KC’s Cerner got a no-bid contract for VA health record system. There’s a better choice | Opinion

In 2018, the Veterans Health Administration signed a no-bid contract with Kansas City’s Cerner for a new electronic health record system to replace the VA’s longstanding one. The contract stipulated “a $10 billion ceiling over 10 years.”

No-bid contracts are extremely rare, their undue use characterized as “the essence of corruption.” Furthermore, there were significant problems with earlier contracts between the company now known as Oracle Cerner and the VA and the Department of Defense.

Enter Donald Trump’s son-in-law Jared Kushner and “the Mar-a-Lago group” of wealthy insiders with no relevant expertise. They justified the rushed, no-bid contract because of “the urgency and the critical nature of this decision,” according to then-Secretary of Veterans Affairs David J. Shulkin.

Five years later, the “urgent” project with an initially-promised $10 billion ceiling has rolled out to just five VA hospitals. The contract has ballooned to $16 billion, heading toward $50 billion. With terrible reviews and user distrust, further Cerner record system rollouts are on hold because of malfunctions causing lost productivity, chaos and even deaths. These problems go far beyond the growing pains of new technology deployment.

It is time to scrap it.

Open-source VistA already works well

As the nation’s largest health care system with about 9 million enrollees, the VA oversees 172 hospitals and 1,321 clinics. It is a crowning American achievement, akin to the National Highway System or NASA. It compares well with the nation’s best health care systems. A crown jewel is its pioneering VistA record system, aggregating nearly all health information, as well as enabling appropriate access for patients. Without robust, dependable systems like VistA, modern health care would collapse.

Created by VA computer engineers, in partnership with the Indian Health Service and Defense Department, with hundreds of thousands of users, VistA has been rated the top electronic health record system in the country. It employs a consistent systemwide look and feel adaptable to different hospital environments. Clinicians can link to other VAs, providing care continuity for the wide-ranging needs of veterans. While commercial record systems focus on charge capture (maximizing income), VistA focuses on the care of veterans. This makes a big difference in the way medicine is practiced.

The federally-developed VistA belongs to all Americans. Open-source and freely available, it has been adapted to hundreds of private and public hospitals in the U.S. and internationally, at a fraction of the cost of commercial record systems. It will never suffer the “walled garden” proprietary protectionism of private technology.

As an oncologist for nearly 20 years at the Kansas City and Topeka VA hospitals, I can attest to VistA’s ease of use, dependability and inter-institutional operability.

While VistA has often been updated, more recent modernization opportunities were forgone, opening it to charges of being antiquated. A 2016 comprehensive Commission on Care review favored replacing VistA with a commercial electronic record system, despite some experts arguing that were VistA adequately resourced it would be just as usable.

The VA adopted the Commission on Care’s recommendation. Rapidly thereafter in 2018, the no-bid Cerner contract was signed.

Edward Meagher, former VA deputy chief information officer, states the VA should have stuck with VistA: “The greatest irony is that the VA has in VistA a system that solves all of its current problems and is the best path forward to real modernization.”

Politics, money are perverse incentives

The VA is often a political scapegoat, and is contrasted to the perceived efficiencies of private corporations — which make substantial political contributions to decision-makers.

The VA indeed has its own organizational struggles. However, it is guided by a unique purpose. Its mission, inspiring every VA employee: to care for those “who shall have borne the battle.” Employees are mandated to report problems, with robust whistleblower protections and a supportive union (the American Federation of Government Employees).

Corporations, with their own bureaucracy, inefficiency and perverse incentives, are guided by financial imperatives, and provide little whistleblower protection. Corporations also have something the VA doesn’t: PR and lobbying budgets to sell their stories and disparage competitors. VistA neither has lobbyists nor contributes to political campaigns.

To go forward, we need to go back — to 2018, to the multibillion-dollar “no-bid contract awarded to a non-performing company” (in the words of health tech firm CliniComp CEO Chris Haudenschild) without adequate compliance guardrails or nonperformance penalties, pushed through by a small political group of non-experts in thrall to privatization interests. The process doesn’t pass a simple smell test for integrity.

It is time to stop wasting taxpayer money on a corporation using the VA for unpaid research and development and on-the-job training, with veterans and clinicians as test subjects. At best, the end product would be grossly overdue and over budget, and would be rewarded with hefty ongoing maintenance and updating contracts. Also, the VA would be locked into proprietary technology with huge barriers to switching providers. The icing on the cake for Oracle Cerner: It could sell the end product, vetted and developed with the unpaid involvement of VA guinea pigs (patients and clinicians) to other health care systems.

Commission should call for new bids

It is time to ditch the Oracle Cerner contract and let it find another research and development test bed. It is time for transparent Commission on Care-type reassessment, by unimpeachable experts and end user stakeholders. Informed by the Oracle Cerner experience and technology updates, it would reexamine cost and scope-of-work assumptions. There could be a transparent call for new electronic health record providers, including a robustly represented, adequately financed VistA as one of the bidders, and with an open-source, nonproprietary product as a deliverable.

The commission could also address a loftier matter: whether “America needs to make a serious commitment to building a health IT structure that is openly shared and directed by science and public interest,” as the Open Markets Institute’s Matthew Buck recommends. Meeting this challenge would be a generational achievement with wide-ranging impact.

VistA could again exemplify a world-class, nonproprietary, affordable records network. It could significantly improve today’s atomized health care system.

It just may be the electronic health record system of the future.

Meanwhile, VA facilities continue to hum along with the tried-and-true VistA, doing its job affordably, with integrity, and always with veteran health care as its North Star.

Ace Allen is a retired medical oncologist. He lives in Overland Park.