VHA overhaul puts the future in focus

When modernizing its health information system, the Veterans Health Administration decided to consider its future upgrade needs as well.

'The traditional way is by asking: How do I fix this? Or, how do I add this piece?' CIO Gary A. Christopherson said. 'Instead, we said the right question is asking where we ought to be three to five years down the road and how can we design a system that anticipates what's going to happen even after that.'

VHA is using this approach to modernize its 20-year-old system, which runs at the Veterans Affairs Department's 174 medical centers and 800 clinics.

The new system, Health eVet, will combine or replace existing systems and use common data standards for sharing information, Christopherson said. It's also designed to give veterans access to their medical records via the Web.

Doctoring codes

VHA expects to spend $100 million a year on Health eVet through 2005, when it plans to roll out the system.

The project's roots go back to 1982 and the Decentralized Hospital Computer Program. VA programmers built DHCP using M, a 1970s programming language formerly known as Mumps and once a standard for medical systems.

In 1996, VHA upgraded the system to VistA, the Veterans Health Information Systems and Technology Architecture. VistA incorporated DHCP data in a client-server environment using a graphical user interface called the Computerized Patient Record System.

VistA has weaknesses, Christopherson said; chief among them are a lack of standard data elements, inadequate documentation, difficult upgrades and costly maintenance.

Health eVet builds on the hundreds of applications that make up VistA. Some are being modernized; others are being rebuilt from scratch. VHA programmers will do some of the work in-house, depending on available expertise, Christopherson said.

VA and VHA have been working since August 2000 on the modernization; the core system will be a national health data repository.

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