Veterans Affairs Seeking Feedback on New Commercial EHR

Aug. 12, 2016
The Department of Veterans Affairs issued a request for information regarding commercial off-the-shelf EHR systems, which appears to be the most recent indication that the agency is moving forward on plans to replace its decades-old, homegrown EHR system.

The Department of Veterans Affairs (VA) is seeking feedback on transitioning to a commercial electronic health records (EHR) system, which appears to be the most recent indication that the agency is moving forward on plans to replace its decades-old, homegrown EHR system.

The department issues a request for information (RFI) on the Federal Business Opportunities website and requested feedback be submitted by August 26.

“The purpose of this RFI is to request industry feedback, guidance and recommendations on all aspects of the change management associated with this Veterans Health Affairs (VHA) commercial off-the-shelf (COTS) EHR acquisition and transition,” department officials wrote in the RFI. “The scope of this RFI does not include the information technology software or hardware change, but rather in helping the VHA clinical and business processes achieve this transformation in the most efficient and cost effective manner.”

The department specifically noted in the RFI that it is seeking information from industry partners with “prime contractor experience supporting the change management and business process reengineering for other large healthcare systems transitioning to a new EHR.”

VA officials are attempting to modernize the department’s electronic health record system, the Veterans Health Information Systems and Technology Architecture (VistA), which has been the subject of numerous Congressional hearings. As previously reported by Healthcare Informatics, during a hearing of the Senate’s Committee on Veteran Affairs in June, lawmakers voiced ongoing frustrations about the VA’s progress on modernizing its IT systems and the progress of achieving interoperability between the VA’s VistA and the Department of Defense’s (DoD) EHR system.

During that hearing, VA officials indicated that the agency will likely look for a commercial EHR system during a discussion about its 40-year-old homegrown system. VA Under Secretary for Health David Shulkin testified that VA officials have reached a consensus that “looking at a commercial product is probably the way to go,” and he added, “But we need to do this in a way that incorporates our ability to integrate with community providers and unique needs of veterans.”

And, during a U.S. Senate Appropriations Subcommittee hearing in July, VA CIO LaVerne Council testified the VA was working with KLAS and other EHR consultancies to “build the business case” for a commercial EHR that would replace VA's VistA system.

In 2011, DoD and VA announced the agencies would develop one integrated electronic records system to replace separate systems. After two years, the VA and DoD announced they would forgo plans to build a new health records system to be used jointly by the departments, at a reported cost of $560 million, in order to pursue separate plans.

In the RFI, VA officials outline the history of the VistA system, which came online back in the 1970s, and its Computerized Patient Record System (CPRS). VistA consists of nearly 180 applications for clinical, financial, administrative and infrastructure functions in the VA in what has become a highly customized information technology system, while CPRS represents the common clinical graphical user interface developed starting in the 1990s, VA officials stated in the RFI.

Today, VistA is the nationwide information system and EHR developed by the VA and operating at more than 1,200 healthcare sites throughout the continental US, Alaska, Hawaii and the Philippines.

“Over the years and due to local customization there are few standard data elements, a variety of complex algorithms and heterogeneous mix of legacy hardware and software supporting 130 unique VistA instances across the VA enterprise making modernization and standardization efforts extremely complicated, expensive and time consuming,” VA officials wrote in the RFI.

Specifically, according to the RFI, the VA is looking for guidance and suggestions in the areas of costs, testing, clinical and patient safety assessment, cybersecurity and analytics. The RFI also mentions guidance as it relates to governance “to ensure responsive yet agile guidance during an admittedly lengthy and complicated transition process,” as well as change management.

In the RFI, VA officials indicate that the agency is looking to develop an “effective, robust and modern information technology system” that is seamlessly interoperable with other systems, including DoD, private-sector providers and with other VA enterprise systems, such as those in the Veteran Benefits Administration.

VA wants the new system to provide clinicians, patients and administrators the data, analytic power, and user interfaces required to monitor the effectiveness of care and improve veteran care over time.  According to the VA, the new system will be more than just a commercial off-the-shelf EHR in order to facilitate and automate business processes that support access and veteran’s care.

VA officials also state that the RFI is for planning purposes only and that the department is not obligated to acquire any products or services described in the RFI.

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