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Black Book: Cerner Best Suited to Replace VA’s VistA EHR System

April 17, 2017
by Rajiv Leventhal
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With the U.S. Department of Veterans Affairs (VA) intending to replace its antiquated electronic health records (EHR) system with a commercial product, a new Black Book survey has revealed that Cerner would be the health IT vendor best up to the task.

Developed by the VA more than 30 years ago, the Veterans Information Systems and Technology Architecture (VistA) currently serves more than 1,200 healthcare sites of the Veterans Health Administration (VHA) throughout the U.S.  But, VistA is considered outdated and unable to meet with the changing healthcare IT landscape. While VA isn’t expected to announce its official decision until July, Cerner is the vendor candidate best positioned now to deliver on President Donald Trump’s key VA initiatives, according to a new Black Book report.

For the research, Black Book looked at the results of its first quarter 2017 surveys of more than 30,000 inpatient and ambulatory EHR end users and clinical decision support end users. Black Book then examined 24 key performance indicators (KPIs) on five leading EHR vendors—Epic, Cerner, Allscripts, Meditech and athenahealth—and how they charted across four of Trump’s VA-related health issues: improve veterans’ health access, satisfaction, veteran engagement and services delivery; solve the opiate crisis; innovate government agencies; and improve government business processes and fiscal performance.

It was Kansas City-based Cerner that topped the list with a mean score of 9.14 of a possible 10.00 across all four initiatives and 24 KPIs, also finishing first in all of the four initiative categories. Coming in next was Allscripts with a mean score of 8.91, finishing second behind Cerner in each of the initiatives. Rounding out the list were Epic (mean score: 8.17), athenahealth (7.89) and Meditech (7.66).

All represented vendors scored 7 or above in all KPIs relating to the first three initiatives, with one exception: Meditech scored a 5.79 in patient portal and experience, which is connected to the third initiative to innovate government agencies.

Cerner outperformed in-technology functionalities that support the healthcare delivery sector’s role in combating the opiate crisis, scoring highest in drug surveillance tools and pharmaceutical prescription record tracking, behavioral health and addiction EHR capabilities. Cerner also scored highest in IT outsourcing and privatization capabilities, hosting, tech support, interoperability and cybersecurity in organizations like the VA Health System with 100 or more facilities and national network locations. The weakest spot for some vendors was in meeting the demands of the fourth initiative: to improve government business processes and fiscal performance, according to the research.

Cerner, of course, was also the vendor that was awarded the Department of Defense (DoD) EHR Modernization Program contract back in 2015, along with Leidos and Accenture Federal. The first wave of that project was delayed last year, but is now underway. Interoperability between VA’s EHR system and DoD’s system has long been a challenge, and also a major critique of Congress.

Last week, VA issued two requests for information (RFI) related to potentially replacing or enhancing its VistA system. In one of the RFIs, VA said it is seeking information about commercial off the shelf replacements for VistA provided in a SaaS model, a Web-based model, as an alternative to VA continuing to operate its VistAs, which are not fully modernized. The department also is separately exploring commercial off the shelf non-VistA EHR alternatives.

“For years highly touted as playing a large role in a positive turn at the VA, VistA is widely credited as the impetus for developing and implementing EHRs nationwide. VistA was a true pioneer in the birth of EHRs more than 30 years ago,” said Doug Brown, managing partner of the Black Book Research. “In fact, much of the architecture of today’s commercial EHRs was based upon VistA’s open-source technology, which is used around the world.”

Brown added, “Three of the companies represented in our Black Book report are taking inspiration from the spirit of VistA, even as they vie to replace it. Cerner, Allscripts and Epic recently indicated they intend to make their EHRs more open, utilizing application programming interfaces (APIs) to enable third-parties to write apps for their platforms.”

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