Strategic Missteps by VA re: VistA & Health IT Systems
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.
Spot on. Unfortunately they are doing exactly what they said they were 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
On Nov 8, 2:06 pm, SuperStar <groe...@cs.com> wrote:
> Strategic Missteps by VA re: VistA & Health IT Systems
> 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.
Can we please, please, *not* have this discussion *on hardhats*? 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?
I worked in the VA for over 30 years and most of the time I agree with 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.
On Nov 8, 10:42 pm, "K.S. Bhaskar" <ksbhas...@gmail.com> wrote:
> Can we please, please, *not* have this discussion *on hardhats*? > 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?
There is a line that was not crossed in this message but which, unfortunately, was crossed in others. It is one thing to express the opinion that a certain decision was a strategic error and quite another to make reckless accusations of malfeasance.
> I worked in the VA for over 30 years and most of the time I agree with > 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.
> On Nov 8, 10:42 pm, "K.S. Bhaskar" <ksbhas...@gmail.com> wrote: >> Can we please, please, *not* have this discussion *on hardhats*? >> 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
"Interaction is the mind-body problem of computing." --Philip L. Wadler
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:
> I worked in the VA for over 30 years and most of the time I agree with > 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.
> On Nov 8, 10:42 pm, "K.S. Bhaskar" <ksbhas...@gmail.com> wrote: > > Can we please, please, *not* have this discussion *on hardhats*? > > 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
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Those are good points Greg.... and it would be very helpful if the 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.
Woodhouse Gregory wrote: > There is a line that was not crossed in this message but which, > unfortunately, was crossed in others. It is one thing to express the > opinion that a certain decision was a strategic error and quite another > to make reckless accusations of malfeasance.
> On Nov 9, 2007, at 5:42 AM, SuperStar wrote:
>> I worked in the VA for over 30 years and most of the time I agree with >> 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.
>> On Nov 8, 10:42 pm, "K.S. Bhaskar" <ksbhas...@gmail.com> wrote: >>> Can we please, please, *not* have this discussion *on hardhats*? >>> 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
> "Interaction is the mind-body problem > of computing." --Philip L. Wadler
Rather than pushing this side issue much further (at some cost to the 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.
