The Department of Veterans Affairs (VA) has transferred 23.5 million veterans’ health records to a shared data center with the U.S. Department of Defense (DoD), thus setting the stage for the go-live of VA’s Cerner electronic health record (EHR) implementation next year.
This data moved spans 21 clinical domains of patient health records, which include lab results; pharmacy prescriptions; inpatient and outpatient diagnoses and procedures; and other veteran medical data, according to department officials.
For background, the VA signed its $10 billion contract with Cerner in May 2018 to replace the department’s 40-year-old legacy health information system—the Veterans Health Information Systems and Technology Architecture (VistA)—over the next 10 years with the new Cerner system, which has begun to be deployed across DoD sites. The VA project is slated to begin with a set of test sites in the Pacific Northwest in March 2020.
This initial data migration phase, which began in late spring, is a key first step in solving VA and DoD interoperability issues, VA Secretary Robert Wilkie said in a statement accompanying the recent announcement. When the new EHR completes implementation, it will replace the 130 plus instances of the current VistA system in a streamlined solution that also powers the DoD’s military health system, called MHS GENESIS.
The ability of VA’s healthcare system to seamlessly share patient data with the DoD, as well as health systems and physicians in the private sector, has been a top concern among Congressional leaders who have remarked that interoperability between VA and DoD and between VA and community providers is a critical step to the success of the VA EHR modernization effort.
Wilkie agrees with this sentiment, noting, “For decades, VA and DoD have been struggling to achieve interoperability and seamlessly share patient records between our health systems—placing an unfair burden on our veterans and their families. No veteran, family member or caregiver should have to carry boxes of paper, medical and service records around. This data migration is the first step to solving that problem for good.”
Last fall, the U.S. Secretaries of VA and DoD signaled their commitment to achieving interoperability between the two agencies by implementing a single, seamlessly integrated EHR, according to a joint statement both agencies issued. Wilkie and then-Defense Secretary James N. Mattis signed a joint statement Sept. 26 pledging that their two departments will “align their plans, strategies and structures as they roll out a EHR system that will allow VA and DoD to share patient data seamlessly."
Another concern among members of Congress and others has been the cost that will be required to successfully complete this project, particularly since the department has had trouble with accurately reporting cost data for the VistA EHR system that it’s replacing.
A recent Government Accountability Office (GAO) report on this issue noted that the VA identified costs for VistA and its related activities adding up to approximately $913.7 million, $664.3 million, and $711.1 million in fiscal years 2015, 2016, and 2017, respectively—for a total of about $2.3 billion over the three years to operate its EHR. “However, of the $2.3 billion, the department was only able to demonstrate that approximately $1 billion of these costs were sufficiently reliable,” GAO stated.
The report added that the department also omitted VistA-related costs from the total. “The lack of a sufficiently reliable and comprehensive total cost for VistA is due in part to not following a well-documented methodology that describes how the department determined the costs for the system,” it said. As such, it recommended that the VA “develop and implement a methodology for reliably identifying and reporting the total costs of VistA.”
The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S., providing care at nearly 1,300 sites to over 9 million Veterans enrolled in the VA healthcare program.
