The amount of tax payer money the GOP, Trump and Trump’s family members have completely wasted and the amount of time they’ve set this country back in fixing some of the problems we face is just staggering. Incompetence and grifting at every level in and around the gov’t, it just boggles the mind trying to comprehend.
Sounds like a plan.
A $10 billion dollar no-bid contract with Jared Kushner’s finger prints on it (however tangentially) simply cannot turn out good. Grifters gotta grift.
These idiots tried to reinvent the wheel, but making it rectangular so their buddies can get in on the Trump family gravy train.
Up next: Massive budget overruns, firing of top officials then more $$ poured on a bad project.
Republicans running government like a business. Wonderful.
This is the exact type of project I spent a 45+ year career completing. I don’t see this working at all. For one it appears it is typically setup and as it bleeds more and more the typical management move will be made. That is grab more and more. That only results in a bigger failure. Instead they would be better at being successful with a small project and using that to build upon. 1, 2, 3 small projects built with interlinks in mind will lead to success and behold the project works for less time and far less dollars. Will they do that, not a chance, they want to rake in the cash, fail then convince the dups to fund another project that this time will work… fat chance as it is just another rinse and repeat.
One wonders if anyone consulted another major healthcare provider that also doesn’t really have to worry about billing: Kaiser Permanente.
It also seems pretty clear that DoD chose the wrong software, and now VA is compounding that error. So, great work, Mar a Lago Crowd!
Yeah, but Kaiser’s vendor is owned by a democrat.
Welcome to the Kakistocracy.
Without defending Kushner (et al), it’s worth noting that the VA EMR implementation is probably the largest, most complex project of its kind ever undertaken. It’s unlikely anybody would’ve been able to do a great job. Vendors who didn’t get to bid dodged a bullet, in a sense, because this thing is a bad press magnet.
“Squaring the circle,” in other words. FUBAR
The VA gave a software company a $10 billion no-bid contract to replace the agency’s records system.
And what are the odds that any/all of these crooks have an interest in that company? Just more corruption from the Trump criminal gang, not surprising.
The industry experts whom the VA had consulted emphasized that clinicians need to lead the program since they’re the people who’ll actually have to use the software. “These initiatives should be regarded as clinical projects, not IT or technical projects,” said Thomas Payne, the medical director of IT services at UW Medicine in Seattle.
This times a million. You can’t get this kind of project right unless you treat the primary users (clinicians) as the primary stakeholders in the design of the system. It just doesn’t work any other way.
From the technical / IT perspective, the model you choose to represent the data in a system is determined by how you intend to use the data, not the other way around. There are necessary tradeoffs involved in any kind of stored data model. If you don’t understand the clinical needs, there is negligible chance you’ll get the data model right. When the data model is wrong, your system a) doesn’t work well, and b) tends to get increasingly buggy as you hack around the deficiencies of your model to provide “user features”. This is not what you want in a medical setting.
Anyone going into a project like this who thinks it’s an “easy win” is broadcasting either naivete, incompetence, or both.
When I read this article, my first reaction was “here we go again”
DoD doesn’t have a good track record on implementing software for business-like functions. They go to private industry to ‘adapt’ existing software to meet their needs, and end up with a product that doesn’t meet user needs.
Two examples - the Defense Travel System (DTS), and the Army’s General Fund Enterprise Business Systems (GFEBS). Both projects were done by contractors - not in-house.
In both cases, the software was pushed out to the users too early, and the functionality was incomplete. Part of the problem was the scope of each effort - instead of picking a subset of users to support first (and getting that part to work right and then building on success) they tried to make the software universal from the start, so it didn’t really work well for anyone.
That may be true, but as a clinician I can guarantee that leaving the clinical people out assures failure. Physicians are focused on taking care of patients, not making the software work. If the EMR doesn’t work, they’ll start keeping their own paper charts, which -surprise- other doctors can’t access.
I have colleagues who worked for the VA and felt the existing system was far superior to anything in the private sector.
Don’t disagree about the importance of clinical buy-in. But it’s simply untrue that VistA is/was superior to commercial EMRs. I don’t doubt it has loyal users, and I also don’t doubt that it’s got a few highly tailored workflows that are difficult to recreate in a COTS system. But overall it is/was years behind modern COTS products.
Since this was over 10 years ago, I can’t disagree.
Yeah the industry’s moved forward a lot in the last 10 years. I hardly recognize the systems I used to work with 10 years ago. And while I’m personally biased against Cerner’s product(s), I can tell you it’s likely 10x better than VistA today. Not the best on the market, but absolutely a huge upgrade.
GReat article by Pro Publica with lots of critical detail.
As someone who lived through two massive implementations of healthcare software in his career, I would like to echo the concerns of many of the people here.
- if it isn’t user friendly and logical, clinical people will not use it - period. They will cheat it, work around it and ignore it.
- For something as inherently complicated as healthcare, there is no such thing as rolling out a system wide program that will start working for everyone. This has to be done in multiple, incremental phases with user testing and criticism all along the way. Imagining how you would like something to work and actually using that something are two entirely different things.
- For some reason, communication between healthcare providers and IT people is especially fraught - it is like working with Chinese speakers trying to design an English speaking program.
I could list 5 more issues but, really, what is the point? The bottom line is that business people, whose main tools consist of spreadsheets and ledgers that translate particularly well to software, have a terrible time understanding why it is so difficult to translate healthcare records and diagnostics into software. Of the 2 huge rollouts I underwent, I would say one was 20% successful and the other was a great white whale of failure that ate up money and resources like plankton.
But Cerner’s product didn’t do that. Its software was primarily designed to help private hospitals bill insurance companies, a function that the VA, as the sole payer, had little use for.
That is all you need to know. Billing software for healthcare is as related to providing healthcare as cash registers are to cooking the food.
So many scams to investigate, so many scandals to expose. Once the Dems get back into the majority, we’re going to need a whole new office building on Capitol Hill, just to contain all the investigative hearings and backlogged urgent oversight work.
Maybe they can assert eminent domain to seize a certain large hotel building nearby.