The proposed new, best-of-breed, joint electronic health-record system to be created for the Veterans Affairs and Defense Departments will cost $4 billion just to develop and probably a lot more to license and install, said Roger Baker, the assistant secretary for information and technology at the VA.
$4 billion price tag for VA, Defense EHRs
“We think that the scale of dollars that the VA and DoD spend are going to help us on that best-of-breed path,” Baker said in a telephone interview. “Our current estimate is about $4 billion, and that's just for development.” That figure will be split evenly between the two cabinet departments, he said.
The upgrade will likely affect the Indian Health Service, which also runs its own modified version of the VistA system.
Baker said he had no estimate of the full cost of the system, but “deployment in an organization for the scale of VA, a lot depends on what do we end up licensing. I don't have an estimate on that."
Last year, the VA committed to upgrading its VistA electronic health-record system by creating a not-for-profit organization, the Open Source Electronic Health Record Agent, to serve as custodial agent for an open source development project for the upgrade. The Defense Department has joined the effort to upgrade its various EHR systems. The VA and the Defense Department operate about 200 hospitals and many hundreds of clinics.
Earlier this month, former VA Secretary and military physician Dr. James Peake was named chairman of the board of OSEHRA .
Initially, commercial vendors looked askance at the project, Baker said.
Baker said "a bunch of vendors" when the open source project was introduced "said no way do they want to play. That's not what we're hearing now. There is no vendor out there that can ignore the market share the DoD and the VA have available.”
Much of the VistA system is in the public domain, enabling anyone to download copies of the bulk of the software without charge under the Freedom of Information Act. As a result, a still small but growing community of software developers of open source version of VistA have penetrated the private sector hospital IT market.
“I'm hoping that a lot of what is there in current VistA remains in opens source,” Baker said, but the VA will not require developers to give up proprietary interests in their software to participate in the joint VA/Defense EHR development project. What impact that tack will have on the open source VistA community remains unclear. “Those packages may be open source or they may be proprietary,” Baker said, but they must integrate with whatever open source software remains.
“We have a strong preference for the best,” Baker said. “My job is not to build the best electronic health system in the world,” he said, but rather, but to ensure the VA “is running the best system in the world.”
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