
VA’s foray into Internet of Things faced ‘catastrophic failure’ - us0r
http://www.mystatesman.com/news/local-military/foray-into-internet-things-faced-catastrophic-failure/tlxTO87eQO8uX4CFyk810J/
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skywhopper
It sounds like the VA hospitals are suffering from major failures of protocol
and procedure, none of which can be solved by IT systems, even if they work
well. Turns out that computerized systems also require that humans follow
protocol and procedure in order for them to function properly. But either way,
these systems don't operate in a vacuum. Someone needs to analyze the real-
world impact of these problems and develop a workflow and procedures that work
with the hospital's organizational structure, physical layout, current and
planned staff, training, auditing, procurement, patient scheduling, and
accounting systems. No software contract for one piece with HP or IBM or
Cerner is going to address all of that.

~~~
ganoushoreilly
You're Spot on, the problems aren’t unique to IT, it’s a systemic policies /
process / procedure failure.

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chuckdries
> The VA has also vowed the project would prevent death and disease from
> unsterilized equipment, a persistent problem at the VA.

Oh my god how is this a problem in the modern age? Stop wasting our money on
gimmicks and focus on adopting modern hospital practices.

~~~
gaius
_Oh my god how is this a problem in the modern age?_

The modern age? 100 or even just 50 years ago hospital wards were run by
"matrons", fierce and experienced nurses who ran their wards like a Sergeant
Major inspected a Guards regiment, everything immaculate. That system was
scrapped in favour of what we have now, a fluffy blame-free culture where no-
one is responsible for anything. The problem of failing to maintain standards
is entirely a "modern" one, sadly.

~~~
pjc50
This sounds like a nostalgia-tinged anti-political-correctness view; a hundred
years ago was the end of the first World War, and the controversial
introduction of hygene was in living memory.

Could do with some stats either way.

~~~
shifter
To be fair, you're discounting the possibility that nostalgia-tinged anti-
political-correctness views are correct ;-)

~~~
Apocryphon
A hundred years ago was also the outbreak of the Spanish Flu pandemic which
killed 3-5% of the global population, not exactly a golden age for public
health.

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keypusher
> the department’s $543 million contract with Hewlett-Packard

> The system [...] has been hailed as a way to potentially save millions of
> dollars

Does not compute.

~~~
tolien
> Today, the VA spends more than half of its $4.3 billion IT budget on
> maintaining increasingly archaic legacy systems.

Not difficult to see how they’d claim their Great New Thing would cost less to
maintain than the Really Old Thing that nobody likes which was built by
someone else.

> employees were shunning another troubled IT program, called Catamaran, that
> manages supplies through predictive analytics

> employees complained of frequent crashes that made it difficult to order
> supplies

Also, if they stopped infecting people with Hepatitis and HIV (most likely
among other things) due to using dirty equipment they would realise savings
through not having to pay compensation and/or treat those people for the rest
of their lives. That could also be done by following proper cleanliness
procedures but that would require some leadership to achieve.

~~~
skywhopper
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.

~~~
kaitai
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](https://en.wikipedia.org/wiki/VistA)
[2]
[https://www.medscape.com/features/slideshow/public/ehr2016#p...](https://www.medscape.com/features/slideshow/public/ehr2016#page=8)
[3] [http://www.healthcareitnews.com/news/see-what-top-ehr-
vendor...](http://www.healthcareitnews.com/news/see-what-top-ehr-vendors-
contributed-2016-presidential-campaigns) [4]
[https://www.bizjournals.com/kansascity/news/2017/10/24/judge...](https://www.bizjournals.com/kansascity/news/2017/10/24/judge-
dismisses-suit-about-cerner-va-contract.html) [5]
[https://www.beckershospitalreview.com/healthcare-
information...](https://www.beckershospitalreview.com/healthcare-information-
technology/in-leaked-audio-jared-kushner-says-the-va-cerner-deal-happen-
in-2-weeks.html)

------
Dowwie
By paying consultancies half a billion dollars on new product development,
they could potentially save millions.

~~~
us0r
thats not even close to the final price. they'll probably drop another $250
mil then cancel the project. they dont even have this running in 1 VISN and
there are over 20.

------
arca_vorago
Having first hand experience with the VA I can't say I'm surprised, but really
it doesn't matter that it's the VA, because I think most companies doing iot
things already are likely going to face failure on their project as well.

In this case I'm mostly thinking about the horrible security environment of
the iot ecosystem, especially cellularly connected ones.

"VA officials worried that the department’s $543 million contract with
Hewlett-Packard Enterprise Services to implement a real-time locating system,
or RTLS, was careening off the rails"

Wow. Let me guess, good ol boy contract kick-back where the good ol boy can't
deliver as promised. It's a classic American tale. Great thing the government
bid system is blindingly fair and egalitarian. Yup, that's it I bet.

"VA officials have said work here stalled about 18 months ago due to contract
issues"

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slavik81
> When it was awarded in 2012, the RTLS contract represented an opportunity
> for the VA to shed its reputation as an old-school tech dinosaur and chart a
> path toward what leaders were calling a “transformation initiative.”

That sounds a lot like a mid-life crisis.

~~~
devonkim
This is usually synonymous with “devops” transformations as part of huge
personnel problems (read: no young people want to join / stay) in most large,
old companies that are facing a form of a late-life crisis that was plainly
visible decades ago to anyone but the willfully blind.

The standard situation of the usual F500 and government technology stack is a
Petri dish of half-finished projects by an army of consultants maybe a couple
years out of school charged at $300 / hr to the customer and everything is
solved by throwing bodies at problems when a square peg was sold for a non-
Euclidean hole because the decision-makers are so directly inexperienced in
how technology works that 25-year old tech sounds like it’s cutting edge on a
marketecture deck (or presume that something written recently couldn’t
possibly be archaic already). It’s a lot like failed relationships with dozens
of illegitimate children that you’re paying child support on.

------
walshemj
why would you track a catheter surly these are single use items that are never
reused

~~~
vonmoltke
The system is intended to cover all aspects of inventory control, not just
tracking the location of reusable equipment. It's about knowing what they have
and where it is.

