VA intends to modernize legacy EHR despite plans to replace it

The Department of Veterans Affairs will continue to modernize its legacy electronic health record system through Fiscal Year 2018 despite agency plans to replace it with a commercial off-the-shelf EHR from Cerner.

In testimony on Wednesday before the Senate Committee on Veterans’ Affairs, VA Secretary David Shulkin, MD, told lawmakers that the department intends to complete the next iteration of the Veterans Health Information Systems and Technology Architecture (VistA) Evolution Program—VistA 4—in FY 2018 in an effort to improve its efficiency and interoperability.

“VistA Evolution funds have enabled investments in systems and infrastructure that support interoperability, networking and infrastructure sustainment, continuation of legacy systems, and efforts such as clinical terminology standardization,” testified Shulkin.

“These investments are critical to the maintenance and deployment of the existing and future modernized VistA and essential to operational capability,” he added. “That said, our current VistA system is in need of major modernization to keep pace with the improvement in health information technology and cybersecurity, and software development.”

VA has obligated more than $500 million in information technology development funds to build critical capabilities into VistA since FY 2014, when Congress first provided specific funding for the VistA Evolution program. In addition, VA has obligated more than $150 million in IT sustainment funds towards the decades-old legacy EHR.

On June 5, Shulkin announced that the agency plans to replace VistA with Cerner’s Millennium EHR, the same platform that the Department of Defense is currently implementing as part of Military Health System (MHS) Genesis.

“VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the departments without the manual and electronic exchange and reconciliation of data between two separate systems,” Shulkin said. “Still, VA has unique needs, and many of those are different from the DoD. For this reason, VA will not simply be adopting the identical EHR that DoD uses, but we intend to be on a similar Cerner platform.”

At the same time, he added that VA clinicians will be “very involved in how this process moves forward” and in the implementation of the Cerner system.

Earlier this week, House appropriators provided an initial $65 million in FY 2018 funding for VA to replace VistA with a Cerner EHR. However, they have put restrictions on those funds until Shulkin provides Congress with details on how the agency plans to transition to the new system.

Also See: Bill puts conditions on $65M for VA to procure Cerner EHR

In particular, the FY 2018 Military Construction, Veterans Affairs and Related Agencies Appropriations Bill states that no more than 25 percent of the funds can be obligated or spent until Shulkin explains how the new EHR would match up with the MHS Genesis system developed by Cerner for DoD, as well as the enhanced capabilities the VA requires to achieve complete interoperability with the military’s system and the VA’s commercial providers.

Further, House appropriators have demanded details on how VA plans to maintain current functionality and integration with DoD records during the transition to MHS Genesis, as well as how VA plans to manage the transition process to MHS Genesis, including possible pilot programs, training for users and use of change management tools.

For its part, DoD intends to sustain its legacy EHR for another five years as the military rolls out MHS Genesis system. Four sites in the Pacific Northwest will deploy the Cerner Millennium system in 2017, with full deployment to be completed in 2022.

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