Fred Trotter, an open-source medical software programmer and an IT consultant, spoke to Government Health IT about how the VA’s old open system used to work: “historically, each hospital hired programmers to solve that hospital’s needs. Other hospitals then adapted those solutions to their own needs. [But] with the centralization process, all VistA programmers will be working for a central bureau. This could stop 30 years of innovation in which the best local innovations were taken national.”
It’s no exaggeration to say that we’re seeing the corporatization of the VA—not just in the sense of privatization, but also in the broader ethos of highly structured management systems. This means that the features that have made VistA such a success—flexibility, customizability, and openness—are in trouble. The balance between security and innovation is a very sensitive one, but in the past, we have figured out how to keep information secure. What’s harder is figuring out how to foster creativity. Centralized bureaucracy is rarely the answer.
As they say: Read the whole thing if you’re into a) it or b) policy analysis.