Grant-Thornton Report - A FOIA request just came through after 2 years

[Nancy Anthracite]

If you recall, Dr. Shulkin made the statement that based on this report, for the VA to keep maintaining VistA would cost more than implementing Cerner.

From my initial read scan of the the report, the statement Dr. Shulkin made is NOT even addressed in the report.

 

This report addresses the VA adopting a commercialized VistA as one of 4 options and maintaining and upgrading VistA. Keeping VistA open source and maintained by the VA was not even considered. It certainly does not address the option of returning to using VA programmers to maintain VistA and upgrade the software, which is what the open source community know needs to be done.

 

The commercialized VistA option was the least expensive at $12B total expensive of the estimates of 4 different options, none of which were for the VA to maintain VistA. The estimate for a for COTS system was $16B total with an estimate of $5.5B of that being for the software vendor, considerably less that the $10B of the Cerner contract.

 

It also cites dissatisfaction with VistA as if using a COTS product would cure those problems. We we already know what most physicians think of COTS products based on the never ending complaints of dissatisfaction with the COTS EHRs that we are seeing in news reports.

 

A link to the report can be found here:

 

http://opensourcevista.net/NancysVistAServer/GrantThorntonReportFINAL20170601.pdf

 

Nancy Anthracite

 

[Nancy Anthracite]

I have to correct myself. I looked up when I submitted the FOIA request for the Grant-Thornton report and it was in November of 2017, not 2 years ago.

 

Nancy Anthracite

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[Nancy Anthracite]

I also am beginning to wonder if I got the right Grant-Thornton report. I just found an excerpt from an autogenerated transcript from a November 15th hearing of the House Appropriations Committee that said the following:

 

"upgrading and maintaining Vista to industry standards will cost

approximately 19 billion dollars over ten years that's an independent study

that was done by Grant Thornton and we will still not achieve the necessary VA

DoD interoperability that the new EHR system that we're proposing will provide

the new EHR system over ten years we'll be billions less than the 19 billion"

 

So I need to go back and put in another FOIA request.

 

Nancy Anthracite

[Nancy Anthracite]

Here is a link to the whole autogenerated transcript of the House Appropriations Committee meeting from Nov. 15, 2017.

 

http://opensourcevista.net/NancysVistAServer/AutogeneratedTranscriptOfHouseAppropriationsSubcommittee11-15-2017.txt

 

Nancy Anthracite

[Dennis Murphey]

I tried to read it but found very little factual technical content, a lot of hopey changey stuff. You just know the oversight and technical judgement will be flawed, the budget will swell and nothing will work. I just know it.

My eyes ache.

"We have an RFI out to connect Cerner to other 3rd party COTS EHR systems, we're gonna get that done."

What are they smoking?

Dennis

[Dennis Murphey]

I still get irritated when i read how the VA needs to get out of the software business and focus on caring for the Vets. I recall the 4 hour waits in the ER, cobwebs in the corners and 3 terminals on one physicians desk.

But also the forced regulations on accountability and records that drove the VA IT to create 130 systems to perform all the required tasks. No system on earth has these same requirements. The VA had to develop these types of systems. And today there is no COTS that can take over all 130 system functions. And budget. $20B over 10 years is a hell of a software development startup contract. I am shocked we can't find a means to ease into a Next Gen VistA with the progress in software methods and tools by addressing low hanging fruit, to really migrate in a slow controlled manner with open standardized interface standards that can survive long term. Its not a technological wonderment, its a lack of intelligent management and basic will.

I almost think simple greed is at fault.

The COTS provider lobby must be poisoning this process. That's not new.

Neither is ignoring Veteran's plight while egos fight over control. I always felt this was the root cause.

Seems VA should be the leader in Medical Info Exchange Technical Solutions and i don't mean an RFI for COTS. I mean the old Center of Excellence approach with best and brightest in info exchange, standards, validation testing, verification testing and a serious management oversite in execution. We need EVERY COTS EHR to contain an import export function the meets a standard format and can exchange information reliably. 

Oh i forget, i am retired, too old to be relevant, so many new kids know so much better. They are not going to pay for a standardized middleware environment, they want true open source just program to our specification.

