Link to the Senate hearing on VA Electronic Health Records: Modernization and the Path Ahead - Recording of the Senate Meeting

[Nancy Anthracite]

https://www.veterans.senate.gov/hearings/va-electronic-health-records-modernization-and-the-path-ahead-07-14-21

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Nancy Anthracite

[Kevin Toppenberg]

I've been listening to this while doing some other tasks...  I'm about 1 hr in... 

I hear lots of questions like "I have concerns about issue ABC" and the director saying "Yes, ABC is a real problem, we are going to address this."  It is hard for me to see if this is grandstanding?  Or are they actually providing steering directions to the VA IT director?  If so, then can the VA IT director work effectively with ~17 congressional bosses?  One person said that they had been working on this issue for the 15 years he had been on the committee....  How would this compare to a project progress in Silicon Valley?  Are legislators even competent to guide a technology project?  The skill sets needed for getting elected likely don't overlap with the skill set needed to successfully get such a monumental task completed. 

Another thought is that anytime there is a large organization, it would be easy to create a report of bad things happening.  I hope that by using the OIG that the reports are neutral.  But it would be interesting to compare reports of burnout with Cerner to burnout with VistA.  Is it that Cerner is of poorer quality?  Or is it that change is difficult?

To me it seems that the entire process involves > 10,000  persons all putting in an effort "good enough for government work."  And I don't see how it could possibly  be controlled.  It seems like a glacier slowly grinding its way down a mountain.   So the options seem to be to keep feeding it billions of dollars, or throw the entire thing out and waste the billions already spent.

Good grief...

Kevin

[John P. Willis]

You're so spot-on with this analysis, Dr. Toppenberg. I think another of the problems is a lack of accountability: even

if these politicians had the skill and foresight to understand and oversee projects of this magnitude, they always know

that if they just keep feeding the beast, even if it fails, they'll probably be out of office by that time anyway. Or, they

can blame it on VA upper management and do a shakeup of VA bureaucracy.

Fixing these problems IMO will require a wholesale re-evaluation of how public-sector IT is done, and a deeper investment

in community involvement. Not just creating another kneecapped-from-the-start agency like OSEHRA, but an organization

within each nucleus of public-sector IT activity (VA, DoD, and even non-healthcare-related agencies) that has real resources

dedicated to evaluating and integrating community contributions into their software lifecycles. I'm talking along the lines

of dedicated staff within each agency that can evaluate pull requests and merge them when appropriate, and providing

feedback when they're not.

It also requires healing the COTS pandemic in the public sector: they have to learn at some point that public-sector

operations are fundamentally different and with different workflows from private-sector operations. But, communities that

operate on free software principles tend to have goals more in line with the public-sector by nature. There could be a really

healthy and beautiful relationship built up in such kindred communities, if the specter of lobbying dollars was severely

curtailed.

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