What’s Next for VistA?

Published: November 18, 2015

Health CareHealth ITVA

Despite Congressional criticism and skepticism, VA is marching on with plans to continue modernization of its electronic health records system, VistA.

According to a recent Federal News Radio interview with Dr. Alan Constantian, the assistant deputy CIO for product management at Veteran's Affairs, the next phase of VistA upgrades will focus on clinical and infrastructure functions.


The next round of VistA Evolution, VistA 4, will center around three major goals, according to Constantian:  patient centric, team-based approach especially in primary care, and quality first.


“Things are different than when VistA was first developed.  Data and information that wasn't captured years ago is now needed,” said Constantian.  VistA improvements will facilitate patient-centered care by allowing patients access to their own records and the ability to play a role in their own care and to make their own choices. 


Continued interoperability functionality with DOD is a key factor in achieving the goal of a team-based approach to health care. As part of the interoperability effort, VA and DOD are standardizing data with national health record standards where they exist.  VA wants to be able to share data with DOD and they are working to the meet nine goals established in NDAA for interoperability.   “Additionally, even in VistA if they are calling the same thing something different in another VistA system, it's not aggregable or comparable now,” said Constantian. Standardization will allow for more analytical functionality in order to improve quality of care and ultimately outcomes.


VA and DOD have received much Congressional scrutiny over the last two years in conjunction with their decision to abandon the plan to implement a new joint EHR and their slow progress toward EHR interoperability.  When the departments scrapped plans to implement new, matching EHRs, they recommitted themselves to achieving full interoperability.  Executives at both DOD and VA claim that interoperability is currently being achieved via the use of the Joint Legacy Viewer, a read-only data-presentation application that shares information between VA and DOD providers.  VA CIO LaVerne Council told Congress on Oct. 27 that the Joint Legacy Viewer has 19,000 users, up from just a few hundred a year ago. The VA Office of Information and Technology is also combining its VistA modernization, patient scheduling and health record interoperability efforts under a new program office.


Constantian echoed interoperability accomplishments, as well as plans moving forward.  He stated the VA is making strides for interoperability now with DOD’s current health record system, AHLTA, and are in sync with DOD implementation of its new EHR, DHMSM, and achieving even further interoperability with that system. “VA has known DOD requirements for quite some time.  VA is staying in a place where they need to be [to achieve interoperability requirements] based on [DHMSM] contract requirements,” Constantian told Federal News Radio.  


Another key component to VistA enhancements and functionality is interoperability with outside systems operated by commercial health care providers.  “People not closely involved in the program [DOD and VA EHRs], think if DOD and VA used the same system, interoperability would be solved.  But veterans don't get care exclusively from the VA.  Many get care from commercial providers,” said Constantian. 


Both departments recognize that interoperability with commercial health care providers is a key element.  More than half of veteran care is delivered via the private sector.  VA is developing partnerships with private sector providers.  They currently have connections with 57 different entities, such as Kaiser Permanente, Sisters of St. Mary Health Care, etc.  But interoperability is not just about the technical connection, because VA values the veteran’s privacy and ability to choose their healthcare.  The veteran must express their willingness to let the data be shared with VA from the private systems.


VA has a number of different projects underway supporting VistA Evolution.  VA CIO LaVerne Council has put in place a “buy first” policy which seems to go against the modernization of a homegrown system, such VistA.  However, Constantian pointed out that Ms. Council’s new policy is not “buy only.”  It also supports looking at what is already available and in existence.  This could be open source applications.  According to Constantian, there are COTS apps available for VistA. For example, the new Medical Appointment Scheduling System (MASS) is a COTS system and part of VistA.  “It's not all VA coders sitting in a basement and writing in MUMPS,” said Constantian.  VA has contractors helping them and they are buying expertise where it’s needed, but where they do have internal talents, they want to make use of them.