The U.S. Department of Veterans Affairs recently announced the creation of the Office of Electronic Health Record Modernization (OEHRM), aimed at helping the VA make the transition from its legacy patient data systems to a new electronic health record (EHR) system from the vendor Cerner.
The OEHRM is tasked with preparing, deploying and maintaining the VA’s new EHR system as well as the health IT tools around it. The effort will be headed up by Genevieve Morris, formerly the principal deputy national coordinator at the Office of the National Coordinator for Health IT in Washington.
The VA’s efforts to update its EHR systems have thus far been a bust. The department has spent around $1 billion over the last six years attempting to overhaul and modernize its legacy systems with efforts known as VistA Evolution and iEHR, but with little success.
Now, Cerner steps to the fore, agreeing to a 10-year $10 billion project with the VA. When accounting for the necessary improvements to the legacy systems, the project is estimated to cost closer to $16 billion when all is said and done.
“As technology and the needs of our Veterans evolve, we must also evolve our systems to support better care for our Veterans,” VA’s Acting Secretary Peter O’Rourke said in a statement on the VA website. “This office is dedicated entirely to our electronic health record modernization and will bring significant and diverse expertise to get VA to the end-state that will allow medical records to transition seamlessly for service members departing active duty into Veteran status.”
EHR History at the VA
The VA has been a leading player in the development of EHRs for a long time, well before massive technology firms stepped in to provide their proprietary solutions. Dating all the way back to 1977 with the creation of the Decentralized Hospital Computer Program (DHCP), the VA’s EHR effort helped spur some of the biggest innovation in health information sharing to date. In 1994, the DHCP was rebranded as the Veterans Health Information Systems and Technology Architecture (VistA).
Since then, VistA has been the agency’s EHR tool. It is open source and well-liked among VA physicians, leading many within the field to the conclusion that the VA should keep VistA and simply support it better, according to an article from Healthcare IT News.
But there has long been a movement within the VA to outsource the work of creating an EHR system to private vendors, according to an article from Politico that outlines the long, complicated history of VistA’s development within the VA, a development centered on collaboration between doctors and developers.
But VistA has also been in need of crucial updates that have been set aside as the move to a commercial off-the-shelf solution seemed inevitable, being favored among leaders within the VA. In June 2017, then VA Secretary David Schulkin announced the partnership with Cerner. It would take nearly a year and the installation of new leadership at the VA before the deal would finally have the necessary signatures to move forward. Schulkin had this to say when it finally happened.
— David J. Shulkin, MD (@DavidShulkin) May 18, 2018
Despite the rumblings of critics, the deal is set to move forward on a ten-year timeline. The project’s first goal is to launch the Cerner platform with initial operating capability at VA hospitals in the Pacific Northwest by March of 2020. Implementation will then spread to the rest of the country over the next decade, a process that former VA Chief Information Officer Scott Blackburn said would require “very strategic, targeted investments to maintain the state-of-the-art nature of VistA.”
VA facilities along the eastern seaboard are likely to be on VistA for years to come, requiring extensive maintenance as the Cerner project goes through its own growing pains.
A large number of vendors placed bids on the VA’s EHR modernization process, but Cerner had one clear advantage: It’s already working with the Department of Defense (DoD) on an EHR system known as MHS Genesis, which is currently in a pilot phase.
With 168 hospitals and more than 1,000 outpatient facilities, the VA project is much larger than any project Cerner has ever taken on before, sparking concern from critics that the project may take longer and cost more than estimated. One critic was Niam Yaraghi, a non-resident fellow at the Brookings Institute who wrote in a recent blog post:
“The VA’s EHR project is similar to other government IT projects, but judging from this history, the VA project is also very likely to fail,” he wrote, noting that VistA has been ranked among the best EHR system by physicians and that the VA’s physicians and nurses have never used another software before.
He also noted concerns over how the project plugs into overarching interoperability efforts.
“This deal guarantees that Cerner shouldn’t worry about sending or receiving data from other EHR systems because the most important connection is between their own system and the DOD,” he said in an interview with Fierce Healthcare. “To some extent, it’s a missed opportunity. The VA could have used its buying power to force interoperability.”
Amid the Trump administration’s leadership changes at the highest levels of the VA, there is a growing need for stability as the project sets its course for the next decade. The first step toward steadying the ship came recently when the Senate confirmed former DoD under secretary Robert Wilkie as the new Secretary of the VA. Soon to follow will be a new CIO, among other key positions.
Wilkie has his hands full moving forward. If the VA is going to achieve a long-awaited goal of creating a single common EHR system with the DoD, it’s going to need physician buy-in and collaboration with DoD to learn from MHS Genesis’ growing pains.
As House Veterans Affairs Committee Chairman Phil Roe put it in an interview with EHR Intelligence: “The EHR modernization effort is not just a technology project. It will have a major impact on how the Veterans Health Administration operates. That means clinical and administrative workflows. It also changes the culture, as VistA has.”