From the hardhats list on Google Groups: “I have been watching some of the steps VA has taken over this past year with regards to management of health IT systems that I would consider to be major strategic missteps. The following are some informal observations.”

“VA reorganized and centralized its IT resources under the VA Office of
Information & Technology (OIT). Rather than centralizing selected
corporate wide functions and resources (e.g. planning, policy,
security), the VA went further and centralized IT development and
operations resources of all administrations under OIT. Rather than
following best practices that have emerged and are being followed by
many other organizations with regards to decentralizing management of
these type of resources to the business side of the house, the VA
chose to pursue an approach that was widely used in the past but which
are no longer strongly advocated. The expected result will be a loss
of innovation, lack of responsiveness to business needs, and a
tendency to lose its leadership position in the healthcare industry,
especially with regards to health IT systems.

The VA Office of Information & Technology (OIT) recently chose to
award a contract to Cerner to replace the VistA laboratory module.
This seems to be part of a pattern of steps being taken to unplug
VistA software modules over time and replace them with commercial off
the shelf (COTS) products. This strategy leads to a system composed of
a mix of multiple, costly commercial systems that will all need to be
interfaced – an approach that many private sector hospitals have put
in place and been roundly criticized for following. The VA has
consistently been praised for the tightly integrated VistA software
modules that are written in the same language, use the same database,
and require no extensive interface solutions. This appears to run
contrary to recommended best practices in health IT.

The VA Office of Information & Technology (OIT) has begun to
centralize its hospital information systems at four regional
processing centers. Unfortunately, one of these centers recently went
down basically disabling all the VA healthcare facilities on the west
coast, Hawaii, and Pacific Islands. While on the surface this was an
unfortunate incident and centralizing IT systems seems cost effective,
that may in fact be way off base. If you think of centralizing data
that will simply be viewed by users, like a personal health record
(PHR), this makes sense. However, if you use a different analogy and
realize that hospitals are very similar to factories, and hospital
information systems are interfaced to laboratory equipment, radiology
x-ray and MRI systems, pharmacy Rx dispensing units, bed control, and
food handling systems this makes no sense. Patient care at a hospital
is handled in a very systematic way, with patients moving down a
production line with specialized components put in place to serve the
needs of the patient and healthcare provider – much like a healthcare
‘factory’. Ford or GM would not centralize the operation of its
information systems and equipment located in a factory that make up
the line used to produce and/or care for their product – cars.
Similarly, centralizing a hospital system being used in the minute to
minute care of a patient as they move through the hospital makes no
sense. You can centralize a PHR or EHR data repositories to view data,
but not a heavy duty industrial automated system being used in patient
care.

Finally, the VA Office of Information & Technology (OIT) has begun to
disengage from its health IT partnering activities with the larger
‘open’ VistA community that has grown quite large. This unfortunately
leads to an inability of the VA and the federal government to tap into
the knowledge and development resources that community is willing to
make freely available to the VA. Given the continual change to
healthcare and health IT systems, this is a potentially great loss. It
slows down innovation, ability to rapidly change, increases costs, and
harms efforts to help the country to move towards interoperable EHR
systems and health information exchange (HIE) networks.

If I could think of four strategies I would think the VA would absolutely choose to avoid, the new OIT management team has chosen to pursue all four.”