Recently, there’s been a perfect storm of bad news for the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD) and their efforts to modernize their electronic medical record (EMR). Both the DoD and the VA plan to standardize on Cerner’s EMR. The hope is that this will provide a more complete longitudinal health record and make the transition from DoD to VA more seamless for active duty, retired personnel and their dependents. It’s a laudable goal and we can all agree that those who serve our country deserve the best healthcare we can provide.
However, these efforts are running into significant problems:
- The DoD recently announced it would pause the rollout of their new EMR known as MHS Genesis. The pilot project began in February 2017 at Fairchild Air Force Base and concluded when Madigan Army Center, the fourth pilot site, went live in October 2017. Reports vary on why this pause is occurring but seem to center on workflow problems and results retrieval.
- After announcing in June 2017 that they had selected Cerner in a no-bid contract, the VA has now halted the contracting process due to concerns about interoperability. According to reports, the concerns are not around how well Cerner's system would work within the VA's network, but rather, if it would be fully interoperable with private-sector providers who play a key role in the military health system.
- Scott Blackburn, CIO of the VA, recently injected important realism into the discussion about how long it will take to complete the transition from VistA, the VA’s legacy EMR, to Cerner. According to Blackburn, “The Cerner implementation will take about a decade. If it’s starting in the northwest quadrant of the country and moving east, those on the Eastern Seaboard are going to be using VistA for about 10 years [more] or so...”
I wish I could say I’m surprised by these events but, I am not. I shared my concerns in this article back in August 2017. To be very clear, I am not criticizing the DoD, VA or Cerner. They are trying to do the right thing and provide an EMR that will better serve everyone. The challenges the VA and the DoD are encountering are endemic to healthcare and highlight a set of problems that are also affecting the civilian health system. At the heart of this challenge are two fundamental issues: an anemic definition of interoperability and the inevitable short comings of a “one platform” strategy.
Single Platform Strategies Usually Fall Short
The “one platform to serve them all” approach is seductive. In theory, if all patients and providers are on the same EMR, interoperability will become a minor issue. I used to believe this, too. I was wrong for several reasons: