The VA’s superb record in turning around its health system to become one of the best in the world in quality and cost management has not escaped attention. The fact that the VistA software, training and documentation is freely available as public domain is making the DNA of this transformation available to health systems everywhere. The Cerner press release announcing the VA’s intention to integrate a proprietary laboratory component into the public domain VistA software ecosystem has the potential if carried out to severely hamper the strategic leveraging of the VA transformation across the US and the rest of the world.

Given the specific mandate of the VA to serve veterans it is very likely that the various decision makers involved are not aware of the bigger picture and the negative, health system-wide consequences of this decision. So let’s help them out and brainstorm the top ten or more reasons why the VA should reconsider this strategic direction. To prime the pump, here is one that came to mind:

While the VA is tightly focused on Veterans care a symbiotic community has evolved that greatly magnifies the impact of any investments the VA makes. This magnification while still in its infancy has tremendous untapped potential that is off most policy and decision maker’s radar.

Introduction of a major proprietary component in VistA will seriously hamper the trickle down application of affordable, clinically proven EHR software to the under served and uninsured population. Given that affordability and sustainability of software will continue to be a major stumbling block to leveraging HIT in health systems, integrating proprietary components in public domain VistA will make the software unaffordable and compound the already severe cost and quality challenges facing those serving the undeserved and uninsured and exacerbate the regional disparities.

Joseph Dal Molin is President, e-cology corporation.