Several options are under consideration including:
1) using a commercial vendor to develop and maintain the Veterans Information Systems and Technology Architecture (VistA) electronic health record and provide VistA back to the VA using a Software as a Service (SaaS) model or 2) purchasing a proprietary commercial-off-the-shelf (COTS) electronic health record.
Using my perspective of more than a decade of support to various parts of the VA, work in the open source software community, and my broad health IT domain experience, I have looked at this choice from eight different business case perspectives. The software acquisition cost for open-source VistA maintained and developed by a commercial vendor is likely significantly lower than a COTS electronic health record solution.
The acquisition of a COTS electronic health record will likely require billions in software licensing costs across VA (DoD’s initial contract award to the Leidos/Cerner team was $4.3 billion). For commercial VistA, the value provided to the VA will be nearly immediate as VistA will continue to be used and evolved over time from commercial / open-source enhancements. VA can leverage its current software enhancements efforts including initial investments in the electronic Health Management Platform (eHMP) and Digital Health Platform (DHP).
However, to be successful, the VA culture and strategy of open source must become fundamental to VA and the concept of open collaboration with the community must impact the entire information technology lifecycle. Proprietary COTS health record software currently lacks the enabling services support functionally that VA has built into VistA over the last 40 years.
Since VistA is already in use at VA and current work is taking place to standardize VistA across all the VA sites, there would be limited clinical or business process changes at the outset and any enhancements downstream will be incremental, requiring a manageable change management process. VA currently provides care at 1,233 health care facilities, including 168 VA Medical Centers and 1,053 outpatient sites.
Open-source products such as VistA allow system allow VA to avoid vendor lock-in, leverage community enhancements, and reduce the cost of product lifecycle management. A powerful global community has accelerated innovation in VA and the private sector through the Open-Source Electronic Health Record Alliance (OSEHRA).
An open-source commercial VistA could easily accommodate transformational changes such as using blockchain (a transformative technology) to secure, manage, and share health records). The VA Community of Care will require VA IT systems to exchange health data with virtually every electronic health record (EHR) system in use today.
A commercially supported VistA (VA employees not part of software development, maintenance, and VistA operations) provided as a service, has some advantages.
Ref:
https://www.healthcareitnews.com/blog/8-business-case-elements-consider-choosing-ehr-veterans-affairs
