I just gave 11 addresses to front line VA employees in the last few weeks, and I heard over and over again their frustration over not being able to get to the people at the Department of Defense (DoD) making the hand-offs. Not only can't the computers talk to each other, they can't get the Army doctor in Germany on the phone to answer a simple question.
While VA care is still excellent, Longman said, three forces are killing VistA:
Security concerns are causing the Department of Defense (DoD) to seek centralized systems.
The DoD has its own medical computing system, called AHLTA, built by contractors, and sets its priority there.
Ideology, a desire to privatize all government functions. "John McCain has come out for closing the VA and giving everybody vouchers," Longman said.
When wounded soldiers are discharged they move from the AHLTA system to VistA, and the two systems still don't communicate, Longman said. (To the left, Longman's book based on the article.)
"They could wire Walter Reed or Bethesda (the two biggest military hospitals) for VistA in an afternoon. Technically there's no big problem, even in creating an interface. Yet there are DoD people who have built their careers on AHLTA and want people to switch to their system."
It's those voices which are being heard.
"If you look at the recent political appointees to the VA, they're people with DoD backgrounds. And the DoD culture is procure everything – they don't make anything themselves, they procure it. When they get to the VA they don't appreciate the open source culture."
While the VA has been using electronic health records for years, and depends on them, AHLTA is just now starting to make them mandatory, Longman said.
"The doctors don't have buy-in, and some doctors don't even use electronic health records. They're having retention problems as the Department of Defense tries to make Electronic Health Records mandatory .
Security is the other big concern, leading to everything being centralized. It's like waiting for a computer vendor to create a patch and not being allowed to write it yourself, Longman said.
"In the old days, whether you were in Durham or Puget Sound doctors would see an application, call in the local techies, then create a solution. Then they'd share it. That's how VistA came to be. That's why it had buy-in from users.
"That's all gone now. All gone." He gave an example from the Durham VA facility, which he visited recently:
At Durham, where I was, they have been known for IT innovation and there's just one programmer left. Now if you have an IT idea, it's like the 70s. It has to go to Washington, it will be contracted out to Perot Systems or someone, and any tinkering is all under the domain of central office, which uses security as a pretext to wipe out the innovation.
Ironically the VA has turned its back on VistA just as the commercial market is showing interest in open source health care tools.
The creation of Open Health Tools, a project based on Eclipse, the growing commercial success of Medsphere, based on VistA, and the launch of Tolven Inc., which is expanding the VistA code which Medsphere sells, all point to a growing VistA market.
"Even if the VA doesn't want VistA there's a community of people who use VistA outside the VA and program applications," Longman said.
"I'm watching a standoff in Washington on what will be the standards for electronic health records. Years go by. Why can't we take VistA?"