VistA's scarlet letter: A Gartner rating

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An analyst firm's rating is one major obstacle standing between the Defense Department and the Veterans Affairs Department's Veterans Integrated System Technology Architecture.

Despite the fact that Defense Undersecretary for Acquisition, Technology, and Logistics Frank Kendall said there's a one-in-five chance the DoD will select a VistA-based technology for its electronic health record, the odds of the department making such a selection are hurt by a 2011 Gartner report (.pdf) commissioned by the VA and obtained by FierceGovernmentIT.

The report assesses the maturity of VistA as a computer-based patient record using Gartner's 2007 criteria for the Enterprise CPR (reg. req.)--the same criteria noted in the DoD's request for information for its Medical Electronic DoD Integrated Core System.

"Based on a high level Generations Assessment, we would estimate that VistA is more than a Generation 1 EHR and may in fact be a Generation 2 EHR but is not a Generation 3 EHR," wrote Gartner Vice President Martin Geffen in the report.

As a point of reference, Geffen noted that the seven EHR market leaders all provided a Generation 3 product.

That VistA is a Generation 1 or 2 product on the Gartner scale is a problem for DoD.

The first objective listed in DoD's Feb. 8 RFI for MEDICS is to "replace the current DoD systems with an EHRS that is at least a Generation 3 EHRS, or later generation, as defined in Gartner's 'Criteria for the Enterprise CPR', Published: 29 June 2007."

The Generation 3 technology requirement could also apply to the DoD and VA's integrated electronic health record--which is now described by officials as a data interoperability platform rather than shared health record software.

An amendment to the National Defense Authorization Act for fiscal 2014 (H.R. 1960), which sets specific requirements for the iEHR, would mandate that by the point of full deployment a joint record "must be at a generation 3 level or better for a health information technology system."

Since the 2011 Gartner assessment, VA's Open Source Electronic Health Record Agent--known as OSEHRA--has been busy refactoring code and adding functionality. It's possible this work has moved VistA along the Gartner scale.

In February, OSEHRA publicly responded to DoD's MEDICS RFI. In the draft document (.doc), OSHERA President Seong K. Mun offers a self assessment, saying VistA now meets Gartner's Generation 3 criteria.

"VistA inherently exceeds the Gartner defined Evidence-Based Level 3 CPR system containing patient-centric, electronically maintained information about an individual's health status and care, focused on tasks and events directly related to patient care and optimized for use by clinicians," said Mun.

"Out of the box, VistA can meet DOD's MEDICS EHRS/VISTA, legal and administrative requirements for the clinical process," he adds.

It is unclear whether or not OSEHRA or VA have commissioned another assessment of VistA Enterprise CPR maturity since the 2011 report.

For more:
- download the report, "VistA Comparison to the Commercial Electronic Health Record Marketplace" (.pdf)

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