The US Veterans Affairs Department bets $10 billion on EHR modernization

Will the Veterans Affairs Department’s fourth attempt to modernize and connect its electronic health records to those of the Department of Defense succeed? It’s a $10 billion question.

If at first, you don’t succeed, try, try again, the old saying goes, and that seems to be the logic behind VA’s decision to scrap previous efforts and launch a fourth attempt to modernize the agency’s electronic health records system. Between fiscal years 2011 and 2016, the Government Accountability Office found that VA paid out roughly $1.1 billion to 138 contractors working to update the agency’s outdated Veterans Information Systems and Technology Architecture to better share data with the Department of Defense (DoD).  Said Secretary of Veterans Affairs Dr. David J. Shulkin:

At VA, we know where almost all of our Veteran patients are going to come from — from the DoD, and for this reason, Congress has been urging the VA and DoD for at least 17 years—from all the way back in 2000—to work more closely on EHR issues.

To date, VA and DoD have not adopted the same EHR system. Instead, VA and DoD have worked together for many years to advance EHR interoperability between their many separate applications--at the cost of several hundred millions of dollars--in an attempt to create a consistent and accurate view of individual medical record information.

While the efforts have established some degree of interoperability, the goal of seamless care has been stymied by what Shulkin describes as ever-changing information sharing standards, separate chains of command, complex governance, separate implementation schedules that must be coordinated to accommodate those changes from different program offices that have separate funding appropriations, and a host of related complexities requiring constant lifecycle maintenance. It's one heck of a laundry list.

The bottom line is we still don’t have the ability to trade information seamlessly for our Veteran patients and seamlessly execute a shared plan of care with smooth handoffs.

Starting over

The VA’s solution—which still awaits funding authorization by Congress--is to dump the failed attempt to link up the homegrown and integration resistant, VistA platform that it has relied on to manage health records for its 9 million beneficiaries since the 1980s and start all over again, this time with a single vendor contract to Cerner, a large provider of health information technology solutions, headquartered in North Kansas City, MO.

Cerner was chosen mainly because the company is already developing the DoD’s MHS  Genesis platform, which has  Cerner Millennium EHR, a tested commercial platform at its core. Putting both agencies on the same system should allow medical records to be shared between agencies and solve the costly issue of disparate medical systems that have plagued both organizations for years. Said Scott Blackburn, acting CIO for the VA:

This is going to be the largest implementation of a healthcare system EHR ever, and it's going to be a really big undertaking. The key difference between previous efforts is we're going to be buying a commercial off-the-shelf solution and absolutely minimizing the customization.

The VA’s 168 nationwide facilities all currently run a unique version of VistA but Blackburn believes adopting the Cerner platform will force the VA to standardize procedures across the medical system and also align them with the workflows of DoD.

VA is also hoping that the transformation will help its FITARA scorecard--—an oversight tool that grades IT acquisition reform compliance. VA received an overall B+ on the 2017 scorecard but got an F in the data center optimization category. Migrating from the highly customized VistA system to a primarily commercial platform through Cerner should enable the agency to reduce its reliance on data centers drastically. Blackburn said he believes the new health records platform will allow VA to reduce its number of core data centers from more than 400 to just 14 by 2020.

 My take

This is a herculean initiative with a massive price tag, and VA doesn’t have an excellent track record in its long-held goal to integrate its medical records with those of the DoD. But, one independent group estimated the total project would top $19 billion if VA continued down the same path. Settling on a common platform for both agencies will obviously make that task considerably more manageable and $10 billion is a lot better than $19 billion. Using a commercial software platform will make it easier to integrate the system with outside clinicians, researchers and healthcare providers who need access to certain patient data.

If the agency achieves the kind of gains in data center consolidation that it anticipates, that will go a long way towards justifying the high cost of migration.

Having a Veteran’s complete and accurate health record in a single standard EHR system is critical to that care, and to improving patient safety.