An Autoethnographic Account of Innovation at the US Department of Veterans Affairs

The history of the U.S. Department of Veterans Affairs (VA) health information technology (HIT) has been characterized by both enormous successes and catastrophic failures. While the VA was once hailed as the way to the future of twenty-first-century health care, many programs have been mismanaged, delayed, or flawed, resulting in the waste of hundreds of millions of taxpayer dollars. Since 2015 the U.S. Government Accountability Office (GAO) has designated HIT at the VA as being susceptible to waste, fraud, and mismanagement. The timely central research question I ask in this study is, can healthcare IT at the VA be healed? To address this question, I investigate a HIT case study at the VA Center of Innovation (VACI), originally designed to be the flagship initiative of the open government transformation at the VA. The Open Source Electronic Health Record Alliance (OSEHRA) was designed to promote the open innovation ecosystem public-private-academic partnership. Based on my fifteen years of experience at the VA, I use an autoethnographic methodology to make a significant value-added contribution to understanding and modeling the VA’s approach to innovation. I use several theoretical information system framework models including People, Process, and Technology (PPT), Technology, Organization and Environment (TOE), and Technology Adaptive Model (TAM) and propose a new adaptive theory to understand the inability of VA HIT to innovate. From the perspective of people and culture, I study retaliation against whistleblowers, organization behavioral integrity, and lack of transparency in communications. I examine the VA processes, including the different software development methodologies used, the development and operations process (DevOps) of an open-source application developed at VACI, the Radiology Protocol Tool Recorder (RAPTOR), a Veterans Health Information Systems and Technology Architecture (VistA) radiology workflow module. I find that the VA has chosen to migrate away from inhouse application software and buy commercial software. The impact of these People, Process, and Technology findings are representative of larger systemic failings and are appropriate examples to illustrate systemic issues associated with IT innovation at the VA. This autoethnographic account builds on first-hand project experience and literature-based insights

Building blocks for a clinical imaging informatics environment.

Over the past 20 years, imaging informatics has been driven by the widespread adoption of radiology information and picture archiving and communication and speech recognition systems. These three clinical information systems are commonplace and are intuitive to most radiologists as they replicate familiar paper and film workflow. So what is next? There is a surge of innovation in imaging informatics around advanced workflow, search, electronic medical record aggregation, dashboarding, and analytics tools for quality measures (Nance et al., AJR Am J Roentgenol 200:1064-1070, 2013). The challenge lies in not having to rebuild the technological wheel for each of these new applications but instead attempt to share common components through open standards and modern development techniques. The next generation of applications will be built with moving parts that work together to satisfy advanced use cases without replicating databases and without requiring fragile, intense synchronization from clinical systems. The purpose of this paper is to identify building blocks that can position a practice to be able to quickly innovate when addressing clinical, educational, and research-related problems. This paper is the result of identifying common components in the construction of over two dozen clinical informatics projects developed at the University of Maryland Radiology Informatics Research Laboratory. The systems outlined are intended as a mere foundation rather than an exhaustive list of possible extensions

Building Blocks for a Clinical Imaging Informatics Environment

Over the past 20 years, imaging informatics has been driven by the widespread adoption of radiology information and picture archiving and communication and speech recognition systems. These three clinical information systems are commonplace and are intuitive to most radiologists as they replicate familiar paper and film workflow. So what is next? There is a surge of innovation in imaging informatics around advanced workflow, search, electronic medical record aggregation, dashboarding, and analytics tools for quality measures (Nance et al., AJR Am J Roentgenol 200:1064–1070, 2013). The challenge lies in not having to rebuild the technological wheel for each of these new applications but instead attempt to share common components through open standards and modern development techniques. The next generation of applications will be built with moving parts that work together to satisfy advanced use cases without replicating databases and without requiring fragile, intense synchronization from clinical systems. The purpose of this paper is to identify building blocks that can position a practice to be able to quickly innovate when addressing clinical, educational, and research-related problems. This paper is the result of identifying common components in the construction of over two dozen clinical informatics projects developed at the University of Maryland Radiology Informatics Research Laboratory. The systems outlined are intended as a mere foundation rather than an exhaustive list of possible extensions

Building blocks for a clinical imaging informatics environment.

Over the past 20 years, imaging informatics has been driven by the widespread adoption of radiology information and picture archiving and communication and speech recognition systems. These three clinical information systems are commonplace and are intuitive to most radiologists as they replicate familiar paper and film workflow. So what is next? There is a surge of innovation in imaging informatics around advanced workflow, search, electronic medical record aggregation, dashboarding, and analytics tools for quality measures (Nance et al., AJR Am J Roentgenol 200:1064-1070, 2013). The challenge lies in not having to rebuild the technological wheel for each of these new applications but instead attempt to share common components through open standards and modern development techniques. The next generation of applications will be built with moving parts that work together to satisfy advanced use cases without replicating databases and without requiring fragile, intense synchronization from clinical systems. The purpose of this paper is to identify building blocks that can position a practice to be able to quickly innovate when addressing clinical, educational, and research-related problems. This paper is the result of identifying common components in the construction of over two dozen clinical informatics projects developed at the University of Maryland Radiology Informatics Research Laboratory. The systems outlined are intended as a mere foundation rather than an exhaustive list of possible extensions