Veterans Affairs’ transition from its legacy VistA EHR to the $16 billion Cerner platform.
This is the typical lobbying effect and waste of public money.
This is a twelve zeros scam
$16 billion((16,000,000,000,000)
As an internal medicine physician who worked in VA for 12 years and was a power user of legacy VistA EHR this I think is the biggest scandal of this decade.
A little History:
Long Long time ago when private players did not even hear the word electronic medical records ,VA took a bold decision.
and employed physician_Developer teams to develop VISTA.
VistA's actual architecture genesis, then, to 1977
The Veterans Information Systems and Technology Architecture (VISTA) is the nationwide veterans clinical and business information system of the U.S. Department of Veterans Affairs. VISTA consists of 180 applications for clinical, financial, and administrative functions all integrated within a single database, providing single, authoritative source of data for all veteran-related care and services. The U.S. Congress mandates the VA keep the veterans health record in a single, authoritative, lifelong database, which is VISTA.
VISTA supports the clinical, administrative, and financial operations of over 1200 hospitals and clinics of the Veterans Health Administration (VHA).[1] The VHA is the largest integrated health delivery network in the United States,[2] providing care for over 8 million veterans by 180,000 medical professionals throughout the continental U.S., Alaska, and Hawaii on a single, integrated national healthcare information network of VISTA systems.
VISTA was developed by physician-developer teams within the U.S. Department of Veterans Affairs (VA), and as such has high physician user satisfaction. VISTA received the Computerworld Smithsonian Award for best use of Information Technology in Medicine in 1995, and continues to receive the highest overall physician satisfaction scores in national Electronic Health Record (EHR) surveys. In 2014 and again in 2016 national surveys of over 15,000 physician end-users of EHRs rated VISTA/CPRS the highest overall, above all other commercial EHR systems.[4] Over 65% of all physicians trained in the U.S. rotate through the VHA and use VISTA/CPRS, making VISTA the most familiar EHR in the U.S.
It is not only used for VA but gained international fame and
institutions in Finland, Germany, Egypt,[19]Nigeria,[32] and other nations abroad have adopted and adapted this system for their use, as well ( based on FOIA).
The four major adopters of VistA – VA (VistA), DoD (CHCS), IHS (RPMS), and the Finnish Musti consortium – each took VistA in a different direction, creating related but distinct "dialects" of VistA. VA VistA and RPMS exchanged ideas and software repeatedly over the years, and RPMS periodically folded back into its code base new versions of the VA VistA packages. These two dialects are therefore the most closely related. The Musti software drifted further away from these two but retained compatibility with the infrastructure of RPMS and VA VistA (while adding additional GUI and web capabilities to improve function)
The VA and the DoD had been instructed for years to improve the sharing of medical information between the two systems, but for political reasons made little progress toward bringing the two dialects back together. Many VistA professionals then informally banded together as the "Hardhats" (a name the original VistA programmers used for themselves) to promote that the FOIA (Freedom of Information Act) release of VA VistA (that allows it to be in the public domain) be standardized for universal usage.
VISTA is based on MUMPS programming language
Massachusetts General Hospital registered "MUMPS" as a trademark with the USPTO on November 28, 1971, renewed on November 16, 1992, and expired on August 30, 2003.[21]
https://www.slideshare.net/george.james/mumps-the-internet-scale-database-presentation/3-Internetscale_database_challenges_ulliRapid_growth
So why now the federal government and VA handing over $16 billion((16,000,000,000,000) of public money which can buy so many useful things for veterans health to a private corporation to reinvent the wheel?
"Unfortunately, many governments today are withdrawing from their responsibility to provide quality health services to people and are resorting instead to 'public-private partnerships' (PPPs). Eager votaries of such PPPs and state-supported health insurance schemes would have us believe that the state should hand over large-scale public funds to the private medical sector, based on the uncritical assumption that private providers will provide good quality health care to the population. In this context, these scathing reflections on the private medical sector from within the medical profession provide us with a healthy counterview. These observations give us a glimpse of what we might expect if the state decides to hand over responsibility for providing health care on a large-scale to unregulated, profit-driven private agencies, without"
This is the typical lobbying effect and waste of public money.
This is a twelve zeros scam
$16 billion((16,000,000,000,000)
As an internal medicine physician who worked in VA for 12 years and was a power user of legacy VistA EHR this I think is the biggest scandal of this decade.
A little History:
Long Long time ago when private players did not even hear the word electronic medical records ,VA took a bold decision.
and employed physician_Developer teams to develop VISTA.
VistA's actual architecture genesis, then, to 1977
The Veterans Information Systems and Technology Architecture (VISTA) is the nationwide veterans clinical and business information system of the U.S. Department of Veterans Affairs. VISTA consists of 180 applications for clinical, financial, and administrative functions all integrated within a single database, providing single, authoritative source of data for all veteran-related care and services. The U.S. Congress mandates the VA keep the veterans health record in a single, authoritative, lifelong database, which is VISTA.
VISTA supports the clinical, administrative, and financial operations of over 1200 hospitals and clinics of the Veterans Health Administration (VHA).[1] The VHA is the largest integrated health delivery network in the United States,[2] providing care for over 8 million veterans by 180,000 medical professionals throughout the continental U.S., Alaska, and Hawaii on a single, integrated national healthcare information network of VISTA systems.
