Following weeks of uncertainty and controversy surrounding David Shulkin, M.D., President Donald Trump finally dismissed the Department of Veterans Affairs (VA) Secretary yesterday.
Shulkin, who was confirmed as VA secretary a little over a year ago, was the last remaining holdover from the Obama administration. President Trump made the announcement on Twitter yesterday that he will be nominating Ronny L. Jackson, M.D., White House physician and rear admiral in the Navy, as his choice to take over. But in the meantime, it will be Robert Wilkie, Department of Defense (DoD) undersecretary, who will serve as acting secretary in the interim.
It has been reported and rumored for weeks that Shulkin’s days in the Cabinet were soon to be numbered, and that it was a matter of when, not if, his departure would occur. The secretary started to come under fire when in February, a VA Office of Inspector General report revealed that Shulkin took a taxpayer-funded trip to Europe last year with his wife.
The report also said that Shulkin improperly accepted tickets to a Wimbledon tennis event in July 2017 and that his time in Europe was misused planning tourist activities for his group. The report stated that Shulkin made false representations to a VA ethics official and altered an official record, resulting in VA paying for his wife’s travel.
Things continued to get worse for Shulkin later in the month when it was reported that VA's assistant secretary for public affairs asked a senior aide at the House Committee on Veterans Affairs to persuade lawmakers to call the White House and say they wanted Shulkin ousted. The move was not successful at the time, but the poor optics were undeniable as rumors strengthened that some of Shulkin's own staff wanted him out.
David Shulkin, M.D.
Shulkin was considered to be well-liked by both Republicans and Democrats in Congress, but over the last few weeks it became clear that Trump would dismiss him. According to some reports, Shulkin fought hard for his job at the end, but it was a lost cause. In a recent Congressional hearing, he said that he “deeply regrets” all of the distractions and that he wants to get back on track with a focus on veterans rather than on himself.
From a health IT perspective, Shulkin’s most noteworthy moment was when VA announced last June that it will replace its aging EHR (electronic health record) system, called VistA, by adopting the same platform as the U.S. Department of Defense, a Cerner EHR system. Since then, senators have pushed the agency for a timeline for the EHR project and for plans to ensure that the technology systems of the VA and DoD will be integrated. During an October House Committee on Veterans’ Affairs hearing, Shulkin told lawmakers that it will be seven or eight years before Cerner's EHR system is fully implemented throughout all VA locations.
Reports have surfaced that the VA-Cerner contract, which has not yet been signed, will be in the $10 billion range, making it one of the largest health IT implementations in history. The hefty cost has concerned Congressional members since that $10 billion figure doesn’t even include infrastructure improvements or implementation support.
What’s more, negotiations between VA and Cerner have been delayed. In December, Shulkin announced “a strategic pause” in the EHR acquisition process, with the purpose being to conduct an assessment of national interoperability language contained in the Request for Proposal that would ultimately support an EHR contract award. MITRE Corporation would be conducting the external assessment and Shulkin said earlier this month that MITRE provided the VA with 51 recommendations, and that the agency was building these into the contract with Cerner.
It remains to be seen how Shulkin’s dismissal will impact the contract, though recent reports have alleged that he was going to sign it soon. What’s also of note is that one company, CliniComp International, a San Diego-based EHR vendor, sued the government last summer, attesting that VA improperly awarded its EHR upgrade contract to Cerner without a competitive bidding process. And now, following Shulkin’s firing yesterday, Chris Haudenschild, the CEO of EHR firm CliniComp, said in a statement, per Politico’s eHealth newsletter, that "Acting Secretary Wilkie should delay the award of any EHR modernization contract so that the next Secretary has an opportunity to fully review the facts."
Meanwhile, in an op-ed written last night in the New York Times, Shulkin wrote that “the advocates within the administration for privatizing VA health services…saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”
In a statement, AMVETS, a Congressionally-chartered veterans service organization, said it is “deeply concerned for our nation’s veterans over the news that President Trump has fired Veterans Affairs Secretary David Shulkin in favor of installing a sixth top official in four years.” The statement continued, “Veterans’ lives depend on this decision, and the Trump administration needs to substantiate that this active-duty Navy officer is qualified to run a $200 billion bureaucracy, the second largest agency in the government.”