What I sent to congressional staff members yesterday

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Nancy Anthracite

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Feb 21, 2017, 11:58:20 AM2/21/17
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This is probably why Christopher contacted me. I sent this out to about 100 congressional staff members yesterday. The attachment was a slightly updated version of what you have seen before...

 

http://opensourcevista.net/NancysVistAServer/WhyTheVAShouldKeepVistAPlusCommentOnTheCommissionOnCare-02-07-2017.doc

 

and the subject line was "Are there good Reasons for Replacing VistA? "

****************

Well-meaning people believe that VistA is replaced with a COTS product, that the problems the VA is having will be greatly reduced, costs will go down and many of the problems with IT in the VA will be solved. This will almost certainly not be true.

 

You have already seem the attached paper explaining why VistA should not be replaced, but what you have not seen is what the replacement is likely to be like.

 

In 2007, 50% of all implementations of EHRs failed. I doubt it is anywhere near as high now but that is largely because of the artificial environment created by the HiTech Act and the payment system being linked to using a Meaningful Use certified EHR. Now an EHR installation has to succeed or a hospital will go out of business. This does not mean that hospitals and those caring for patients are delighted with their EHRs. They basically have been forced to swallow a somewhat bitter pill. Even Mayo is replacing its Cerner and Centricity EHRs looking for something better, but better is not ideal. (see http://www.motherjones.com/politics/2015/10/epic-systems-judith-faulkner-hitech-ehr-interoperability)

 

HIMSS is the big showcase for Electronic Health Records that occurs yearly. As I recall, 40-50,000 people attend. Andy Savitt, who just resigned at as administrator for CMS, was quoted in POLITICO as follows:

 

"I get a little bit sickened every time I go to HIMSS, in some part, because we've got this massive industry that puts on a great party and has massive shows, and yet they have a customer base that is basically unsatisfied with the product. That seems like it's where we should put all our energy. From Politico eHealth Newsletter, Feb 13, 2017

Most CEOs are not going to admit that implementing an EHR was a mistake. It may be in the contract with the EHR or, after all, that would be admitting to what might have been a multibillion dollar error or their part. VA management does not suffer from that problem. By the time a new EHR is implemented, upper management will have been replaced and only the users and patients inside and outside of the VA will face the consequences.

Installing a COTS EHR is not going to get rid of problems, it is just going to create a whole set of new ones. All of the work that has been done to customize VistA for Veterans will be lost, productivity will go down as it always does with a new EHR implementation, and the VA will be locked in with a vendor that may not be able to provide for its needs and costs will go up. It is virtually certain that two EHR databases will have to be maintained so veterans' data will not be lost.

As you have seen in the attached paper, VistA was the highest rated EHR for user satisfaction in the Medscape survey for both 2014 and 2016. VistA was built to be what users wanted and needed, not foisted upon them by financial necessity. It is not prefect and never will be, but all EHRs are alive and growing and improving as circumstances change, not something static and VistA is no exception.

The lament is that the VA has all of its expert retiring and therefore cannot maintain VistA, but this can be fixed. The truth is that the VA has done almost noting to prepare to replace those retiring personnel. Generally programmers have expertise in multiple languages and can relatively easily learn a new one, but they have to have deep expertise in the products they support to do great work. To do that they have to be hired, trained and retained. The VA has done almost nothing to sustain its programming staff and has wasted hundreds of millions of dollars on poorly informed contractors. Within a year with rapid hiring and training, this problem can be largely reversed if people will commit to it. The hiring freeze should not affect this as good programming for an EHR is a patient safety issue.

 

Thank you for your consideration. If you would like to speak with me, I am generally available to come to DC on Wednesdays. The other days I am occupied with patient care.

 

Nancy Anthracite, MD

240-246-0123

240-793-743699 (cell)

 

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