U.S. Department of Veterans Affairs (VA) officials indicated that the agency will likely look for a commercial electronic health record system during a discussion about its 40-year-old homegrown system at a Senate committee hearing this week.
During the hearing of the Senate’s Committee on Veteran Affairs, 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.”
Congress remains concerned about the status of efforts underway at the Department of Veterans Affairs to modernize their electronic health record system, the Veterans Health Information Systems and Technology Architecture (VistA), and the hearing focused on examining progress and challenges with modernizing IT at the VA.
During the hearing, lawmakers voiced their 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.
“I’ve been in the Senate for six years, and every time we’ve raised the issue, we’ve been reassured that it’s been solved and then we come back and ask the same question,” Connecticut Sen. Richard Blumenthal said. “The decades of unsuccessful attempts to establish an electronic health records system that is compatible across the VA and DoD has caused hundreds of millions of taxpayer dollars to be wasted and in efforts that have been abandoned. I’ve said to the secretaries of both the VA and DoD that these kinds of integrated up-to-date EHRs are absolutely critical to ensure healthcare providers have access to the health information they need to care for veterans and transitioning service members.”
Blumenthal continued, “The cost to the VA has been very high both in terms of budget and it’s credibility and reputation. As the VA undertakes efforts to transform its IT infrastructure, security has to be a top priority, security breaches have to be prevented and remedied, because this information is sensitive and personal and I am hopeful that as new leadership that has taken over that leadership will address these problems with the seriousness they deserve.”
The lawmakers also pointed out that many of the IT systems are 40 to 50 years old, and VA CIO LaVerne Council acknowledged that with regard to software development lifecycle, “40 to 50 years is ancient in the world of IT.” “I cringe when I think about that because of the end of day you’re working with something that very few people can tell you what it does and what it does well," Council said.
On the issue of interoperability with DoD, Shulkin pointed out the VA’s joint legacy viewer currently has 138,000 VA users with more than 4.6 million veteran records available through it.
Sen. Patty Murray said she was disappointed with the VA’s decision back in 2013 to abandon the fully integrated EHR system with the DoD. “That provided an opportunity to really lead the health industry. And I’m equally frustrated that the VA did a new review to implement improved EHRs in order to make a decision whether to upgrade VistA or purchase a commercial product. That’s a fundamental question that should have been asked before. I’m concerned by the lack of long-term planning,” she said. Sen. Murray then asked Council why the VA has decided to “walk away from VistA.”
Council responded, “I have a lot of respect for the VistA product, but the VistA product is a 40-year-old product. We have to think about the care to veteran, clinical management, clinical operations management, the fact that key analytics are needed to understand if we are showing meaningful use, and really getting us to the point where we are really engaging the veteran where they are, not where we need them to be. That required us to look at how we are moving data, how are we doing analysis, how we are using clinical information and using our supply chain and getting pharmacy aligned. So as we started to go through this, we looked at what can tech do today that it did not do yesterday, and it’s a lot.”
Council said the VA IT leaders are laying out a digital platform, with insight from the Office of the National Coordinator for Health IT (ONC) and the DoD.
“I want you to be successful, but I’ve heard the same words over and over, and we really need results,” Murray stated.
The DoD announced earlier this year that it's massive project to modernize the Military Health Systems’ EHR system, now called MHS Genesis, will launch at the end of this year. As previously reported by Healthcare Informatics Managing Editor Rajiv Leventhal, it was announced last July that EHR vendor Cerner won the DoD’s Healthcare Management Systems Modernization (DHMSM) EHR contract. Epic Systems, Cerner and Allscripts Healthcare Solutions were the three vendor finalists for the contract, each with its own team aimed to upgrade the military’s EHR system. Along with Cerner, MHS also is partnering with Accenture Federal Services and Leidos on the project.
Valerie Melvin, director of information management with the Government Accountability Office, said in its study of the VA’s IT modernization efforts it had identified examples of management weakness. She said during its study the GAO identified “weakness in IT practices, shortcomings in investment oversight, risk management and system testing and weakness in establishing goals and measures.”
“We also reported on the VA effort to advance electronic health record interoperability, and the VA has not identified outcome-oriented goals and metrics to clearly define what it aims to achieve, and the value and benefits of these efforts for veterans and healthcare providers,” Melvin said. “There needs to be more effective IT management to deliver the modernized systems necessary to fulfil its mission.”
During the hearing, Shulkin also addressed concerns about the access crisis at the VA’s hospitals and issues about healthcare quality at VA facilities.
“As you know our top priority has been fixing the access crisis and through extended hours, productivity and hiring, we’ve added 7.4 million hours of additional clinical time in the past year.”
He said that a study has shown that 90 percent of veterans using VA facilities are satisfied that they can get appointment when they want one.
“In terms of quality, 74 percent of our medical centers improved quality last year. We saw a 35 percent reduction in mortality in our hospitals last year, a 52 percent reduction in urinary tract infections, an 18 percent reduction in central line infections and a 17 percent reduction in length of stay.” Shulkin said, noting that quality outcomes in the areas of cardiac and mental are better at VA medical centers than in the private sector. And since launching its best practices initiative, 160 best practices are now being replicated in over 70 medical centers, he said.