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Alan Brookstone for Doug Diedrich

The following comment is published on behalf of Doug Diedrich: Ironically, a proven EHR system already exists. It's called VistA (no, thankfully not Microsoft's product of the same name)and the beauty is that it is predicated on an open source code. The development of this open source EHR occurred from 1994 to 1999, when Dr. Kenneth W. Kizer, MD, MPH served as the Undersecretary for Health in the U.S. Department of Veterans Affairs (VA). In this role, Dr. Kizer was the Chief Executive Officer of the VA healthcare system, the largest provider of healthcare in the nation, managing an annual budget of more than $20 billion, approximately 200,000 employees, and more than 1,300 sites of care. He was the chief architect and driving force behind the radical transformation of VA healthcare that occurred between 1995 and 1999.

Alan Brookstone

I would like to point out a May 2009 report that was published by the Office of the Inspector General within the Veteran's Administration entitled: Audit of VA's Management of Information Technology Capital Investments. The report indicates that the VistA system has its challenges (as does any large IT implementation).

As reported by Joseph Goedert for Health Data Management:

The OIG conducted an audit after the VA failed to meet a deadline to submit documentation to justify funds for I.T. capital investments for budget year 2010. The documentation is called Exhibit 300s.

In a new report, OIG concludes that the VA's Office of Information & Technology "did not have effective policies, procedures and management controls in place to ensure that the VA managed its I.T. capital investments effectively, efficiently and in accordance with applicable criteria."

Further, the I.T. office has not implemented controls to ensure it does not miss future Exhibit 300 submission deadlines, according to the report.

"More importantly, OI&T's delayed submission of VA's Exhibit 300s signifies a much broader and more serious issue--VA's inability to adequately manage and ensure effective oversight of its I.T. capital investments," the report states. "For example, OI&T has not fully defined and documented new centralized management policies and procedures needed for effective I.T. capital investment management.

OI&T has also not clearly defined the roles of I.T. governance boards responsible for facilitating budget oversight and management of I.T. capital investments or established the criteria the boards will use to select, review and assess I.T. capital investments."

The concerns of the VA's Office of Inspector General are timely as the VA strongly considers replacing its core VistA patient care information system with commercially available software.

For the full OIG report, click here

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