Brookings Institute EHR

Brookings Institute: VA $10 Billion EHR Change 6.4 Percent Odds Of Success

Citing one study, the Brookings Institute critiques the current DOD, VA approach to modernizing its EHR systems because DOD is failing modern exchange solutions.

Get this. According to The Standish Group, in assessing IT projects over $10 million or more in labor costs, found 6.4 percent odds of success:

The VA’s EHR project is similar to other government IT projects, but judging from this history, the VA project is also very likely to fail. In addition to the usual causes of failure, the VA adds an extra layer of complexity that increases the odds of failure: its personnel show an immense resistance to change. Year after year, VA’s legacy EHR system, VistA, has been ranked amongst the best EHR system by physicians. VA that takes pride in its EHR system and its physicians and nurses have never used another software before. I imagine a large number of those physicians who think VistA is the best EHR system available will have some difficulty adjusting to an unfamiliar system.

The article from Brookings highlights that DOD is presently experiencing problems implementing the change over because, in part, the system does not facilitate exchanging of medical data. This means that even if VA is successful in its change over from VistA, there may not be much data from DOD, which was the point in selecting Cerner as the sole vendor.

Instead, the author supports use of applications like that of Apple or even VA’s own Blue Button technology to allow patients the opportunity to secure copies of their electronic records and then share them with whomever they choose.

Presently, the proposed systems to do not allow simple solutions:

Apple’s health app is the most recent example of such an approach in which patients can receive their medical records from participating hospitals into their mobile phones and then share those records with other providers as they wish. At the Healthcare Information and Management Systems Society annual meeting, Centers for Medicare and Medicaid Services Administrator Seema Verma enthusiastically announced rolling out new initiatives to enable patients’ access and management of health records. Interestingly, VA was the pioneer of patient-mediated exchange solutions: their Blue Button technology allows consumers to access a single, downloadable file with their available health data. It is disappointing to see VA adopting outdated solutions while the rest of the industry is finally implementing the exchange solutions invented by VA many years ago.


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  1. Ok, I’m going to give you my assumptions based on the past 7 months of dealing with my personal issue regarding our electronic health record.

    August 2017 I learned a social worker informed my spouse of something in my psychotherapy notes. I asked my psychologist and nurse psychiatrist and never one spoke to this social worker. The social worker told me she can access my psychotherapy notes and doesn’t have to follow HIPAA, Privacy and VA Privacy. She got a verbal from the national director given her permission to access my medical record and psychotherapy notes.

    This social worker isn’t my provider, never provided treatment, not in billing and nothing to do with benefits. The SW supervisor told me she didn’t understand why I was upset since all VA employees have access to my medical record and psychotherapy notes. I spoke to my psychologist which at first she didn’t believe me to only come back to inform me this was true and she was shocked any VA employee has access to her psychotherapy notes on me. Also, HIPAA prohibits even the patient from having access because it could do further harm.

    I filed several privacy complaints with the VA privacy officers and with the patient advocate and this is when I learned the truth about all Veteran’s electronic medical record.

    VA has combined your medical record, mental health record and your psychotherapy notes into one integrated electronic medical record. VA then classified it as open which allows all VA employees nationwide, DoD and other entities VA has given permission to access our records without having to obtain our written authorization and providing only the minimum necessary. Yes, VA is noncompliant with HIPAA and Privacy laws and with their own VA Privacy policy. Our records are unmonitored, untracked, unprotected, etc. Psychotherapy notes are by law to be separate from the patients medical and mental health records and protected. There are only a few exceptions of law which authorizes the patients mental health provider to disclose the psychotherapy notes and it’s only the minimum necessary. The only other person authorized to disclose for all other reasons is the patient. The patient must provide a written authorization granting an individual access to the identified psychotherapy notes (they don’t everything).

    By integrating our medical record, mental health record and psychotherapy notes to form an integrated electronic medical record, and by classifying them open it allows them the ability to share with other entities such as DoD to show they have made progress in all the millions of dollars they’ve spent. If VA complied with HIPAA and Privacy laws such as separation of records and unclassified them as open, the VA could not share our records and meet the requirements our representatives have placed on them.

    FYI, until VA meets HIPAA and Privacy laws and VA Privacy policy, everyone one who accesses your integrated electronic medical record other than your mental health provider must obtain a written authorization from you to access it. If not, they are in violation of HIPAA and Privacy laws and VA Privacy policy.

    Don’t believe me. If you can access your records and psychotherapy notes via MyHealtheVet then you have an integrated electronic medical record which isn’t complaint. Also, submit a written request to your local privacy officer to mark your integrated electronic medical record sensitive. Wait 2 to 4 weeks then submit a written request to your privacy officer for a SPAR (sensitive patient access report) report to see who has accessed your record. You can submit a written SPAR request monthly, quarterly, etc as often as you want one. In 6 months (Sept – March), I had over 48 individuals (VA, DoD and other entities) access mine. None of these individuals are my providers, provide me treatments, etc. My last appointment for treatment was August 2017 so no idea why these people are accessing my records. I’ve had individuals in California, Arkansas and other states access.

