As an enterprise-wide information system focused on electronic health records (EHR), VistA was built from the ground up, designed by clinicians with a primarily clinical focus. Given the size and scope of the VHA (170 hospitals, 800 community clinics and myriad other facilities), planners quickly recognized that cost could become a major barrier. In response, VistA was developed as an open source, public domain platform that is available to download (free of cost) from the VHA website and highly adaptable to the needs of the local organizations.
VHA invested around US$3.6 billion to implement the program, but research shows that the organization had already yielded more than US$3 billion in savings – after factoring in investment costs – by 2007. This included savings resulting from reduced workloads, freed-up workspaces, the near-elimination of unnecessary lab tests and avoided hospital admissions.
The program has also improved patient safety. As a result of VistA, the VHA has achieved pharmacy prescription accuracy rates of 99.97 percent. The system also enables authorities to use the data to pinpoint problem areas such as medication errors and track how closely professionals are following evidence-based treatment standards.
For the VHA, the most challenging aspects of implementation were organizational factors, change management and the task of training the approximately 180,000 health professionals it employs. The organization also found that many of the commercial ‘off-the-shelf’ systems were designed from a financial perspective and did not adequately serve the clinically-driven needs of the organization. Those involved in the program are also quick to note that setting up an EHR system is every bit as much a clinical transformation as it is an IT implementation project.