Really, how is working out?????

Sorry just feeling bugged out today.

Dennis

[Nancy Anthracite]

All COTS EHRs do need this, but the government and industry needs to figure out what to export and how to exchange it, and that is a work in progress. What they are doing now is not clinician friendly. But lobbyists, the COTS systems and the VA seem to be more comfortable blaming the problem all on VistA. Dr. Shulkin found out for himself how bad it is after he was at it for a while, but I think that initially he was even buying the fiction that the problem was VistA.

 

FHIR is probably the standard that is going to win out for the content that is not imaging, but FHIR is a standard in the process of being birthed, not finalized. I am sure in the end the Cerner exchange solution, which will be used for collecting data from VistA and probably from all of the Cerner instances, and will exchange with outside entities, will use FHIR. The VA is already working with Intersystems to use their product to do FHIR exchanges. I see no reason that the data being delivered to Intersystems by VistA can't either go from the Intersystems product to Cerner or to the Cerner equivalent directly, and the job of intake from FHIR can't be made part of VistA so the whole need to replace VistA can go away and save 10s of billions.

 

Meanwhile, the VA needs to quit screwing around with huge risky contracts and get back to doing their own development. They also need to get the developers back out into the hospital and again beef up the CACs and ADPACs to interact with users and aid in the innovation and the testing.

 

I firmly believe that all VA hospitals and DOD hospitals and clinics are not going to be entering data into one instance of Cerner as the SQL database is not fast enough to satisfy the rapid pace of clinical care. Maybe the data will eventually get to the VA equivalent of the Corporate Data Warehouse, but it is time the wool stops being pulled over peoples' eyes about this.

 

VistA needed an infrastructure upgrade ever since the VistA instances were moved into data centers and performance suffered, but that was not done. Now they are going to have a massive infrastructure upgrade for Cerner, after neglecting VistA, and then they are bound to claim it is Cerner that is the reason for the improvement, not infrastructure neglect.

 

Have you also noticed that there seems to be a large element of blaming the VA IT budget on VistA and a belief that "The Cloud" cures everything?

 

Also, the VA has taken a lot of heat about not interoperating with the DOD. The observations made by the IG and mentioned by Rep. Wasserman-Shultz (see next paragraph) in the Appropriations Subcommittee meeting were enlightening and make me wonder if it has been the DOD that was the issue all along:

 

" Okay. Speaking of governance, the--the collaboration with the various councils and forums where VA doctors, nurses, clinicians, have been advocating for the needs of the VA system, we're also getting feedback that it's not really being taken seriously. It is heard and dismissed. Does DOD participate in these clinical councils? Do they have any decision making authority there? The last thing we want to see is doctors and nurses taking large blocks of time out of their, obviously, you know, full time jobs to provide that kind of feedback and to advocate for the kind of workflows that they want to see out of the Cerner system, only to be overruled by DOD. And so I understand that you're saying that's not the case, but we have a very stark difference of opinion coming to us from the Office of Inspector General. And so if you don't have lack- if you have a lack - of clinician buy-in, which is a major lesson learned from DOD, then this is not going to go well. "

 

Enough for now.

 

Nancy Anthracite

[Joseph Dal Molin]

Writing your own software doesn't mean you're in the software business just like cooking your own food doesn't mean you're in the restaurant business, even if you can cook much better than a restaurant.

Cheers

Joseph
--
Sent from my mobile device please excuse my brevity.

[rrichards]

Nancy,

I was at a press conference with Dr. Shulkin in early March 2017 at the Newseum in DC.

At this meeting he said there were multiple "Blue Ribbon Reports", as well as a report

from Grant Thornton that it would cost VA  $19B over the next decade to maintain VistA.

This cost analysis was the primary motivating factor used by Shulkin to switch to Cerner.

A few weeks later - late March 2017, Dr. Shulkin announced signature of the Cerner contract

based on all of these 'blue ribbon' reports and pressure from the President's son-in-law.

The Grant Thornton report we need is from sometime between Feb- March 2017, not November 2017.

Could you request this again?  This is a critical document to help VA out of this false narrative.

Rafael