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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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VistA – Its Now or Never

Never (nĕv’ər) adv.

  1. Not ever; on no occasion; at no time
  2. Not at all; in no way; absolutely not

Recently president Barack Obama told his Organizing for America fanbase that is was “Now or Never” for healthcare reform, “If we don’t get it done this year we are not going to get it done.” While this is a little dramatic, I think the point is that the stars are truly aligned to actually get something done this year. We are beyond life support in healthcare, let alone worrying about the ~50 trillion of unfunded healthcare liabilities already obligated as part of Medicare system. We absolutely need to shift the paradigm within health care and I am hopeful my little efforts can be contributory.

A major part of any reform effort includes the implementation of Electronic Health Records to bring our physicians into the new millenia. Much has been made about “meaningful use” and standards, and much more will be made of certification and outcomes as the money starts flowing. I have to agree with many of my open source friends who are making loud and passionate pleas to congress to consider including provisions to ensure that these investments have the greatest opportunity to yield a return for the public. I don’t think their message has penetrated the lobbyist fortress that is Washington, DC.

I hope to help the cause by making another plea here. I have been fortunate to be a part of a small group of individuals to recognize that one of our greatest national treasures should be given another opportunity to prove its serviceability in providing the highest care and quality to the most deserving of patients. I speak, of course, of my old friend VistA.  Having see this dignified lady transform state veteran facilities, public health clinics, and modern hospitals into higher performing health organizations, I can only but wonder what would happen if she were given a little makeover what she could do.

VistA has been available for 25 years as part of the Freedom of Information Act. Only within the last five years have serious efforts begun to commercialize the system.While there have been tremendous early successes, the lack of “spread” gives me pause for concern.With all the billions being dedicated to HIT and EHR, I have to think that an excellent public investment would be to extend and build upon VistA as a platform for a specific subsegment of public, state, and federal related facilities. These efforts would be dovetailed into efforts already initiated within the DoD and the VA (who are finally trying to have a single system for their singular patients). It could save hundreds of millions of dollars if these efforts were done openly, collaboratively, and in a true open source fashion.

I believe the event horizon for this opportunity is rapidly narrowing. As the pace of technology and computing advances, the opportunity to retool and reskin VistA is closing. I am concerned that without some direction (clearly none coming from the VA), some leadership (none coming clearly from the community), and some momentum (need to have 25+ Midland size implementations), VistA will become an interesting footnote in the history of HIT. The flood of new money will lock in current proprietary solutions and the opportunity to fundamental disrupt with an open source solution will be lost. This season of opportunity will not be an Endless Summer – the coming stimulus wave may be VistA’s last ride.

Its now or never.

3 comments on “VistA – Its Now or Never

  1. Lorie says:

    You’re right. Breaking through the barricade of lobbyists is no trivial matter. However, there have been a few bright spots such as Senator Rockefeller’s introduction of legislation promoting open source in healthcare.
    We need a critical mass of these.

    1. Lorie,

      Its a start for sure. We need alot more pins to fall down if we are going to have a shot.

      Keep me posted on others who can contribute to the critical mass factor.

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