A senior IT official with the U.S. Department of Veterans Affairs (VA) told members of the House Committee on Veterans Affairs during a hearing Tuesday that the department will move to a commercial off-the-shelf electronic health record (EHR) system.
Rob Thomas, II, Acting Assistant Secretary for Information and Technology and Acting CIO, Office of Information and Technology for the VA, testified before House Veterans Affairs committee members during a hearing focused on accessing the VA IT landscape. House Veterans Affairs committee members scheduled the hearing to get a report on progress and challenges related to the VA’s healthcare IT modernization efforts.
The VA is still attempting to modernize the department’s EHR system, the Veterans Health Information Systems and Technology Architecture (VistA), which has been the subject of numerous Congressional hearings. In previous committee hearings in both the Senate and the House, 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 Department of Defense’s (DoD) EHR system. It has been estimated that the VistA system is at least 30 year old.
President Donald Trump has tapped David Shulkin, M.D., an Obama administration appointee and current VA undersecretary, to lead the Department of Veterans Affairs. Shulkin, 57, a board-certified internist and fellow of the American College of Physicians, is expected to be approved by the Senate Veterans Affairs Committee today.
During the hearing, Committee Chairman Rep. Phil Roe said, “This is the third major attempt to modernize VistA in the past decade. Retaining or replacing VistA is a make-or-break decision for VA and must be made deliberatively and objectively. The VA must judge VistA Evolution realistically against concrete goals. If it falls short, moving the goal posts is unacceptable.”
In response to committee members’ questions about where things stand with the VA’s EHR system, Thomas responded, “I’m comfortable that we’re going with commercial. I can’t speak for Dr. Shulkin, and I’m hoping for a speedy confirmation so that he can come and help us work through that. Knowing his background in the industry and his experience as being a doctor at leading hospitals and I’ve worked with him the past 18 months, he’s very decisive and I’m looking forward to a quick confirmation.”
Thomas also said, “My goal, my charge, is that we go commercial to the greatest extent possible. We don’t have a great track record with developing software.” He did not offer any timelines or schedule for when the department might transition from its homegrown system to a commercial, off-the-shelf system.
Back in August, the VA issued a request for information (RFI) on the Federal Business Opportunities website and requested feedback on transitioning to a commercial EHR system. An initial plan which called for DoD and VA to develop one integrated electronic records system to replace separate systems fell through. After two years of discussions and planning, the VA and DoD announced last year they would forgo plans to build a new health records system to be used jointly by the departments, at a reported cost of $560 million, in order to pursue separate plans.
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 is scheduled to begin this month.
During the hearing Tuesday, David Powner, director, IT management issues, U.S. Government Accountability Office (GAO), testified that in 2015 the VA spent about $3.9 billion to improve and maintain its IT resources, with about $548 spent on new systems development and $2.3 billion on maintaining existing systems and $1 billion on payroll and administration. For 2016, the VA received appropriations of about $4.1 billion for IT, with only about $500 million going to developing or acquiring new systems and about $2.5 billion on maintaining existing systems. “Most goes to operational systems, most of which are old, inefficient and difficult to maintain,” he said. Powner also said interoperability is needed between not only the VA and DoD, but also the VA and private sector providers. “We don’t see evidence that a separate plan [from the DoD] will be cheaper or quicker. DoD is pursuing a commercial solution, while VA is trying to update an aging system. VA is now considering a commercial EHR. This uncertainty is not acceptable; a decision needs to be made. VA needs to let go of VistA and go with a commercial solution. There is no justification for DoD and VA pursuing separate systems,” Powner said.
Thomas agreed that the VA’s IT spending needed to shift. “I’d like to see 60 percent for maintenance and 40 percent for development,” Thomas said.
Several committee members also expressed concerns about the security risks of operating an EHR system that is several decades old. “How many people work in the VA that can do anything on a 50-year old system. Who can work on these systems?’ asked one committee member.
“To your point, the available resources for those aging systems gets smaller ever year, as people retire, and that increases that risk that makes this even more important that we get these legacy systems shut down,” Thomas said.
On the issue of VA's medical appointment scheduling system, Jennifer Lee, M.D., Deputy Under Secretary for Health for Policy and Services, Veterans Health Administration, assured committee members that the department was moving forward with its commercial scheduling system, referring to the Medical Appointment Scheduling System (MASS) contract awarded in 2015 to Systems Made Simple, a subsidiary of giant defense and national security contractor Lockheed Martin, and Epic Systems. The VA is currently running a pilot project and results will be available in 18 months, Lee said. In the meantime, VA must continue developing an interim system, known as the VistA Scheduling Enhancement (VSE) project. A “go/no-go” decision on rolling out the VSE nationwide is set for Feb. 10, Thomas said.
Regarding interoperability with DoD and community healthcare providers, Lee highlighted the VA’s health data exchange efforts through the eHealth Exchange, a health information exchange network supported The Sequoia Project. According to Lee, through the eHealth Exchange, the VA has 88 community partners, representing 815 hospitals, 435 federally quality health centers, 150 nursing homes, 8,000 pharmacies and 14,000 clinics.
Lee also said the VA’s current data exchange is an “opt-in” model but she would like to see a statutory change to enable an “opt-out” model to increase the number of veterans’ patient records that can be shared with other healthcare providers.