VistA will overcome—eventually

A decade ago, a not-for-profit organization called WorldVistA was launched with two missions.

One was to promote the use of the Veterans Affairs Department's public-domain VistA electronic health-record system outside the VA, both in the U.S. and abroad.

The other was to preserve the life's labors of thousands of government workers who created the excellent VistA system over the previous three decades.

To some, recent plans by the VA and the Defense Department to jointly develop an EHR appears to be yet another battle in a long war to kill VistA.

What's WorldVista to do?

"We're just going to stay the course," says board Chairman Joseph Dal Molin. A Canadian IT consultant, Dal Molin helped install the open-source WorldVistA EHR in Amman, Jordan.

From the beginning, the WorldVistA strategy has been to establish a protective and nurturing VistA community outside the VA so that either it, or the Defense Department, "can do stupid things and it won't matter," Dal Molin says.

That strategy is working, Dal Molin says. "I still say that's the right way to do it, and that's definitely where WorldVistA is still focused."

Peter Groen, now retired, worked for the VA for 34 years, at the last as national director for health IT sharing. He sees little to fear in the latest VA/Defense Department plan.

"I pulled the document and looked at it line by line." Groen says.

His prediction?

The VA culture will shrug off most of these latest top-down impositions as it has with others in the past. How?

Every head of a VA hospital–and the VA has 152 hospitals–and every director of a VA decentralized, regional planning and budgeting unit–21–“is the equivalent of a general,” Groen explains.

“The moment it goes from a vague architecture and a roughed up plan,” Groen says, to “now we're going to start pulling things out, the generals will say, ‘Hell no! You're not going to mess with our business. You're not in charge. We're in charge.'”

"I've seen this three or four times in the last 30 years,” Groen says. The powers line up in Washington and it looks like “Hey, this is an unstoppable force. And it gets stopped, dead in its tracks.”

Some things will be consolidated under the new plan, like data centers, and there will be common user screens developed for both the VA and the Military Health System's EHRs, both good things, Groen says. But the Defense Department will do what it always does, contract out its EHR system and the VA will keep most of VistA, with improvements added as needed.

Meanwhile, money from Congress will flow for the joint effort and Roger Baker, the VA's assistant secretary for information and technology "gets to continue to push his open-source development."

"Why would anyone get upset about this?" Groen says.

Follow Joseph Conn on Twitter: @MHJConn.