Imagine if you learned a government agency built its own office furniture, HVAC, or telephones. Even if there were a massive amount of corruption in government purchasing, it would be remarkable if a bureaucracy could do a better job building than buying.
Yet, for decades, the Veterans Health Administration has tried to do that with its Electronic Health Record (EHR). I cannot think of another health system that has built its own EHR, rather than buy it from a vendor. It makes as little sense as a health system manufacturing its own MRI machines.
President Trump's newly appointed VA Secretary has confirmed he will throw in the towel on the VA’s home-brew system, VISTA, and buy a commercial EHR.
Back in 2014, the VA and Department of Defense scrubbed a failed project to make their EHRs interoperable – after churning through $24 billion of taxpayers’ money in a vain attempt to overcome turf wars between and within the departments.
The reason it took so long for the VA to take this step is the VISTA EHR was cutting edge in the late 1990s. At the time, the installation was led by an idiosyncratically outstanding leader, Dr. Ken Kizer, from 1994 to 1999. Then, he went to the private sector.
VISTA began to track towards obsolescence pretty quickly. However, absent market forces, the VA could not make an effective “build or buy” decision for almost two decades.
Buying a commercial EHR will not solve the VA’s crisis, but least it is a sensible step.