I suggest you..
The VA has been running their hospitals with their own home-grown VistA for nearly 3 decades. There has been a freeze on the enhancement of this amazing software package which has already saved the government over a billion dollars when it was used as the seed for the DoD Composite Health Care System back in 1986. It has taken the DoD more than 20 years to replace CHCS-I with their ever failing CHCS-II and AHLTA (AHLTA is universally hated within the military). A group of VA employees and consultants formed WorldVistA to bring the VA's VistA out to the rest of the world. This is a fully scalable, highly functional package which is actually an enterprise wide tool kit that allows the end user, the people at the Point of Care have direct input to how their application should run.
The VA management has been trying to get rid of VistA to make more feeding ground for the vendors. This is very wasteful and time consuming. What happens in VistA environments in days and weeks takes 18 to 24 months to accomplish with the third party vendors. If you will open up site development again, there are means of doing it safely and without risking real patient identities. Remember that the VA can still regulate and accept what is offered from the sites. There used to be user driven development that built VistA. Even with the freeze and other abuses to this system, it is still the predominant health care system in the world. There are areas that do need change, but the cost of those changes is so small as to be able to be paid for by a single boondoggle project like Core-FLS. I have built code that prepares all of the VistA routines for Internationalization in 45 minutes on a laptop. There is work being done by interested healthcare providers that has gotten WorldVistA EHR CCHIT certification. We did that out of our own pockets. We offered to help the VA get certified, and were turned down. IHS accepted our offer and now they are CCHIT certified and it didn't cost them a dime (except for the cost of certification itself). VistA is a process. It was built by the people who had to use it day in and day out. It holds many truths about the process of providing care.
One criticism of VistA is that it is a series of islands. If we could transactionalize VistA, we could turn it into an infinitely scalable solution which is nearly impervious to network outages that now plague VA Regionalization (where a single point of failure can drop 18 hospitals in a second). Our model involves keeping the National and Regional Model, but make them parents of the systems at the point of care. The systems in the hospitals and the clinics can operate in the absence of the network and the completed transaction wait for the network to be repaired and then the completed transaction flow up to the next parent system. Ultimately, the patient data is at the point of care and the physician and the patient have a more normal exchange during the encounter. Once the encounter is done, the completed transaction is a single transmission to the node's parent, where it waits for that parent's parent system to accept the transmission. The systems at the point of care may be nothing more than a laptop which can operate in isolation from the network until it is hooked back into a new parent node. These improvements can be had very cheaply and can be repeated in the IHS, HHS, FEMA, and DoD, lending better transfer of patient information from one organization. There is more, of course, but we have just scratched the surface. Don't the people of the United States deserve to get the advantages that VistA can provide? It has done wonders for IHS, DoD, and US PHS. It is about to become the National Health System of Jordan. What a great gift we could make to the whole world and it won't cost us much, less than one major boondoggle like Core-FLS and it will save so much for so many. It will also create many jobs for folks to support, to enhance, and to teach this new set of skills. Remember that the VA got most of their experts in this technology from their own ranks. It can be done again. Ultimately we will be providing the best care anywhere for our Veterans and our people.