The Department of Veterans Affairs is weighing all options as the agency decides the future of its legacy electronic health record system, including the possibility of replacing the decades-old Veterans Health Information Systems and Technology Architecture (VistA) with a commercial EHR.

“We need Congress to fund our IT modernization to keep our legacy systems from failing and to increase the interoperability of electronic health records essential to any high-performing integrated health system,” VA Secretary David Shulkin, MD, told lawmakers on Wednesday during a House hearing. “We’re also weighing options for adopting a commercial off-the-shelf alternative to our legacy systems.”

Testifying before House appropriators, Shulkin said the VA’s decision on replacing VistA with a commercial EHR is slated for July. Among the options that the agency is currently considering are either finding a “commercial company that will take over and support of VistA, or we’re going to go to an off-the-shelf product,” he added.

David Shulkin

Also See: VA decision to replace VistA with commercial EHR expected by July

Shulkin mentioned that the VA recently issued a request for information from industry seeking feedback on the concept of providing a cloud-based commercialized form of VistA to the agency, using a software-as-a-service model.

According to Shulkin, the VA must modernize VistA. However, he told members of Congress that the agency “has to get out of the business of being a software developer,” adding that software development is not a core competency for the agency.

“If it makes sense to go to the (commercial) off-the-shelf route, we’ll need some additional support from you as well,” testified Shulkin, who lamented that currently there are more than 130 versions of the agency’s legacy EHR system in use. “The VistA system is something that, frankly, VA should be proud of. It invented it. It was the leader in electronic health records. But, frankly, that’s old history.”

Regardless of what the VA ultimately decides to do with VistA, Rep. Charlie Dent (R-Penn.), chairman of the House Military Construction and Veterans Affairs Appropriations Subcommittee, said the agency must ensure that its EHR system works for all veterans.

Another thorny issue raised during the May 3 hearing was the interoperability of VA and Department of Defense EHR systems.

“Where is the VA in implementing and improving its electronic health record system and executing Congress’ mandate for full interoperability with DOD systems?” asked Rep. Debbie Wasserman Schultz (D-Fla.), ranking member of the House Military Construction and Veterans Affairs Appropriations Subcommittee. “A solution to this issue is long overdue.”

Likewise, Rep. Nita Lowey (D-N.Y.), ranking member of the House Appropriations Committee, said the VA and DOD are “not significantly closer to the interoperability of electronic health records than they were years ago,” despite federal spending of $1.4 billion to try to solve the problem.

House Appropriations Committee Chairman Rep. Rodney Frelinghuysen (R-N.J.) contends that the VA systems is the “weak link” in achieving VA-DOD interoperability. “This is something which is enormously important in a day and age when we have so much information,” he said. “To not have that available to our healthcare providers is pretty inexcusable.”

The National Defense Authorization Act of 2014 required that VA and DOD EHR systems be interoperable with an integrated display of data. For its part, Shulkin said the VA in April 2016 certified interoperability with DOD through the Joint Legacy Viewer (JLV), a read-only display that enables clinicians at either agency to be able to access records from the other systems.

JLV serves as an integrated display providing access to more health information than any other legacy viewer or system used by either VA or DOD. Nonetheless, while JLV works and is better than previous capabilities, Shulkin acknowledged to lawmakers that it “is not the complete interoperability that I think that all of us would hope for.

“This is a highly complex issue,” Shulkin concluded. “I’ve lived through personal electronic medical record conversions in hospitals that I’ve led. These are not easy projects in single hospitals, let alone (in something) the size of the VA system. We’re taking this very seriously … As we get more veterans out into the community, out into the private sector hospitals, we have to be very concerned about interoperability with those partners as well.”

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