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What will be the VA's biggest challenge if it decides to implement Cerner or Epic? (Poll Closed)

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Total Votes: 362
4 Comments

  • Cerner user - 7 years ago

    I think it's going to be a mix of problems including some that aren't listed. I agree with Daddio62 that the availability and skills of Cerner consultants and engagement leaders would be a huge factor. We worked with a lot of really execellent Cerner consultants and trainers but there is a finite number of such people. Some of the engagement leaders were lackadaisical, others seemed more focused on "solving" problems by selling you another package of vaporware. The iPhone solution that was touted as the cure to physician acceptance and speedy workflow 4 years ago is still not fully baked enough to be useful except to quickly look up labs or notes when away from a larger device. They have stopped fixing bugs to their powernote documentation solution touting dynamic documentation as their new approach even though dynamic documentation is not compatible with multiple aspects of workflow, including academic workflows or required fields for regulatory requirements. Many aspects of medication workflows remain clunky and downright unsafe, though our organization has invested tons of money, consulting costs and internal staff time to tweak it as best as possible. Our productivity has continued to be less in most areas than before our go lives several years ago. Physicians still end up staying late or logging in to finish notes at home. Cerner suggested best practices to minimize this all require added staff to enter data up front or scribes to speed entry later. The VA is under productivity pressure anyway and doesn't have flexibility to just add staf right and left. Plus, many VA hospitals have academic affiliations and will need appropriate workflows. Budget over-runs are likely upfront AND for ongoing maintenance, which is often overlooked. It's also not clear to me how the performance will be if it includes records for all Veterans nationwide. The bottom line is that I wouldn't expect this to be smooth sailing and Cerner's bottom line would benefit more than the VAs.

  • Art_Vandelay - 7 years ago

    I say, "User Acceptance," due to the unique rules in the VA and work approaches. They need to keep the base Registration, Scheduling, EHR, Ancillary and "activity capture" (aka charge capture) capabilities untouched. This will require quite a bit of process redesign and policy change. Unfortunately, I believe they need to still develop their own wrapper solution to help manage some aspects of veteran prioritization for care (ex: pre-qualification, authorization, triage) and potentially for "billing." VistA has grown-up to deal with a unique "business model" that is a mix of regulations that don't necessarily look like the rest of the U.S. acute, ambulatory and behavioral healthcare world.

  • Daddio62 - 7 years ago

    Cerner is consistently understaffed on projects. When they fill roles it is with newbies that have no clinical experience. If you have a good group of Cerner consultants, be prepared because Cerner will pull them off your project to put them on the VA's project.

  • Red Tape - 7 years ago

    I actually think "None of the above", because governance and decision making are going to be an impossible struggle. They are difficult at well run large medical organizations - "Who can make this decision" "Which committees need to weigh in" - I can't imagine that the bureaucracy and red tape inherent to government are going to give way to the decisiveness good implementations need to stay on track.

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