The Senate on Monday voted 100-0 to confirm David Shulkin, MD, to head the Department of Veterans Affairs, which manages the nation’s largest integrated healthcare system.
Shulkin, who previously served as the VA’s under secretary for health, has the distinction of being the first nonveteran to lead the department.
As VA Secretary, Shulkin faces multiple IT decisions, including whether to keep or replace the Veterans Health Information Systems and Technology Architecture (VistA), its legacy EHR system which is nearly 40 years old.
Last week, Rob Thomas, the VA’s acting CIO and assistant secretary for information and technology, acknowledged before a House committee hearing that VistA lacks the tools and advanced analytics capabilities of a modern commercial EHR.
Thomas even went so far as to say he was confident that the VA would be replacing VistA with a commercial EHR. “I can’t speak for Dr. Shulkin,” he added. “I hope for a speedy confirmation so that he can help us work through that.”
Last year, in testimony during a House hearing, then-Under Secretary for Health Shulkin defended the VA’s current EHR system, offering that he practiced medicine in the VA and the department is “moving full ahead to make sure that VistA is an optimized system…we’re not slowing down anything on VistA.” He emphasized that VistA is “getting better every day.”
Nonetheless, at the same time, Shulkin told members of Congress that “technology has changed so much and we have the responsibility to lay out the plan to make sure that the system that we’re using now is going to meet the needs of veterans for the future.”
Toward that end, Shulkin worked closely in the Obama administration with LaVerne Council, the VA’s former CIO, on a number of health IT capabilities including the emerging Digital Health Platform. DHP is designed to integrate veteran data from VA, military and commercial EHRs—as well as apps, devices and wearables—so that the information is available to providers in real time.
This fall, a DHP proof-of-concept managed by the Georgia Institute of Technology successfully demonstrated mature and emerging interoperability technologies from both the public and private sectors. The demonstration included the capability to obtain patient data from disparate military and commercial EHRs by leveraging HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standard.
“As more and more veterans are being treated outside of the VA system, the need to move their health data efficiency and securely from VA systems to EHRs in private practice medical groups is critical if we are to provide our veterans with the highest possible quality of care,” says Robert Tennant, director of health IT policy at the Medical Group Management Association.
Tennant adds that while health system-wide interoperability remains elusive MGMA is “hopeful that initiatives such as the VA’s Digital Health Platform, cloud-based technology that integrates data from VA, military and private sector EHRs and other devices in real-time, offers an effective pathway to data sharing.”
Sasha TerMaat, chair of the Electronic Health Record Association and director at Epic, congratulated Shulkin on his unanimous confirmation to this important position. “The EHRA recognizes the importance of the VA's continued progress in connecting not only to the DoD, but also private sector providers who their patients may see,” said TerMaat.
“The VA has done some great work over time on content, workflows, platforms and research that could be leveraged should they choose to move to a commercial system,” says Travis Dalton, senior vice president investor owned and general manager federal at Cerner.
“We’re very supportive of VA Secretary Shulkin and we believe his background as a physician is beneficial and will help guide the organization. We are at the ready to assist in any capacity should we be called upon.”
Dalton adds that “Cerner is supportive of any initiatives that enhance healthcare for the Veteran’s Administration and our nation’s veterans.”
However, Oscar Diaz, CEO of the Healthcare Services Platform Consortium, warns that the VA needs to carefully consider how it replaces VistA.
“None of the EHR solutions covers the breath that VistA provides the VA,” says Diaz. “I liked the VistA Evolution strategy and the eHMP model as it created a services set of methods to move logically through a replacement of VistA. Anything else will be a disaster. The VA will not find the functionality required in an off-the-shelf solution. All of those solutions are focused on payor transactions. Not the VA model.”
The VA’s EHR enhancement effort—the VistA Evolution program—includes the addition of an Enterprise Health Management Platform (eHMP)—a set of new modular-based components—to replace the Computerized Patient Record System, which is the existing user interface that clinicians use while delivering care.
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