Should VA opt for a commercial EHR?

On October 28th, 2015, posted in: Industry News by

While the Veteran Affairs Departments homegrown electronic health record system is entrenched at VA outlets around the country, the once cutting-edge EHR appears to be under fire this week.

MITRE Corp. said that the EHR, called the Veterans Health Information Systems and Technology Architecture (VistA), is “in danger of becoming obsolete,” within a 4,000-page report it issued late last month.

The report suggested that the Veterans Health Administration CIO, in partnership with the VA CIO, should oversee a comprehensive cost-versus-benefit analysis among commercial off-the-shelf (COTS) EHRs, open source options, and continued in-house custom development of the VistA iteration currently in use.

“The analysis should take into account all the complexities of the VistA architecture and infrastructure and known issues with performance, scalability, extensibility, interoperability, and security,” the report said. “It should also address full life-cycle costs, including development time (based on recent delivery trends), availability of development resources, maintenance and licensing costs, and infrastructure costs.”

What’s more, VA officials are expected to testify this week in front of a congressional committee, defend the system, and oppose suggestions to scrap it in favor of commercial solutions much like what the Defense Department did when it awarded Cerner, Leidos and Accenture the massive contract this summer, Politico reported.

“VistA is a great big Buick with whitewall tires and tail fins that gets about 8 miles to the gallon,” said Rep. Phil Roe (R-Tenn.), a physician and member of the veterans committee, who noted that the VA is spending 80 percent of its IT budget on maintenance, according to Politico. “It gets you from A to B, but will it last 20 years?”

Another question likely to arise is whether or not VistA will ever be truly interoperable with the commercial EHR DoD announced it would implement this summer.

MITRE’s report said that VistA’s problems “stymie interoperability between Veterans Health Administration facilities as well as with DoD and non-VA providers.”

The DoD in late July awarded a $4.3 billion contract to the team of Cerner, Leidos and Accenture, which edged out two other teams, one being Epic and IBM, the other consisting of Allscripts, Computer Sciences Corp. and Hewlett-Packard.

Prior to that DoD and VA were working on a joint electronic health record system, dubbed iEHR, that fizzled out in early 2013.


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Portals and personal health records have been touted as ways to spur better patient engagement and set the stage for improved outcomes. But a new study shows they often aren’t used at all by the very people who may need them most.

The report, Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics, was published this month in the Clinical Journal of the American Society of Nephrology.

“Electronic health record patient portals allow individuals to access their medical information with the intent of patient empowerment,” researchers write. “However, little is known about portal use in nephrology patients.”

The study tracked patients seen between Jan. 1, 2010, and Dec. 31, 2012, at four university-affiliated nephrology offices; each of the patients had at least one additional follow-up visit before June 30, 2013. Researchers abstracted sociodemographic characteristics, comorbidities, clinical measurements and office visits from the EHR and also tracked median household income for patients’ neighborhoods for added context.

Of 2,803 patients, 1,098 (39 percent) accessed the portal. Of those, more than 87 percent of users reviewed their laboratory results, 85 percent reviewed their medical information, 85 percent reviewed or altered appointments, 77 percent reviewed medications, 65 percent requested medication refills and 31 percent requested medical advice from their renal provider, according to the CJASN study.

But in adjusted models, characteristics such as being older, being African-American, being insured by Medicaid or living in a neighborhood with lower median household income “were associated with not accessing the portal,” according to researchers, who pointed to factors such as data security concerns or lack of confidence or skills in accessing health information online as potential barriers.

“While portal adoption appears to be increasing, greater attention is needed to understand why vulnerable populations do not access it,” the report concludes. “Future research should examine barriers to the use of e-health technologies in underserved patients with CKD, interventions to address them and their potential to improve outcomes.”

“Despite the increasing availability of smartphones and other technologies to access the Internet, the adoption of e-health technologies does not appear to be equitable,” Khaled Abdel-Kader, the study’s lead author, told NPR. “As we feel we are advancing, we may actually perversely be reinforcing disparities that we had been making progress on.”

Access the study here.

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Arlington, VA (October 27, 2015) – HIMSS applauds the Senate for passing S. 754, The Cybersecurity Information Sharing Act (CISA) of 2015. CISA marks an important step forward in creating an infrastructure to promote greater sharing of cyber threat information between government and the private sector.

In particular, HIMSS strongly supports provisions in the bill aimed at addressing the cybersecurity needs of the healthcare sector. This includes the creation of an industry task force charged with, among other critical tasks, developing a plan to ensure healthcare leaders have access to actionable cyber threat information, through a single source, at no cost.

The healthcare community will further benefit from the establishment of a common set of security and risk management best practices that can be implemented consistently across the sector and mapped to a single, voluntary, national health-specific cybersecurity framework.

As CISA moves forward to a Conference Committee, HIMSS strongly urges the House and Senate to retain these essential provisions so critical to supporting healthcare organizations in more effectively protecting patients and their health information from growing cyber threats.

About HIMSS North America
HIMSS North America, a business unit within HIMSS, positively transforms health and healthcare through the best use of information technology in the United States and Canada. As a cause-based non-profit, HIMSS North America provides thought leadership, community building, professional development, public policy, and events. HIMSS North America represents 61,000 individual members, 640 corporate members, and over 450 non-profit organizations. Thousands of volunteers work with HIMSS to improve the quality, cost-effectiveness, access, and value of healthcare through IT. Major initiatives within HIMSS North America include the HIMSS Annual Conference Exhibition, National Health IT Week, HIMSS Innovation Center, HIMSS Interoperability Showcases™, HIMSS Health IT Value Suite, and ConCert by HIMSS™.

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