Earlier this month Secretary Shulkin announced he would sole source the replacement of the Veteran electronic health record (EHR) system to Cerner. The decision makes a great deal of sense on many levels. It is, clearly, the fastest way to start implementing a new EHR for VA and it will, finally, align DoD and VA records which is certain to ease the transition from active duty to Veteran status. Moreover, assuming VA can implement the program without creating unnecessary customization (not a strength of government) and accept a better solution is better, even if not perfect, the decision should save taxpayer dollars in the long run. All of that? The optimist’s perspective and an important one. If years from now, VA scraps the idea and starts over, please remember that implementing the solution is actually possible. There are no technological limitations that would make the system fail. Business rules and the inflexibility of humans will derail it, if the worst happens.
And, the decision has long term negative impacts on many currently inside, and almost all who are currently outside, the government contracting industry. As mentioned in a recent post titled, “The Innovator’s Dilemma” our government is trapped by continuing to do what it has always done. In the short term, this decision can be justified by the budget savings and economic value of repeating what is proven. In the long run, we end up with critical government systems built on a MUMPS platform for which there are fewer and fewer people who can keep the systems running. The looming nationwide infrastructure problem we don’t see is the one comprised of 20 and 30 year old technologies that simply can’t sustain the demands of today’s government or consumer. At some point, somebody has to stand up and be the voice of doing the harder thing now to make the later thing easier. Our government and our people are ill-served by taking the easy way out in order to portray the illusion of progress. If we fix government procurement, at a macro level, perhaps we can get better solutions to better address change.
There would be some unknown and possible better benefit if the Secretary had declared he would open a competition to seek the best EHR for the VA healthcare system in 20 years. Might that have been Cerner? Quite possibly. And, it is also possible that the team at athenahealth could have helped us evolve a very important part of Veteran care even beyond what DoD is implementing. The point, more importantly, remains the same. Until we stop doing what we’ve always done we can’t expect what we’ve never gotten.