    Yet, VA is willing to violate us and waste more tax payer dollars for something they have been unable to make work without breaking laws.

  2. Washington, like Wall Street is now purely transaction driven. A product’s usefulness doesn’t matter. Look at the Credit Default Swaps, which, if not identical will soon morph into something similar now that Dodd Frank – for all its warts, has been nutted. The goal is the to make the sale. Period.

    With IT, functionality all boils down to who wrote the specification, and, who is monitoring the progress and subsequent implementation. You gotta know the lawyers weave a sticky web that leaves the bidder indemnified in the event of … a thousand things.

    So, deals will be cut. Transaction bonuses handed out, and tons of money will be spent. Billions in “overhead” will be pocketed, and the shit won’t work.

    Why? Because the next beltway scumshop won’t be able to bid to fix it in three years – if it did work.

    We arrogant Amerikans used to scoff at third world corruption. Shady Colonels brown-bagging sacks of greenbacks for Prime Minister Douschey. But – some stuff actually got done. But our corruption is so much more sophisticated. A well healed lobbyist convinces Senator Fuchschtich to draft a bill or regulatory measure to develop a program, or project or other trough. The lobbyist and the senator’s staffer draft the precise language, and friendships grow, and promises are made. It slides through some committee because Senator Fuchschtich just gave reciprocal noggin to some other Senator, and the project slides through unscathed. The good senator can wait for five years to cash in as a director, or otherwise claim his insider stock larder. All of it legal.

    This shit is so embedded in our governments that I have very serious doubts that the voting booth can change it. The alternative is damned ugly and would not likely succeed anyway. Corruption is in our national DNA. It’ll simply mutate.

    1. Corruption is absolutely embedded in the Federal Government. It’s built in as cost of doing business. It’s the same way in the private sector. There’s no profit in building a washing machine that will last 20 years. So instead you tell your engineers that you want a machine that will last 5-6 years. So that washing machine is now engineered to fail at an approximate time. The bottom line is now you have to walk into a store 5-6 years later and drop another 600-1000 on a “decent” washer. CEO’s are happy because business is brisk and their bonus’ are fat and the shareholder is happy because their stocks are going up due to forced consumption.

    2. Spot on Windguy. The unintended (or fully intended but unstated) consequences of this is Senator Fuxtix blocking any hint of reform to insure that future payoff.

  3. That’s a good one. I usually ask them which terrorist organization their affiliated with. It usually ends with me saying “Fuck you porkchop”

    To any Jihad Jonnies or Suicide Sallies that may be watching. Remember one thing guys and gals. You can’t spell Mohammed without HAM.

  4. It’s a good thing I’m baked and don’t give a fuck. The scammer/jihadis keep ringing muh damned phone.

    1. What you do is answer each and every time as if you were a pork only butcher shop. NO LAMB…only pig, every which way you could order pig…BUT NO…LAMB!

    2. WC, have fun with the freaks. Can’t do much for the activist and such that can block their calls or calls when called back to get a recording stating ‘phone not in service at that time, or disconnected. But you can locate or find out who a lot of them are: political activist, spammers, insurance or medicare crap, credit card chunk, rip-offs, and phones wanting your ID and info, etc.

      Some of these will put the location of the callers number on the map. Very interesting stuff at times. Or pay a bit for names plus.






  5. Ben, not sure what us going on, but email notifications are not working.

    Also seeing indications of pop ups being blocked which is strange.

    Maybe some IT contractor is hacking you.

    1. Maybe I’m doing something wrong, but every time I post a website address it disappears.

  6. Interesting to note the claim that VA physicians like Vista so much.

    They like it so much when records errors are pointed out, the claims most hear are that they are unfamiliar with the software, it was a mistaken entry, and they can’t change it once the entry is made.

    If the VA has their way, the only way a vet can get records is to request them a month in advance, then go into their VA hospital between the hours of 315 and 330pm to pick up an 8 inch floppy disk.

    Only to find out they got another veterans records.

    Who died 4 years ago.

    But his PAP smear was good.

    1. 91, Beyond words. Thought that kind of screw-up could happen to me. Calling me up and telling me I should be in the hospital, stop drinking, and that I’m dying. blah blah blah.

      Damn crazy world we live in. At least “his” PAP smear was good. I am freaking baffled for the day, and that’s hard to do.

      1. T, I bet you could see the above happening though.

        Ben, email notifications may be working again. Thanks.

