The Department of Veterans Affairs faces a major IT decision—whether to continue modernizing its nearly 40-year-old electronic health record system or replace it with a commercial EHR.
The Veterans Health Information Systems and Technology Architecture (VistA), the VA’s legacy EHR system, continues to come under fire from members of Congress and auditors at the Government Accountability Office for its antiquated capabilities.
“DoD is pursuing a commercial solution while VA is attempting to modernize its 30-plus-year-old VistA system,” testified David Powner, the GAO’s director of IT management issues, during a February 7 House Veterans’ Affairs Committee hearing. “VA is now considering a commercial electronic health record. This uncertainty is not acceptable, and a decision needs to be made. VA needs to let go of VistA and go with a commercial solution.”
Although the DoD and VA once had plans to develop a new jointly integrated EHR system, they scrapped those plans because of concerns about the program’s cost, schedule and ability to meet deadlines. Instead, in 2015, the Pentagon awarded the Leidos-Cerner vendor team a 10-year, $4.3 billion contract award to modernize DoD’s EHR worldwide.
However, Powner said that the GAO “sees no justification for VA and DoD pursuing separate systems.”
When it comes to deciding the future of VistA, 2017 and 2018 are “pivotal” years because the VA has major decisions to make about how to modernize the EHR system, according to House Veterans’ Affairs Committee Chairman Rep. David Roe, MD (R-Tenn.).
“Retaining or replacing VistA is a make-or-break decision for VA,” Roe said in his opening statement at the hearing. “It must be made deliberatively and objectively.”
While the VA’s VistA Evolution Program is attempting to “catch the system up and put it on a stable course for the future,” the chairman noted that the initiative is the “third major attempt to modernize VistA in the past decade.” At the same time, he also noted that last year the Commission on Care recommended VA retire VistA in favor of commercial-off-the-shelf software.
“VistA is no longer the state-of-the-art. VistA is no longer…able to do all the things that we need it to do,” said Ranking Member Rep. Tim Walz (D-Minn.).
Testifying before the committee, Rob Thomas, the VA’s acting CIO and assistant secretary for information and technology, acknowledged that VistA lacks the tools and advanced analytics capabilities of a modern commercial EHR.
Still, Thomas, who has been in his current position for less than a month, defended the investment that the VA continues to make in the legacy EHR system.
“VistA Evolution funds have enabled critical investments in systems and infrastructure, supporting interoperability, networking and infrastructure sustainment, continuation of legacy systems and efforts—such as clinical terminology standardization—that are critical to the maintenance and deployment of the existing and future modernized VistA,” he said in written testimony.
“These investments will also deliver value for veterans and VA providers, regardless of whether our path forward is to continue with VistA, shift to a commercial EHR platform as DoD is doing, or some combination of both,” according to Thomas, who manages the VA’s $4 billion IT budget.
Nonetheless, when pressed by Walz, Thomas offered that it is his goal that the VA “go commercial to the greatest extent possible because we’ve not had a great track record on developing software,” primarily as a result of schedule delays.
Thomas added that the VA completed a business case analysis in late December and that the department would be glad to brief members of Congress on its findings.
When asked whether DoD-VA interoperability requires that both agencies use Cerner as their respective vendors, Thomas said a Digital Health Platform (DHP) proof-of-concept conducted in this past fall successfully demonstrated that the VA “could have full interoperability with the Cerner EHR” by leveraging HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standard.
The goal of the DHP proof-of-concept, managed by Georgia Tech, was to demonstrate 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.
“We wouldn’t have to be on the exact same commercial EHR, and we could have that interoperability,” concluded Thomas.
On February 7, the Senate Committee on Veterans’ Affairs voted unanimously to advance the nomination of David Shulkin, MD, to serve as VA Secretary. Shulkin has served as the VA’s under secretary for health since July 2015.
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