The Cerner electronic health record system that the Department of Veterans Affairs plans to implement will achieve interoperability with the Department of Defense and community healthcare providers, according to VA Secretary David Shulkin, MD.
Shulkin told lawmakers on Thursday during a House hearing that the commercial-off-the-shelf EHR system will create a “single accurate lifetime electronic health record” for veterans. At the same time, he acknowledged that it is a “very risky and complex” implementation and “a lot of things could go wrong.”
To keep the project on track, the VA plans to align the deployment and implementation of its new Cerner EHR with the rollout of DoD’s own Cerner system, which has so far been installed at four military sites in the Pacific Northwest.
Asked by Rep. Charlie Dent (R-Penn.), chairman of the House Military Construction and Veterans Affairs Appropriations Subcommittee, about reported technical problems with the DoD rollout of its Cerner system, Shulkin assured members of Congress that he is confident that the VA has made the right decision in deciding to make a $10 billion sole-source contract award to the EHR vendor.
“Congress has been asking us for now 18 years to find a way to get our systems to work together with the Department of Defense—and, so, that will certainly be achieved with this,” testified Shulkin. “I do believe that working with the Department of Defense as closely as we are—we have a very close working relationship—we’re using their lessons to make sure that our contract reflects the issues that we’ve learned but also that we’re going to have a smoother implementation.”
In December, Shulkin ordered a “strategic pause” in the agency’s negotiations with Cerner—as part of the EHR acquisition process—to have the MITRE Corporation conduct an external assessment of the VA’s interoperability requirements.
“What I’ve done is I’ve asked for a pause until I can make sure that we have the interoperability with community providers,” said Shulkin. “Since 36 percent of veterans now receive care in the community, I think that’s essential to do.”
Shulkin revealed that, as part of its interoperability assessment, MITRE has provided the VA with 51 recommendations and that the agency is currently building them into the contract with Cerner.
“We’ve said to the Cerner Corporation that we are not going to sign a contract that’s going to allow proprietary protection and information blocking to continue—we will not allow that for veterans,” Shulkin added. “The Cerner Corporation has been extraordinary in working with us to respond to that.”
According to Shulkin, open application programming interfaces (APIs) are the “key to having free flow of information” as well as HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standard, which the VA will build into its contract with Cerner.
“We’ve gotten 11 major hospital systems to sign on to a pledge that they will adhere to open APIs and industry standards,” Shulkin testified. “More health systems that want to work with veterans—and I know all across the country there’s a commitment to this—are going to be working with us on this pledge.”
President Trump’s Fiscal Year 2019 budget request for the VA includes $1.2 billion to start implementing Cerner’s Millennium EHR platform, which will replace the agency’ Veterans Health Information Systems and Technology Architecture (VistA).
“It’s an expensive investment and it’s a long investment, and if we don’t get it right in the beginning, I don’t think that we’re going to have a chance to go back and do it over,” Shulkin told lawmakers. “So, we’re taking extraordinary lengths to get the expertise around the country to give us their input. But we absolutely did build in the MITRE recommendations, and we’re still looking to do a few more reviews before we say that we’re ready to move forward—and, hopefully, that will be soon.”
Rep. Debbie Wasserman Schultz (D-Fla.), ranking member of the House Military Construction and Veterans Affairs Appropriations Subcommittee, commented that the replacement of VistA is “excruciatingly long overdue,” but she warned Shulkin that “we need to be very careful to establish accountability—which is something I know you share—and accountability measures through the whole implementation process that could fundamentally change the nation’s use of electronic records.”
While Wasserman Schultz acknowledged that the VA’s massive Cerner EHR rollout will no doubt have its growing pains, she said “it’s crucial that we understand how its procurement will work.”
As part of the implementation, the agency will migrate more than 130 instances, or versions, of its legacy system to a single virtual instance in the VA—one instance of VistA at a time, according to Shulkin.
“I’ve done two previous electronic health record implementations—never on this scale,” concluded Shulkin. “Of course, nobody’s done anything on this scale. But, if you don’t have involvement from your clinicians, you might as well not start to begin with. That is the absolute key. And, so, having this being driven through our clinical leadership and our clinicians is going to be the factor that’s going to be successful.”
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