U.S. Secretary of Veterans Affairs David J. Shulkin, M.D. announced Monday that the Department of Veterans Affairs (VA) will replace its aging electronic health record (EHR) system, called VistA, by adopting the same platform as the U.S. Department of Defense, a Cerner EHR system. However, the agency also said that while it would be a similar Cerner platform as DoD, it would not be identical, citing the need to create an “integrated” product in order to achieve interoperability with other healthcare provider organizations.
The decision to move to a Cerner EHR is part of ongoing effort by the VA to modernize its healthcare IT system, the Veterans Health Information Systems and Technology Architecture (VistA), which was developed in the 1970s. VistA currently serves more than 1,200 healthcare sites of the Veterans Health Administration (VHA) throughout the U.S., but, VistA is considered outdated and unable to meet with the changing healthcare IT landscape. Black Book issued a report back in April that identified Cerner as the vendor candidate best positioned now to deliver on President Donald Trump’s key VA initiatives.
The VA's announcement of the decision fulfills a promise to decide VistA’s fate by July 1.
In a written statement announcing the decision to replace VistA with the same Cerner platform being used by the DoD, U.S. Secretary of Veterans Affairs David J. Shulkin, M.D., said that the need to be interoperable with DoD drove the decision to move to a Cerner EHR system. The Defense Department awarded a multi-billion dollar EHR contract in 2015 to Leidos and Cerner. Although initial deployment was set to begin in December 2016, the contract was delayed and the deployment began this past February.
“At VA, we know where almost all of our Veteran patients is going to come from — from the DoD, and for this reason, Congress has been urging the VA and DoD for at least 17 years — from all the way back in 2000 — to work more closely on EHR issues. To date, VA and DoD have not adopted the same EHR system. Instead, VA and DoD have worked together for many years to advance EHR interoperability between their many separate applications — at the cost of several hundred millions of dollars — in an attempt to create a consistent and accurate view of individual medical record information,” Shulkin wrote.
He noted that while the two agencies have established interoperability for key aspects of the health record, “seamless care is fundamentally constrained by ever-changing information sharing standards, separate chains of command, complex governance, separate implementation schedules that must be coordinated to accommodate those changes from separate program offices that have separate funding appropriations, and a host of related complexities requiring constant lifecycle maintenance."
“Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the Departments remain on two different systems. For these reasons, I have decided that VA will adopt the same EHR system as DoD, now known as MHS GENESIS, which at its core consists of Cerner Millennium,” Shulkin wrote.
The VA’s adoption of the same Cerner EHR system as DoD will result in all patient data residing in one common system and enable seamless care between the departments, Shulkin said, without manual and electronic exchange and reconciliation of data between two separate systems.
In remarks made during a press conference on Air Traffic Control reform, President Trump praised Secretary Shulkin and the decision to move forward with modernizing the VA’s EHR system.
“We are finally taking steps to solve the situation, once and for all. Secretary Shulkin announced this morning that the VA will announce its plan to modernize its medical records to use the same system as the DoD, no more complications. The records will now be able to follow the veteran when they leave service, meaning faster and far better quality care. This is one of the biggest wins for our veterans in decades and I congratulate Secretary Shulkin for making this very important decision,” Trump said.
Shulkin also pointed out that the VA has unique needs that are different from DoD, and, for this reason, the agency will not be simply adopting the identical EHR that DoD uses. VA clinicians will be very involved in the process moving forward and in the implementation of the system, Shulkin wrote, as the agency works to obtain interoperability with DoD but also with its academic affiliates and community partners, many of whom are on different platforms.
“We are embarking on creating something that has not been done before—that is an integrated product that, while utilizing the DoD platform, will require a meaningful integration with other vendors to create a system that serves veterans in the best possible way,” Shulkin wrote. “This is going to take the cooperation and involvement of many companies and thought leaders, and can serve as a model for the federal government and all of healthcare.”
It’s interesting to note that the VA will be overriding the requirement for full and open competition in its technology acquisition and will be issuing a solicitation directly to Cerner Corporation for the acquisition of the EHR system being deployed by DoD. In his written statement, Shulkin noted DoD’s lengthy technology acquisition process, which began in 2014. Beginning with the requirements generation until contract award, the acquisition process took approximately 26 months, according to Shulkin.
“Because of the urgency and the critical nature of this decision, I have decided that there is a public interest exception to the requirement for full and open competition in this technology acquisition,” he wrote, “For the reasons of the health and protection of our veterans, I have decided that we can’t wait years, as DoD did in its EHR acquisition process, to get our next generation EHR in place."
Under a “Determination and Findings,” which is written approval to solicit directly to a vendor, Shulkin will be able to move forward with acquiring Cerner’s EHR system for deployment and transition of the VA enterprise.
The VA’s EHR modernization efforts have been the subject of numerous Congressional hearings. In previous committee hearings in both the Senate and the House, as covered by Healthcare Informatics, lawmakers have 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 DoD’s EHR system.
In February, the DoD announced the deployment of its commercial, off-the-shelf EHR system from Cerner at Fairchild Air Force Baes in Spokane, Washington as part of a DOD-wide roll out of the EHR system. The new EHR system, named Military Health System (MHS) GENESIS, which is a single, integrated electronic inpatient and outpatient health record, will be implemented throughout the MHS by 2022.
Shulkin said he reviewed numerous studies, reports and commissions, on this topic, including the recent commission on care report. Further, he said he spoke with clinicians, and he uses the legacy VistA system as a current practicing VA physician.
“We have consulted with Chief Information Officers from around the country, and I've met personally with CEO's from leading health systems to get their own thoughts on the best next-generation EHR for VA. We’ve studied reports from management consulting companies and from the GAO and the IG on VA's IT systems. I can count no fewer than 7 Blue Ribbon Commissions, and a large number of congressional hearings that have called for VA to modernize its approach to IT,” Shulkin wrote.
