Part 2: What VA Can Do to Fix the Doomed $ 16 Billion (and More) Modernization of Electronic Health Records



In Part 1, former Deputy Director General of Veterans Affairs Ed Meagher explained why the effort to modernize electronic health records will struggle to succeed.

Never has Will Rogers’ warning “When you find yourself in a hole, stop digging” been more appropriate than it is now with regard to American veterans and the organization that has been tasked with “caring for”. the one who has endured the battle ”.

The price of over $ 16 billion in unnecessary, unexamined, single-source dollars to a commercial software vendor best known for its medical billing system aimed at replacing the widely popular cloud-based Veterans Information System, reliable, integrated, tested, rugged and best-in-class enterprise-wide. Technological Architecture (VISTA) is a self-inflicted injury which, if continued, will fester, degrade and ultimately critically damage the ability of the VA to perform its mission.

Secretary Denis McDonough is perhaps at the most obvious yet most difficult inflection point ever presented by a new cabinet secretary. On the one hand, over $ 16 billion has already been committed to this effort. Huge expenditure of labor, energy and management went into preparing for this conversion. Multiple reorganizations, policy changes, process changes and disruptions to other important programs have been launched in order to prepare for the enormous impact that this “tear and replacement” of the fully functioning “central nervous” system called VISTA by a product. which at best, replace well less than half of VISTA’s functionality and do so less productively and at huge additional costs.

And these costs will not only be in financial terms. The impacts on productivity, efficiency and employee morale have been enormous and will continue to grow exponentially if the secretary decides to continue with this program.

On the other hand, if the secretary stops the EHRM program, the government will face multiple lawsuits, harsh criticism from all sides, and further degradation of veteran and public confidence in the VA.

These are not attractive options.

Recognizing that it is easy to criticize and much more difficult to solve, I offer the Secretary the following specific recommendations to solve this epic conundrum.

  1. All the next steps must be filtered through a rigorous view of what is in the best interests of the veteran. You are responsible for the health and care of over 9 million veterans, including 325,000 World War II veterans more than 75 years after the end of that war. Is it better for the veterans if the VA controls the critical systems that support these men and women or is it better for the veteran to give that control to a for-profit business entity that must serve the needs of the veteran? over 27,000 non- VA commercial facilities worldwide?
  2. Any consideration of practical, contractual, political, personal, personnel and organizational matters must be addressed in a transparent manner; that is, fully identified and the weight applied to these issues explained. To be more precise, if it is going to cost a lot of money to terminate or materially adjust these contracts, say so and say how much and why it is so. Likewise, if the consideration is how the termination of the current VA contract will affect another department’s program that should be spelled out and addressed.
  3. Take a look at where your advice and guidance is coming from. We all have biases based on our experience, background, and priorities. We all have different motivations and different levels of motivation. All of this must be understood and factored into the weight given to such advice and guidance. It cannot be taken at face value.
  4. Protect your alternatives. Fund and fully staff the VISTA program office with competent and dedicated staff and protect it from those who may seek to deprive it of the necessary resources to eliminate it as a viable alternative.
  5. Take the time to appreciate what you have in VISTA. Challenge the idea that VISTA is an old “legacy” system in need of replacement, as it is often misrepresented. It’s not. It is a system designed by VA clinicians to meet their needs of providing “great care” to veterans, which has evolved over time and which is safe, reliable and reliable, which must be upgraded. up to date and modernized, not replaced.
  6. Insist that an independent, scientific and professional organization such as Sandia National Laboratory or Oak Ridge National Laboratory perform an end-to-end modeling simulation of the proposed solution using the best estimate of workloads, capabilities credible system and realistic infrastructure assumptions to prove that this proposed system is capable of meeting the needs of DoD and VA. Without it, you are relying on assumptions, aspirations, and hype.
  7. The VA is currently engaged in three essential, interdependent, and major system replacements. The failure of one of them will cause the failure of the other two. Two of these systems involve a high risk “rip and replace” strategy. This situation must be considered as a significant risk for each of these programs. At a minimum, organizations such as NASA and the Nuclear Regulatory Commission would insist that an outside entity conduct a Complex Systems Analysis (CSA) to identify the main risks posed by these system interdependencies. The success of the VA mission requires this level of scrutiny.
  8. You said, “Our success as a team – our ability to provide world-class care to our veterans – also depends on how we treat each other. You need to engage with this team. Not just with the officers, directors and assistants of the central office. Not just with contractors, former contractors, or recent imports from other agencies. Not just with the staff who have the “skin in the game” because of their years of hard work and effort trying to make the decisions of previous administrations work. You need to interact with your grassroots team members in a safe and trustworthy personal environment. Their concerns must be heard and taken into account. Meet them. Ask them what their concerns and considerations are. Many of them have experience with VISTA and the software solution offered. You have the most educated, professional, and experienced team in the entire government. They use a system that they helped create, improve, and develop. Forcing them to have a system, especially one that reduces their productivity, overloads them with non-medical administrative tasks, reduces their confidence in the security of the system, and affects their ability, in any way, to provide the level of care at which they are expected. come to expect to use VISTA will guarantee ethical, medical and professional rejection. Survey those you cannot meet in person. Ask them what their concerns and problems are. You can have the most cohesive, dedicated and engaged management team around you, but if directors, end users, those who deal face to face with our veterans feel like an inferior solution imposed on them without their involvement, without their contribution, without their voices being heard, your “team” will not succeed. Consider the wisdom of “what is imposed will be fought.”
  9. Ask and demand answers to the many critical questions that have been asked and remain unanswered. Where did this $ 16 billion sole-source contract come from? Was it due to internal VA specific requirements or was it politically imposed to solve another agency’s problems? Will this solution work at full scale, breadth and complexity? Besides verbal assurances from the supplier and contractor, what evidence is there to prove that it will meet VA’s needs? Has it ever worked in a similar environment? What recourse do you have in case of failure of this solution?
  10. Appreciate that this inflection point is your “Rubicon moment”. If you continue with this solution, you will own it. You will own all the consequences that will flow from your decision. When this solution fails – and it will inevitably fail – you will bear all the consequences. You will not be able to go back to previous administrations or previous decisions to explain the failure. There will be no “unforeseen” circumstances that you can cite to explain this failure. They have all been seen and described. They are known and cannot be “unknown”. This is your last and best chance to avoid this

Mr.Secretary, the best advice I can offer you is that right now it may seem that staying the course is your best option and stopping this multibillion dollar juggernaut seems like a failure and a waste of money. money and effort. many dedicated and committed people. This is not the case. It would be an act of courage and fulfillment of your commitment to always put the veteran first. In the long run, when your servant leadership is judged, when your pros and cons add up, it is only important that you do the right thing, for the right reasons, at the right time.

As a disabled Vietnam veteran, I wish you good luck and support you.

Edward Meagher retired after 24 years in government, 26 years in the private sector and four years in the US Air Force. He was for seven years Deputy Assistant Secretary and Deputy DPI at the Department of Veterans Affairs. Ed divides his time between his own executive consulting firm, VETEGIC, LLC, and extensive involvement with several veteran-focused organizations, including his own Service Member Support (SMS) foundation.



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