Petition to have DoD adopt the EHR used by the VA posted on the White House web site

With a backlog of more than 900,000 benefit claims for wounded veterans, the VistA community steps in and asks the President to finally address the root cause of the problem.

Members of the WorldVistA organization have just posted a petition at the "We The People" White House website asking for President Barack Obama to instruct the Department of Defense (DoD) to quit dragging their feet and adopt the world-renowned electronic health record system (EHR) developed and successfully deployed by the U.S. Department of Veterans Affairs (VA) over the past 35 years. In contrast to the VA, DoD has spent twenty years and over ten billion dollars trying to develop an EHR. The latest version, called AHLTA, is as much a catastrophic failure as all the previous attempts. AHLTA is unable to properly interoperate with VA's VistA system, thus making it very hard to properly transition wounded soldiers from the Military Health System (MHS) to the VA medical system.

Both the VA and DoD have been criticized heavily over the past few months regarding the massive backlog of pending claims by military veterans applying for veterans benefits, including healthcare. Currently the claims backlog stands at over 900,000 and in many cases it's taking nearly a year for many of the claims to be processed. The lack of interoperability between the different EHR systems used by the Departments has been cited as one roots of the problems. Despite extensive efforts to move data between the two systems, major problems still exist due to the incompatibility between them.

Members of WorldVistA, an open source organization that represents the VistA community, hope that by going directly to the President they can outflank the long-standing opposition in the Pentagon's entrenched bureaucracy to to ditch their dysfunctional systems and adopt VistA. If the petition gathers 100,000 signatures by April 28, then the President will have to act on the petition. By ordering the Pentagon to adopt VistA he can expedite access to medical care by war veterans.

This is the same point made by pundit Jon Stewart last week in a special report in Comedy Central's The Red Tape Diaries segment. Stewart took aim at the lack of interoperability between DoD's AHLTA and VA's VistA. He discussed the absurdity of the situation and also noted that VistA is the superior system. Stewart pointed out “These two programs are unable to communicate with each other,” pausing, and then adding, “I swear to you this is true -- how insane is this complication?”.... Stewart understood that this dreadful situation has a simple solution, which is for President Obama to act as Commander-in-Chief and instruct the Department of Defense to implement VistA. Stewart also made a very insightful observation during the show. While the VA is taking most of the blame for the backlog, Stewart pointed out that it is the Pentagon that creates these wounded veterans in the first place.

VistA – The Solution

VistA is the EHR system developed by VA staff using an open source, collaborative development model, to care for Veterans. It is available as an open source application to the private sector and it is widely recognized as the best hospital-based EHR system in the world. Adoption of the government developed, open source VistA system by DoD will save the American taxpayer many billions of dollars and ensure the continuity of care for military service men and women as they transition into civilian life and assume their status of honored veterans who have served their country well.

The VA recently submitted a formal proposal to the DoD for their Military Health System to migrate from its currently dysfunctional EHR system, known as AHLTA, to VistA. The proposal was submitted in response to a Request for Information (RFI) from DoD requesting advice on how to replace their current systems with a more fully functional EHR. The VA drafted the proposal in collaboration with the open source VistA community including members of WorldVistA, the HardHats, and OSEHRA, and numerous companies that support the VistA eco-system in particular the VistA Expertise Network (VEN).

Designed by clinicians for clinicians, VistA is patient-centric and embodies the clinical workflow processes that support VA’s models of care. It has enabled measurable improvements in health outcomes and is central to its ability to deliver high quality lifetime care to a large and varied Veteran population. VistA has played a major role in transforming the VA medical system into the best healthcare system in the United States by all measures of quality of care. This transformation is documented in detail by journalist Phillip Longman in his book Best Care Anywhere: Why VA Health Care Would Work Better for Everyone.

VistA supports the daily operations of one of the world’s largest health care enterprises, encompassing:

• Over 8 million patients, with 75 million outpatient visits and 680,000 inpatient admissions
• More than 1,500 sites of care, including 152 hospitals, 965 outpatient clinics, 133 community living centers, and 293 Vet Centers
• 244,000 employees including more than 20,000 physicians and 53,000 nurses
• Affiliations with more than 1,200 educational institutions with more than 100,000 health care students receiving clinical training from VA each year

Over the past twenty years the Military Health System has spent over $10 billion in multiple failed attempts to develop an EHR. The current system, AHLTA, is dysfunctional and passionately disliked by most of its users. The running joke among the military's medical core is that they would rather be deployed to the frontlines in Afghanistan for a year than to have to use AHLTA for a day. This sad history has been documented in many places by Tom Munnecke, one of the original developers of VistA who was hired to help MHS develop their EHR.  More recently veteran Health IT journalist Joe Conn wrote an article in Modern Healthcare that clearly lays out why DoD should adopt VistA.

In addition, Open Health News has written a detailed analysis of this subject, including a comparison of the VA's and the Military Health System's approach to developing their respective EHRs (hint: one approach, based on an open source collaborative development methodology works, the other approach, invariably fails).

In contrast to AHLTA, the VA VistA system is widely considered one of the world's best EHR solutions and has been in use by 100% of all VA hospitals, clinics, and nursing homes for over 20 years. In the past few years, more that 50 private and State hospitals in the US have successfully implemented VistA at a fraction of the cost, time, and effort required to implement most proprietary EHR solutions. The demand for VistA implementations in the private sector has created a whole ecosystem of companies that implement and support VistA, and develop all kinds of enhancements to customize its use. DSS and Medsphere are two such VistA companies that could help DoD with the transition to VistA.

Although not for the faint of heart, there is even one hospital that has implemented VistA on its own. This hospital, Oroville Hospital, has not only been a complete success, it has in fact become one of the clearest examples of the advantages of implementing VistA. As we detail in this story, Oroville Hospital's staff was facing a grim situation as proprietary EHR vendors were asking $25 million and up to implement an EHR for the 153-bed rural hospital in Northern California. Such an expenditure would have driven them out of business. So they chose to self-implement VistA in their own hospital. The implementation has been a complete success and the hospital has already collected close to $5 million in Meaningful Use payments while the cost of the VistA implementation was just over $6 million for the EHR componenet of the implementation, less than a quarter of the lowest-priced proprietary EHR. The Oroville story and its implications has even been covered by Zina Moukheiber in Forbes magazine here and here.

The question is, how is it possible that implementing VistA in the Military Health System is soo hard, when a small rural hospital in California was able to do it on their own? Perhaps Secretary of Defense Chuck Hagel needs to hire Oroville Hospital's CEO, Robert Wentz, and appoint him CIO of the Military Health System.

The petition is posted at the White House's "We The People" site and can be found here.

This story was updated on 4/3 at 11pm EST.