VA Secretary David Shulkin is currently in the process of deciding among electronic health record alternatives for the future. Here are the main aspects VA should take into account when making its pick.
Department of Veterans Affairs Secretary David Shulkin has committed to a decision about the use of a commercial approach to the VA’s electronic health record by July of this year. 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.
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Support for Health Care Delivery Transformation / Interoperability
VA’s real challenge is to transform how care is delivered to Veterans – this goes well beyond rebuilding the electronic health record and focuses on expanding the capability of digital health services. Technology beyond the health record is needed to enable the transformation. VA’s DHP provides some of that vision. An open source commercial VistA could easily accommodate transformational changes such as using blockchain (a transformative technology) to secure, manage, and share health records). For example, the Hyperledger open source project provides blockchain code for community use. Interoperability with DoD and community providers will ideally be standards-based, which a commercial VistA will need to support.