Lawmakers Concerned About Accuracy of Projected VistA and EHRM Costs

On July 25th the Subcommittee on Technology Modernization under the House Committee on Veterans Affairs held a hearing entitled, “VistA Transition:  Assessing the Future of an Electronics Health Records Pioneer.”

Rep. Lee presided over the meeting, hearing testimony from Dr. Paul Tibbits, Executive Director, Office of Technical Integration under OI&T at the VA, and Carol Harris, Director, IT Acquisition Management at GAO. Tibbits was joined by the following VA colleagues:

• Charles C. Hume, Acting Assistant Deputy Under Secretary for Health for Office of Health Informatics, at VHA
• Dr. Thomas O’Toole, Senior Medical Advisor, Office of the Assistant Deputy Undersecretary for Health for Clinical Operations at VHA
• John Short, Chief Technology and Integration Officer, Office of Electronic Health Record Modernization at VA

Tibbits testified that there are 130 unique instances of VistA nationwide at four regional data centers. Each of the VistA instances share a standard core of functionality but are customized to each medical center’s needs, according to Tibbits. Additionally, VistA is enhanced by many third-party COTS products which further customizes the environment. VistA will need to be maintained while migration to the new Cerner system is taking place over the next ten years.  Tibbits stated, “The estimated minimum cost for VistA during this 10-year transition period is $4.89 billion, not including any required development.”  Tibbits also stated that remaining VistA instances will be migrated to the cloud during the transition period to Cerner, which should bring some cost savings.

Harris testified on the following key points:

• VA lacks a comprehensive definition of VistA, but work is underway to clearly define VistA. Decentralization of VistA contributed to the lack of a comprehensive definition.  Site evaluations are underway to define the system.
• VA believes Vista has cost $2.3 billion, but it can only account for $1 billion clearly.  The other $1.3 billion was not well documented. Because of this, VA lacks reliable information to predict the costs of continuing to run VistA over the next 9 years. 
• VA has initiated a number of activities to transition to the new EHR.  They’ve sat up a separate office and governance structure. And additional actions are also in progress to address GAO recommendations to establish clear roles and relationships of DOD and VA working together.

Chairwoman Lee asked Tibbits, “How will you address the cost reliability issue?”  Tibbits said that VA concurs with GAO’s report and recommendations.  Technology Business Management (TBM) is the framework VA is using to classify technology costs.  They are working with OMB to do this.  Their FY 2021 budget will correspond with the TBM framework.  In so doing, they will be able to address GAO findings and recommendations. 

Tibbits stated that some of the problems they are having with accurately accounting for VistA costs are due to not associating personnel costs with specific systems. With the methodology they used in the past, they did not see the need to classify personnel costs by system, but they will be doing it moving forward.

Rep. Banks stated that according to GAO, VA had adopted unreliable figures in the past. He asked Tibbits if he stood by the current cost estimates for maintaining VistA. Tibbits stated that he did, but their ability to accurately calculate those costs will improve over time.

Rep. Lamb asked why it was going to be so expensive to continue to maintain VistA.  Tibbits replied that it was due to the system’s complexity and age. He also stated that their migration to the cloud for VistA will deliver some cost savings.

Rep. Lee asked about Cerner only replacing 60% of VistA capabilities. She wanted to know where or how the other 40% of capabilities were being modernized or migrated.  Hume stated that most of the other functions are being replaced by Financial Management Business Modernization (FMBM), their new ERP, and the supply chain system from DOD.  Short mentioned that some of the functions of VistA are administrative capabilities, like the ability to split and parse data, not a clinical functionality.  Some of these functions will just naturally go away, he said. Tibbits confirmed that the costs for replacing this 40% of VistA’s functionality are not part of the cost estimate he gave for maintaining VistA.  The financial and supply chain systems have their own investment line items.