VA to spend $4.89B on VistA until Cerner EHR fully replaces system

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The Department of Veterans Affairs will need to maintain its legacy electronic health record system at a cost of nearly $5 billion over 10 years until it is replaced by a commercial off-the-shelf EHR from Cerner.

Paul Tibbits, executive director of technical integration in the VA’s Office of Information and Technology, told lawmakers on Thursday that the Veterans Health Information Systems and Technology Architecture (VistA) requires updates and maintenance to keep it functioning until the Cerner system goes live.

“Until the new electronic health record solution is implemented across the VA enterprise, VistA remains VA’s authoritative source of veteran data,” said Tibbits. “Sustaining VistA for the duration of the EHR modernization ensures that VA continues to provide uninterrupted care and services.”

Tibbits emphasized that VistA will only be completely retired “when every capability and functionality” of the legacy system is replaced by a modern EHR.

Also See: VA intends to modernize legacy EHR despite plans to replace it

“As the nationwide Cerner rollout progresses, VA will decommission VistA instances as necessary,” testified Tibbits on Thursday before the House Veterans’ Affairs subcommittee on technology modernization. “However, during the transition period, VA must maintain VistA to ensure current patient record accessibility and continued delivery of quality care.”

However, Rep. Jim Banks (R-Ind.), ranking member of the subcommittee, commented that “this mixed environment will be extremely challenging, in which some medical centers will still use VistA while others use the Cerner EHR—the complexity of the mixed environment is the biggest difficulty confronting VA.”

Nonetheless, Tibbits insisted that VistA is expected to run without service degradation until all VA medical centers have been migrated to the new Cerner EHR.

At the same time, he acknowledged that “it becomes more expensive to maintain a legacy system than to replace it,” noting that critical upgrades to VistA could be extremely costly over the 10-year transition period and that maintenance costs are even higher.

“Sustainment costs during the transition include development for new capabilities and interfaces, congressional mandates, maintenance and other costs,” he added. “The estimated minimum cost for VistA during the 10-year transition period is $4.89 billion, excluding any new required development.”

However, Rep. Susie Lee (D-Nev.), chair of the House subcommittee, charged that the VA does not yet have a reliable accounting of all the costs associated with VistA management.

Carol Harris, GAO’s director of IT management, told the House subcommittee that VA identified costs for VistA and its related activities adding up to about $913.7 million, $664.3 million, and $711.1 million in Fiscal Years 2015, 2016, and 2017, respectively—for a total of about $2.3 billion over the three-year period. Yet, Harris testified that “this figure is neither reliable nor comprehensive” and the VA “can only reliably account for $1 billion of the $2.3 billion total.”

VistA is a technically complex EHR system that has been in operation for more than 30 years and is costly to maintain, according to Harris.

Adding to the complexity of maintaining the legacy system is the fact that “customization of the system by local facilities has resulted in about 130 clinical versions of VistA” with no two instances alike, she said in her testimony.

“Given these issues, the department is not in a position to accurately report annual costs to develop and sustain VistA,” concluded Harris. “As such, VA lacks reliable information needed to make critical management decisions for sustaining the many versions of VistA over the next 10 years until Cerner is fully deployed.”

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