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Comment by skywhopper | Hacker News Reader

Honestly, a mature institution like the VA probably ought to be spending a significant portion of their IT budget on maintenance. There's a lot of systems to maintain. And new IT systems are not always the solution to problems, especially problems that aren't actually new.

Since the phrase "archaic legacy systems" is left completely undefined, we don't even know what this means. "Legacy systems" can include stuff that was written a few years ago. I think it may actually be a bigger problem that nearly half of their $4.3 billion IT budget is being spent on _new_ systems. If this half-billion dollar contract with HP is any indication, that money is being poorly spent, and it would be better to invest in the existing systems, instead of trying to solve problems by adding more future-legacy systems to the mix.

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There is a big story here that is not being told, alluded to in one paragraph of the parent article. "[R]eplacing the decades-old VistA medical record system."

VistA used to be the VA's electronic health record system. It is open source. It used to be maintained by the VA IT people with a host of third-party plugins. The name of the part physicians interacted with is CPRS or VA-CPRS. It has a good track record in improving prescribing accuracy.[1] It's cheap. [1] It's tops in physician satisfaction, for several years. [2] It definitely needs maintenance, and isn't getting it any more. Third party vendors have stopped producing for it, too. A big proximate cause: they're ditching the whole system to outsource to Cerner. Cerner makes a not-very-popular electronic health record system. Cerner did make more corporate donations to Republicans than Epic, the biggest EHR provider in the US. [3] Now, Cerner was already working for the DoD and there is some effort to harmonize systems, so it made sense in some practical ways, but it was a no-bid process. Spending close to $10 billion of taxpayer money without any bidding process... ugh. The lawsuit about that has been dismissed, though.[4]

Jared Kushner was pretty proud that the VA chose "in two weeks" to go with Cerner and ditch open-source VistA. [5]

[1] https://en.wikipedia.org/wiki/VistA [2] https://www.medscape.com/features/slideshow/public/ehr2016#p... [3] http://www.healthcareitnews.com/news/see-what-top-ehr-vendor... [4] https://www.bizjournals.com/kansascity/news/2017/10/24/judge... [5] https://www.beckershospitalreview.com/healthcare-information...

archaic legacy systems = paper and Windows XP.

What they should be doing is testing in a single location first to get the kinks on the system out and define facility needs, then expanding to 10 and then moving to roll outs by region. None of the problems that they have experienced should have made it past 6 months.

I'm starting to think that it's purposefully incompetent people at the top that are causing problems, because without a doubt I could have run this program better but I'm pretty sure I couldn't get the job because I don't have a bachelor's.

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