VistA: Could a Phoenix Rise from the Embers?
The VistA (Veterans Information Systems and Technology Architecture) EHR system, with its initial development dating back to 1977, was one of the first Electronic Health Record Systems in the world. For many decades it has been recognized as a leading Health Record System. In addition, since VistA is open source software, an implementation can cost orders of magnitude less than commercial systems. VistA was designed by physicians for physicians. As a result, it continues to rank highly on user satisfaction and usability up to the present day. However, it would be no surprise to say, with the announcement made in May 2018 of the US Department of Veterans Affairs (VA) that they decided to replace VistA with the commercial Cerner system that questions could be raised about VistA’s long-term future.
There is a perception that VistA is old and out of date. However, I strongly believe this perception is more of a messaging issue rather than a technology issue. There has been a mismatch in communication between decision makers, hospital users and the hardcore VistA engineers. VistA was designed by doctors, and doctors continue to find it easy to use. However, the developer community has diminished, and I would say the system is some 10 years behind where it could have been had the initial momentum among developers continued. However, VistA is still technically very sound and is an extremely competitive option for any healthcare institution.
VistA is a very solid and cost effective EHR infrastructure. Unfortunately, EHR infrastructure and tooling is not a very sexy topic. Want to put a room full of people to sleep? Throw together a slide deck on refactoring and web services. But it’s a conversation that needs to be had because once you have good infrastructure, everything else becomes easy. Want an Instapot delivered to your door next day? Amazon needs good infrastructure to distribute packages quickly and efficiently. Looking to binge watch Game of Thrones this weekend? Our telecommunications backbones make that possible. We barely need to think about the logistics associated with these things because these pieces of public infrastructure are just there and work.
I would also say there seems to be a lot of business potential in VistA. Oroville Hospital in rural California is a great example of how VistA can be successfully implemented at a fraction of the cost of commercial systems. One of the key factors I’ve seen in successful VistA implementations is quite simply that they wanted to do it and they put the resources behind it. Oroville Hospital has been consistently ranked in the top 5% of US hospitals in terms of quality measures. Oroville Hospital accomplished this at a fraction of the cost of what other hospitals have spent in their EHR systems. As described in this article, one of the key steps that Oroville Hospital took was bringing in the right CIO, someone that Oroville Hospital CEO Robert Wentz described as a ‘wartime CIO’ who was just willing to roll up his or her sleeves and get the job done.
There seems to be a large gap in the marketplace regarding inexpensive, quality open source EHR options. VistA is well positioned to compete in this space. I think with all the investment the VA put into VistA, it got close to a working public/private model with OSEHRA; at least the groundwork was laid. In addition, the VA has committed to continue supporting VistA for at least the next decade. With this in mind, OSEHRA or an organization like it could continue to serve the role of VistA custodian while companies develop their individual models around marketing full EHR solutions based on VistA. VistA has an active community. Entire nations such as the Kingdom of Jordan are still committed to running the entire nation’s health infrastructure on VistA. What VistA needs is a messaging overhaul and the community must step fully into the 21st century if VistA is going to be an EHR powerhouse over the coming decades.