Efforts by the Department of Veterans Affairs to finalize a $10 billion sole-source contract award with Cerner for a new electronic health record system were put on hold pending an independent assessment of the VA’s interoperability requirements for the commercial EHR.
VA Secretary David Shulkin told the Senate Veterans’ Affairs Committee on Wednesday that a “strategic pause” in the agency’s negotiations with Cerner—as part of the EHR acquisition process—has been in place since the middle of last month to conduct the external assessment of national interoperability language contained in the request for proposal supporting the award.
“MITRE Corporation was selected to coordinate and lead an independent assessment of the aforementioned contract language,” said Shulkin in his testimony. “The independent review was held on January 5 and consisted of a diverse, distinguished and highly respected group of clinicians, chief information officers and executives, well-versed in national interoperability challenges/issues, from across the healthcare industry.”
According to Shulkin, MITRE is in the process of gathering the recommendations and comments provided during the January 5 interoperability forum and will submit a final report to the VA for review by the end of the month.
“My objective when it comes to healthcare for our veterans is to have a fully integrated, interoperable, operationally efficient healthcare system that’s easy for veterans, employees and community partners to navigate,” Shulkin told senators.
Both the VA and Department of Defense will implement Cerner’s Millennium EHR platform in an attempt to achieve full VA-DoD interoperability. In addition, the agency is working with the White House’s Office of American Innovation to figure out how to achieve interoperability with community providers in the private sector.
However, in an interview with Politico earlier this month, Shulkin said the VA’s decision to delay signing a contract with Cerner followed a contentious meeting with the EHR vendor concerning the definition of interoperability. In particular, he indicated that he personally objected to Cerner’s contract language which described interoperability “largely as sharing an administrative data set” through the Consolidated Clinical Document Architecture (C-CDA).
“I can’t practice off a C-CDA. I’m a primary care internist. I need notes from consultants, I need imagery reports. I need to see some of the images on my patients,” Shulkin told Politico.
While Cerner declined to comment on Shulkin’s reported remarks, the EHR vendor did provide a written statement on its overall approach to interoperability when it comes to the VA.
“Cerner supports any effort to advance interoperability—not just among our service members and veterans, but also across the commercial healthcare sector,” said a company spokesperson. “This commitment is consistent with who we are, and we acknowledge and agree with the Secretary that seamless care and interoperability among the VA, DoD and community providers is central to the success of the project. Cerner is the only supplier equipped to deliver upon VA’s vision for seamless care, and we look forward to pressing ahead with the VA.”
VA’s planned purchase of the Cerner EHR, replacing the agency’s legacy Veterans Health Information Systems and Technology Architecture (VistA), calls for aligning the deployment and implementation of the system with DoD’s ongoing rollout of its own system—starting in the Pacific Northwest—to achieve substantial savings in efficiencies and timelines.
But, with the pause in the VA-Cerner contract negotiations until MITRE reports back its interoperability findings, some lawmakers are concerned that the delay could put those savings and efficiencies at risk.
Senator Jerry Moran (R-Kan.) sent a January 16 letter to Shulkin expressing his concerns about the delay in the EHR implementation.
“Further delay disrupts your implementation plan that requires 900 Cerner IP engineers to support the VA’s deployment of the system in the Pacific Northwest,” wrote Moran. “Unless you finalize the contract this month, there will be a considerable shift within Cerner to reassign these 900 IP engineers to other projects, which will be difficult to reset or recommit to this contract in the future. It is unclear how you intend to mitigate deviations from the VA’s plan developed with Cerner.”
In his letter, Moran asked Shulkin to provide information to his office on how the VA will address this change in planning and at what cost.
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