Black Book: Cerner Tops Shortlist of Vendors to Replace VA's Outdated EHR

Rankings based on how key performance indicators on five largest commercial electronic health record vendors chart across four Trump Administration initiatives.

​​​​​Long under pressure from Congress, the U.S. Department of Veterans Affairs (VA) intends to replace Veterans Information Systems and Technology Architecture (VistA), its antiquated electronic health records (EHR) system, with a commercial EHR. Developed by the VA more than 30 years ago, VistA currently serves more than 1,200 healthcare sites of the Veterans Health Administration (VHA) throughout the United States.  Although the VA isn’t expected to announce its official decision until July, Cerner is the vendor candidate best positioned now to deliver on President Donald Trump’s key VA initiatives, according to a new Black Book report.

Black Book looked at the results of its first quarter 2017 surveys of over 30,000 inpatient and ambulatory EHR end users and clinical decision support end users. Black Book then examined 24 key performance indicators (KPIs) on five leading EHR vendors — Epic, Cerner, Allscripts, Meditech and athenahealth — and how they charted across four of Trump’s VA-related health issues:

1.    Improve veterans’ health access, satisfaction, veteran engagement and services delivery;

2.    Solve opiate crisis;

3.    Innovate government agencies; and

4.    Improve government business processes and fiscal performance.

How the vendors fared

Cerner topped the list with a mean score of 9.14 of a possible 10.00 across all four initiatives and 24 KPIs, also finishing first in all of the four initiative categories. Coming in next was Allscripts with a mean score of 8.91, finishing second behind Cerner in each of the initiatives. Rounding out the list were Epic (mean score: 8.17), athenahealth (7.89) and Meditech (7.66).

All represented vendors scored 7 or above in all KPIs relating to the first three initiatives, with one exception: Meditech scored a 5.79 in patient portal and experience, which is connected to the third initiative to innovate government agencies.

Cerner outperformed intechnology functionalities that support the healthcare delivery sector’s role in combating the opiate crisis, scoring highest in drug surveillance tools and pharmaceutical prescription record tracking, behavioral health and addiction EHR capabilities.

The weakest spot for some vendors was in meeting the demands of the fourth initiative: to improve government business processes and fiscal performance.

Here, finishing lowest in outsourcing and privatization were Epic (6.75) and Meditech (6.85). Epic’s weakest area, according to the Black Book data: cost control through implementations and go-lives, and improving the client's fiscal performance (5.77). Meanwhile, athenahealth had difficulty with ERP and supply chain support (6.68), as well as vendor reputation, trust and viability (6.25). Cerner, again scored highest in IT outsourcing and privatization capabilities, hosting, tech support, interoperability and cybersecurity in organizations like the VA Health System with 100 or more facilities and national network locations.


An April 12, 2017 request for information (RFI) underscored the VA’s existing plans to replace its outdated VistA EHR system. The request was seeking information specifically from vendors capable of producing a “Commercial off the Shelf (COTS) version provided in a Software-as-a-Service (SaaS) model, as an alternative to VA continuing to operate its VistAs which are not fully modernized. VA is also separately exploring COTS non-VistA EHR alternatives.”

For years highly touted as playing a large role in a positive turn at the VA, VistA is widely credited as the impetus for developing and implementing EHRs nationwide. “VistA was a true pioneer in the birth of EHRs more than 30 years ago,“said Doug Brown, Managing Partner of the Black Book Research. “In fact, much of the architecture of today’s commercial EHRs was based upon VistA’s open-source technology, which is used around the world.”

Despite all of this, VistA has struggled to modernize for many years, failing to keep up with the ever-changing world of healthcare IT. 

“Three of the companies represented in our Black Book report are taking inspiration from the spirit of VistA, even as they vie to replace it. Cerner, Allscripts and Epic recently indicated they intend to make their EHRs more open, utilizing application programming interfaces (APIs) to enable third-parties to write apps for their platforms,” said Brown.

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Source: Black Book Research LLC