Faced with increasing demands for its services and the realities of providing integrated healthcare in the 21st Century, the Department of Veterans Affairs is having second thoughts about sticking with its legacy electronic health record system.

Although the VA has been modernizing the Veterans Health Information Systems and Technology Architecture (VistA) over the last couple of years, the department is “taking a step back” from this system modernization to reassess its future clinical needs and to determine whether it should move forward with VistA or follow the lead of the Department of Defense—which last year awarded a $4.3 billion contract to a Leidos-Cerner team—and procure a similar commercial off-the-shelf EHR system.

“We want to take a step back and look at what we really need to have an EHR—as well as a healthcare system—do,” testified LaVerne Council, VA’s CIO and assistant secretary for IT, earlier this month before the House Appropriations Committee’s Military Construction and Veterans Affairs Subcommittee. “There are multiple needs that are different than those that were even looked at in 2014 around women’s health, around the area of the Internet of Things—which is now creating a very different point of view in how we deal with healthcare—but also how do we manage choice and care in the community.”

In the meantime, as the VA weighs its EHR options going forward, the department’s fiscal year 2017 budget request includes a $40 million reduction in funding for the VistA Evolution program that would add an Enterprise Health Management Platform (eHMP)—a set of new modular-based components—to replace the Computerized Patient Record System, which is the existing user interface that clinicians use while delivering care.

For 2017, Council said that VistA Evolution will focus on investments that further expand the VA’s interoperability with DoD and community provider EHR systems. “We will also continue the development of our Enterprise Health Management Platform, primarily around some of the clinical needs we need to address,” she told lawmakers. “We are on schedule to define a clear interoperability with DoD here in March and have an electronic key capability between eHMP and [Defense Healthcare Management System Modernization] by August of this year.”

Rep. Hal Rogers (R-Ky.), right
Rep. Hal Rogers (R-Ky.), right

Late last year, Congress provided $233 million in its final fiscal year 2016 omnibus bill for continued modernization of VistA. However, since the VA’s plans for the legacy EHR system remain uncertain, lawmakers are not happy about the department’s potential change in procurement direction.

“We’ve been at this 10 years. We’ve given you billions of dollars, and I’m hearing muckety-muck here,” Hal Rogers (R-Ky.), chairman of the House Appropriations Committee, thundered at VA’s Council. “Apparently, you’re saying you’ve not made your mind up yet about whether to replace the VistA system with something off the shelf. Is that right or wrong? Yes or no?”

“We have not made our minds up,” replied Council. “The fact is we need to ensure that we have laid out the plan and strategy so that everyone can understand exactly what we’re doing and why we’re doing it. When we came into these roles, we didn’t have that strategy laid out, and it’s important if we’re going to be able to say that we’re good stewards of those millions of dollars, that we act like it and put the plan in—and, that’s what we’re going to do. But, it’s not going to stop anything that’s currently being done.”

David Shulkin, MD, under secretary for health at the Veterans Health Administration, defended the VA’s current EHR system, offering that he practices medicine in the VA and the department is “moving full ahead to make sure that VistA is an optimized system—as Ms. Council said, we’re not slowing down anything on VistA.”

Shulkin added that VistA is “getting better every day.” However, at the same time, he told members of Congress that “technology has changed so much and we have the responsibility to lay out the plan to make sure that the system that we’re using now is going to meet the needs of veterans for the future.”

In response, Rogers admonished Shulkin that the VA’s deadline is 2018 and that “there will be no further excuses after that. This has taken altogether too long.”

Despite the concerns of lawmakers, the House Appropriations Committee on March 22 released its fiscal year 2017 military construction and VA appropriations bill, which contains $260 million for VistA modernization. Still, the proposed legislation includes legislative language restricting funding until the VA has certified interoperability of its EHR system with DoD, and requires the department to meet milestones regarding functionality and management.

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