According to Baker and Petzell, the Interagency Program Office established to oversee the iEHR interoperability project now has 135 federal employees and “several hundred contractor employees” and “approximately $758 million in planned spending for FY 2013,” yet, “despite these resources, the IPO has been challenged to meet its program deadlines.”
The estimated cost of the iEHR project, initially set at between $4 billion and $6 billion—an expense to be split between the VA and the DOD—has since “doubled,” they said.
That led to a revision of the iEHR plan, they said. Now, the VA will commit to using the “core” technology of its existing and largely homegrown VistA EHR system “while DOD will evaluate available alternatives in order to make a 'core' technology selection that will best fit its needs,” they said.
In separate written testimony posted on the House Veterans Affairs Committee website Baker estimated the cost of replacing VistA with a commercial EHR at $16 billion, “based both on VA-commissioned independent validation exercise and on the real-world experiences of Kaiser Permanente.”
“Published reports say that Kaiser spent $4 billion implementing a commercial off-the-shelf EHR system in their 36 hospitals and supporting facilities,” Baker said. “Based on size of VA relative to Kaiser (VA has 153 hospitals), $16 billion is a reasonable estimate.”
To avoid those costs, he said, the VA is turning to an open-source development method to modernize VistA in which “EHR users from across the community are free to comment and contribute to the evolution of the code base, and VA is free to accept or reject any of those contributions.
“In practice, open source has proven to be a powerful method of producing production quality software,” Baker said. “Market leading products such as Unix, Linux, Netscape, Mozilla, Apache, and many others are the result of open-source software approaches. And while key product elements such as licensing, cost, security, etc., are different with an open-source product, they are neither better nor worse. Open source methodologies have been proven many times in high-reliability production environments in the private sector to deliver products that meet or exceed the quality and robustness of proprietary and government-off-the shelf products.”
“VA has spent more than a year conducting a very deliberative process to examine the implications of open source for VistA,” he said. “We have seen two substantial studies on the topic contributed by the private sector and academia. We have consulted with hundreds of organizations, and thousands of individuals. We have conducted three requests for information (RFIs), and received numerous papers, emails, and comments. Our path forward with open source has been broadly advised and highly transparent, and is certainly much the better for it.”
Baker said the VA “expects that the rate of innovation and improvement in VistA can be increased without increasing our current budget by better involving the private sector (and true private sector practices) in both the governance and development of the VistA system through open source. To that end, we have released a Request for Proposal to establish an open source “custodial agent,” to run the open source community. Our estimate of the costs of establishing the custodial agent are less than $10 million per year.”
Last month, Baker, whose duties mirror those of a chief information officer, announced plans to resign.
Baker said his department with its 7,100 employees provides IT services to 152 hospitals, 791 community-based outpatient clinics, 57 benefits processing offices using 314,000 desktop computers, 30,000 laptops, 18,000 BlackBerry smartphones and mobile devices, and 448,000 e-mail accounts.