VA mulls cloud-based version of Vista

Veterans Affairs Secretary David Shulkin has promised a decision by July 1 about whether to retain the agency’s homegrown Vista electronic health record system, or to move to a commercial version.

But VA is also charting a middle ground that would allow it to retain Vista, which is popular among agency physicians and highly rated in surveys, but outsource the work of maintaining the code while negotiating the knotty problems of keeping multiple versions of the software working harmoniously.

Call it Vista as a service.

In an April 12 request for information, the VA is asking vendors for their ideas on providing a cloud-based commercialized form of Vista to the agency on a software-as-a-service basis.

The idea is to reduce the 130 instances of Vista at five physical VA data centers to a single version, to be maintained by a vendor, in a high security environment.

The VA is looking for a cloud-based Vista to accommodate its multiple modes of presentation, the Computerized Patient Record System, the more web- and mobile-friendly Electronic Health Management Platform, and its connections to outside systems including the Joint Legacy Viewer that connects VA data with health- record information from multiple Department of Defense systems.

The offering does not propose to integrate the non-clinical components of Vista. The underlying architecture is used in VA's financial, procurement, administrative and business systems.

The VA is moving quickly. The RFI notes that "any services to be provided for this effort, which may span multiple contracts, will create interdependencies which must be managed to achieve the ultimate goals described herein on an aggressive timeline."

Vista is already in wide use in hospital systems worldwide. The Vista code is available from the VA under the Freedom of Information Act, and a community of open-source Vista providers and integrators has sprung up to service commercial users of the electronic health record system, and some are already on the books as VA contractors.

A team led by PriceWaterhouseCoopers bid for the Pentagon's multibillion electronic health record contract with plan based on a version of Vista, although it was eliminated from the competition before the final decision was made. Responses are due from vendors by April 26.

In a related move, VA also released a request for information for a supplemental commercial health IT platform that could support the operations of the eHMP while preparing the agency to transition to a commercial off-the-shelf health record system. The idea here is for a system that "sits on top" of the VA's data infrastructure and deliver functionality to practitioners while taking away the VA's responsibility to maintain software. The commercialization of the eHMP product in this approach appears to be a first step to the acquisition of a more fully featured electronic health record. The agency is giving vendors until April 25 to respond to the RFI.

"The Secretary is committed to making a final decision on our EHR modernization approach in July 2017.  Our current assessments will provide for the necessary due diligence required insofar as to select the best solution possible to meet VA's immediate needs, as well as its long-term goals," said Tim Cox, a spokesperson for the VA's Office of Information and Technology, in an emailed statement to FCW.

The two RFIs will help inform the decision as to whether and how to go to a commercial health record product, Cox said. "We want to be certain to take into account the lessons learned from the emerging advancements in the healthcare arena, so the RFIs will assist in that way," he said.