Commercial health record software would cost $16 billion, says VA

If the Veterans Affairs Department replaced its existing Veterans Health Information Systems and Technology Architecture with commercial software, it would face a bill of $16 billion, Roger Baker, the department's chief information officer, told a House Veterans Affairs Committee hearing Wednesday.

By contrast, the open source software approach now planned by VA will allow the department to upgrade VistA incrementally, avoiding "a huge outyear expense," Baker said at a hearing of Subcommittee on Oversight and Investigations.

This March, VA Secretary Eric Shinseki and Defense Secretary Robert Gates agreed to jointly develop a new electronic health record. While Baker backed the open source model, a March 25 memo signed by the top officials of the two departments makes using commercial software the first choice for the joint project.

This February, five Wisconsin lawmakers had urged Defense and VA to consider using software from one commercial vendor for the joint record. Epic Systems Corp., based in Verona, Wis., is one of the country's largest vendors of electronic health record software.

Baker said last month that the open source approach will ensure commercial software vendors "can easily and confidently integrate their products with VistA to make them available for VA to purchase and use in our facilities."

The VA-Defense electronic health record would end up as one of the largest in the world. VA has 6.1 million veterans in its health care system and stores information on them in a 65.8-terabyte VistA database. The Defense AHLTA electronic health record stores information for 9.6 million active-duty and retired military personnel and their families in a 70-terabyte database.

At the hearing, Rep. David Roe, R-Tenn., told Baker he was concerned that a final agreement for a joint record will not be completed before Gates leaves office this June. Baker replied that "our objective is to have this nailed down" before Gates leaves.

Both Roe and subcommittee chairman Bill Johnson, R-Ohio, repeatedly asked Baker to provide a timeline for development and deployment of the joint record. Baker declined, saying such information needed to come from the two secretaries.

Joel Willemssen, managing director for information technology at the Government Accountability Office, said in a response to a question from Rep. Joe Donnelly, D-Ind., that GAO had not yet done an analysis of the costs savings that could result from a joint record. But because both departments each spend billions of dollars on their separate records, Willemssen said, he expected significant savings.

Asked why the two departments had taken so long to agree on the use of a joint health record, Willemssen attributed it to "institutional and cultural resistance," finally overcome at the top by Shinseki and Gates.

Johnson, who has extensive experience with large system development from his service in the Air Force and as an information technology consultant, repeatedly pressed Baker during the hearing if he had developed overall information technology architecture for VA in the two years since he took office.

Such architecture, Johnson said, would help VA cut costs and generate savings, and he wondered why it has taken so long to develop.

Baker bridled a bit, telling Johnson, "I don't believe I have a reputation for sitting around," and added that immediately upon taking office he had to deal with problems that "bite us," such as failing systems rather than proceeding to architecture development, which he agreed was necessary.

Belinda Finn, assistant inspector general for audits and evaluations at GAO, agreed with Johnson that VA should develop an overall IT architecture. "I don't think any software methodology works unless you have an end game in mind," Finn said.