, and
they may cease to participate in the hardhats list. We need this
forum for technical discussions, and by not disciplining ourselves we
are cutting our own throats. The VistA community cannot thrive
without the active participation of technical experts, many of whom
work at the VA.
PLEASE RESTRICT THE HARDHATS FORUM TO TECHNICAL DISCUSSIONS ONLY.
PLEASE?
Thank you very much.
Regards
-- Bhaskar
SuperStar
Bhaskar, but unfortunately, in this case I disagree. There is a need
at times to discuss strategy and point out missteps and suggest
corrective action. The strategy effects the technical side of the
equation.
Woodhouse Gregory
K.S. Bhaskar
All I can say is that there are people who work at the VA and who have
been contributing to this forum and who feel the need to leave if
non-technical discussion continues. I cannot say whether your post
specifically made them uncomfortable but the topic certainly does. A
forum for discussion of technical aspects of VistA is crucial for
VistA's success outside the VA. So let's keep hardhats technical.
As discussed, there are other forums for non-technical topics:
Business related: http://yahoogroups.com/group/worldvista-services
Civilized VistA related discussion that doesn't fit anywhere else:
http://groups.google.com/group/vista
Thank you for understanding.
Regards
-- Bhaskar
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Joseph Dal Molin
moderator(s) of this list created a short list of important does and
don'ts for this list so the line is well defined and so that no one is
turned away or feels they have to leave.
Joseph
JohnLeo Zimmer, MD
comfort level of Hardhats membership), let's take a stab at using
http://groups.google.com/group/vista for this discussion. That list has
never really gotten off the ground.
I've taken the liberty of forwarding one small piece. I'll have to add
that list to my Thunderbird, etc. Then maybe we can have the best of both.
With respect to all,
GrandpaZ