If you’re like me and enjoy a little inside baseball in the EHR world, then you have to watch what’s going on with EHR use in the government. In many ways, it’s like passing that car wreck on the freeway. There’s no way you can pass by without taking a look and seeing what’s gone on and what’s still going on. You want to know what’s happening.
A car wreck might be an apt comparison since we’re talking about the various government EHR situations. For those who haven’t followed this as closely, here’s a quick recap.
The DoD had the awful AHLTA EHR system. The VA had (and still has) their own homegrown VistA EHR system which most users seem to like. After a bunch of political jousting back and forth, the DoD did a $9+ billion RFP and finally selected Cerner EHR (although, Leidos was really the lead company and much of the $9 billion was going to them and not Cerner).
Meanwhile, the Coast Guard had selected Epic as their EHR. Long story short, things didn’t work out and the Coast Guard stopped implementing Epic and went back to paper. Yes, I said that right. They had to go back to paper.
Near the start of 2017, word came out that the VA was likely to replace their current VistA EHR with a commercial EHR replacement. That process is ongoing.
In the last week, the Coast Guard published their RFI to purchase an EHR. I guess that’s the final nail in the coffin for Epic at the Coast Guard.
I’m sure I’m leaving out some other government organizations that have EHR or are looking for an EHR. However, these are some of the high profile ones. As we sit here today, the question remains, which EHR will the VA and Coast Guard choose?
The obvious choice to everyone watching this is that the VA and Coast Guard and every other government organization that needs an EHR should go with Cerner. Interoperability between the DoD and VA has been awful and you’d think that having one EHR would help that situation. Plus, shouldn’t the VA be able to benefit from the experience the DoD has had implementing Cerner already? Not to mention, shouldn’t the VA and Coast Guard be able to get a discount from Cerner for bundling the purchase or does that not happen with $8 billion purchases.
The problem is that most of us (including me) don’t know all the politics at play. What seems completely obvious to us outside observers misses many of the political and cultural nuances at play in this situation. I’m not saying those nuances are right or accurate, but you can be sure that the EHR selection decision is going to have a lot of people chiming in with their own personal biases.
One simple example that’s easy to understand is you could see the VA making the case for why they should go with a commercial version of the VistA EHR that they’re already familiar within their organization. It’s hard for me to see them making this decision, but you can see why one could make a pretty solid argument for why choosing a commercial version of VistA would be a good idea.
When it comes to the interoperability potential I mentioned above, it’s sad to ask, but is having all of these organizations on the same EHR really that much better? We’re not talking about the government implementing a single instance EHR that’s shared across all organization. That would never happen, so even if the DoD and VA both buy from Cerner, they’re still going to need an interface between the systems. This should be presumably easier, but you can be sure it’s not going to be as turnkey as one might imagine it to be.
No doubt we’ll be watching to see what the Coast Guard and VA decide. Which EHR do you think they’ll choose? Which EHR should they choose and why? I look forward to hearing your thoughts in the comments.