VISTA was developed by physician-developer teams within the U.S. Department of Veterans Affairs (VA), and as such has high physician user satisfaction. VISTA received the Computerworld Smithsonian Award for best use of Information Technology in Medicine in 1995, and continues to receive the highest overall physician satisfaction scores in national Electronic Health Record (EHR) surveys. In 2014 and again in 2016 national surveys of over 15,000 physician end-users of EHRs rated VISTA/CPRS the highest overall, above all other commercial EHR systems.[4] Over 65% of all physicians trained in the U.S. rotate through the VHA and use VISTA/CPRS, making VISTA the most familiar EHR in the U.S.
It is not only used for VA but gained international fame and
institutions in Finland, Germany, Egypt,[19]Nigeria,[32] and other nations abroad have adopted and adapted this system for their use, as well ( based on FOIA).
The four major adopters of VistA – VA (VistA), DoD (CHCS), IHS (RPMS), and the Finnish Musti consortium – each took VistA in a different direction, creating related but distinct "dialects" of VistA. VA VistA and RPMS exchanged ideas and software repeatedly over the years, and RPMS periodically folded back into its code base new versions of the VA VistA packages. These two dialects are therefore the most closely related. The Musti software drifted further away from these two but retained compatibility with the infrastructure of RPMS and VA VistA (while adding additional GUI and web capabilities to improve function)
The VA and the DoD had been instructed for years to improve the sharing of medical information between the two systems, but for political reasons made little progress toward bringing the two dialects back together. Many VistA professionals then informally banded together as the "Hardhats" (a name the original VistA programmers used for themselves) to promote that the FOIA (Freedom of Information Act) release of VA VistA (that allows it to be in the public domain) be standardized for universal usage.
In 2011 the Open Source Electronic Health Record Agent (OSEHRA) project was started (in cooperation with the Department of Veterans Affairs) to provide a common code repository for VistA (and other EHR and health IT) software.[40]
In summary, it was the joint collaboration of thousands of clinicians and systems experts from the United States and other nations, many of them volunteers, that the VistA system has developed
Supporters of VistA
There have been many champions of VistA as the electronic healthcare record system for a universal healthcare plan. VistA can act as a standalone system, allowing self-contained management and retention of healthcare data within an institution. Combined with BHIE (or other data exchange protocol) it can be part of a peer-to-peer model of universal healthcare. It is also scalable to be used as a centralized system (allowing regional or even national centralization of healthcare records). It is, therefore, the electronic records system most adaptable to a variety of healthcare models.
In addition to the unwavering support of congressional representatives such as Congressman Sonny Montgomery of Mississippi, numerous IT specialists, physicians, and other healthcare professionals have donated significant amounts of time in adapting the VistA system for use in non-governmental healthcare settings.
The ranking member of the House Veterans Affairs Committee's Oversight and Investigation Subcommittee, Rep. Ginny Brown-Waite of Florida, recommended that the Department of Defense (DOD) adopt VA's VistA system following accusations of inefficiencies in the DOD healthcare system. The DOD hospitals use Armed Forces Health Longitudinal Technology Application (AHLTA) which has not been as successful as VistA and has not been adapted to non-military environments (as has been done with VistA).[41]
In November 2005, the U.S. Senate passed the Wired for Health Care Quality Act, introduced by Sen. Enzi of Wyoming with 38 co-sponsors, that would require the government to use the VA's technology standards as a basis for national standards allowing all health care providers to communicate with each other as part of a nationwide health information exchange. The legislation would also authorize $280 million in grants, which would help persuade reluctant providers to invest in the new technology.[42] There has been no action on the bill since December 2005. Two similar House bills were introduced in late 2005 and early 2006; no action has been taken on either of them, either.[43]
In late 2008, House Ways and Means Health Subcommittee Chair Congressman Pete Stark (D-CA) introduced the Health-e Information Technology Act of 2008 (H.R. 6898) that calls for the creation of a low-cost public IT system for those providers who do not want to invest in a proprietary one.[44]
In April 2009, Sen. John D. Rockefeller of West Virginia introduced the Health Information Technology Public Utility Act of 2009 calling for the government to create an open source electronic health records solution and offer it at little or no cost to safety-net hospitals and small rural providers.[45][46]
VISTA is based on MUMPS programming language
Massachusetts General Hospital registered "MUMPS" as a trademark with the USPTO on November 28, 1971, renewed on November 16, 1992, and expired on August 30, 2003.[21]
https://www.slideshare.net/george.james/mumps-the-internet-scale-database-presentation/3-Internetscale_database_challenges_ulliRapid_growth
So why now the federal government and VA handing over $16 billion((16,000,000,000,000) of public money which can buy so many useful things for veterans health to a private corporation to reinvent the wheel?
"Unfortunately, many governments today are withdrawing from their responsibility to provide quality health services to people and are resorting instead to 'public-private partnerships' (PPPs). Eager votaries of such PPPs and state-supported health insurance schemes would have us believe that the state should hand over large-scale public funds to the private medical sector, based on the uncritical assumption that private providers will provide good quality health care to the population. In this context, these scathing reflections on the private medical sector from within the medical profession provide us with a healthy counterview. These observations give us a glimpse of what we might expect if the state decides to hand over responsibility for providing health care on a large-scale to unregulated, profit-driven private agencies, without"
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