      2. 91, Yeah, I am totally beyond being really shocked by anything humans can or will do, or the VA, gubbermint plus established connected complexes, or ‘professionals’ does/do. Can’t put anything past anyone or anything.

        I read this about PAPs and thought directly to the guy that came by after a motorcylce wreck sent home with no pain meds. Said a MD and surgeons told him they might as well remove his appendics while operating on all his injuries. Holding up x-rays and scans showing his family the little organ to be removed and repairs needed. They all said… it has already been removed years ago. What you looking at doc. lol. And his MD kept trying to tell him that it was there, they were wrong, it is there or not completely removed. Strange stuff happens around here.

  7. “According to The Standish Group, in assessing IT projects over $10 million or more in labor costs, found 6.4 percent odds of success:”

    First we have to understand the definitions used in the study to interpret the results. SO here goes…As best as I can see, the federal interpretation of the word “success” in any given project involving huge $$$ is;

    ANY project in which corruption, scandal, or death has not been reported by Fox News OR that has but can be plausibly denied.

    6.4 percent success for our Federal Government is a slight rise statistically from historical US accounts of our Federal Servant pool in Washington D.C. so progress is clearly being made…

    1. Here is a splash of info.

      The IT, globalization, dangers never stops.


      Hmmm who and what is controlling social media and Utube? More IT dangers to come.

      White genocide. Already happening here. Happening here through the VA, etc., by soft and hard killing – color of stripes may not apply… all are included, expendable.


      Let’s not forget these older failures to the more recent ones. And note that not one agency out there is concerned about our local IT breaches, HIPPA cyber, files, violations, and etc.

      Gov smoke and mirrors.

      If they ALL were so damned concerned about IT issues it seems they’d be concerned about us at the lower pecking order dealing with leaks and the cluster IT F-ing. And would want to find and expose the ‘domestic terrorist’, insider hacks, militants, thugs, and actiivst. No, they don’t change – then merg, game play, go internationally where all can play in the games. While claiming excellence of course.


      1. Yet another way to inderstand “success” in this context is that by a certain logic nobody in prison is a success. They all got caught or couldn’t deny things very well.

  8. This is the VA reinventing the square wheel again, still trying to get a smooth ride out of the seismic thumps of those square wheels and IBM Watson gave-up long ago and became an electronic pleasure device for engorged purple teams.

    **IBM Watson** was NOT ABLE to put the “fix” in the IT mess at the VA, so I wager only Superman or Wonder Woman or tactical nukes can properly put the “fix” in-place and remove the idea of those outdated square wheels at the VA.
    (I’m going with tactical nukes, it’s the only way to be sure of a success in this war of idiots)

    IBM Watson: “Want to play a game?”

    1. RAND Corp. and Brookings Institute recommend a prolonged therapeutic wrap of all those square wheels at the VA with large amounts of taxpayer $$$ that should be going to Veteran Healthcare, then apply more Billion$, repeat as required or desired.

      I will repeat it: It’s my strong hunch that “VA IT Fixes” are indeed an “it” but “S-h-h-h-“…super-secret dark ops shIT. But…all for the Vets. $hIT.

      Folks: We can communicate with space probes outside Pluto and now into the outer solar system and I bet internet porn made it out that far with modern communications means but you can’t convince me that the DoD and VA are inable to toss notes wrapped around rocks and toss across the swamp locations to each other?
      Come on…let’s play a game of $-h-IT. Keep the square wheels to keep the problem and $hIT flowing.

      Meanwhile, how many years a Vet has to wait to get a wheelchair and maybe a decade more for a ramp for that wheelchair and maybe make that a motorized wheelchair at this point as the $hIT is getting thick??!

      1. They don’t give a fuck 10 Billion USD is the new 100.00. All they have to do is go in and add a few more electronic 0’s and it’s all fucking good. What I want to know is who exactly is profiting from this screw job because it’s exactly that on so many different levels. I mean isn’t this exactly what qui-tam lawsuits are for? I would also like to know which government employee(s) looked at this and decided it was approved. Those are the heads that need to roll. The private entitie(s) caught profiting from this bullshit should be burnt out of their mansions and their aircraft targeted as it flees our airspace.

    2. LOL. Shhh. “$hit.” Circus Maximus.

      Trade all those suits off for white jackets, as shown, then they can pretend like the , same old suits, the old guard, VA -unions, the cliques that they know what’s best for us…how much we suffer, what we want or may need, or can improve anything at all… while doing the direct opposite intentionally for various reasons of their own devices, agendas. Aren’t there laws out there for professional misconduct, ethics violations, pretending to be LEOs or MDs?

      All questions still apply to those game players, institutes, corporations, DoD, lefty colleges, med boards, Homeland SS that is supposedly over every aspect of our lives, health care included, and etc.

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