The Department of Veterans Affairs wants House appropriators to designate $782 million of Fiscal Year 2018 funding to kick start the VA’s planned acquisition of a Cerner electronic health record system that will serve as a single common EHR with the Department of Defense.
Although the VA has not completed negotiations with Cerner for the sole-source contract award, which is expected by the end of the month, VA Secretary David Shulkin, MD, told lawmakers on Wednesday that the agency plans to align the deployment and implementation of the EHR with the rollout of DoD’s own system.
Testifying before House appropriators, Shulkin said the VA’s commercial-off-the-shelf Cerner platform will “provide a single system with DoD and give veterans seamless care.” Maintaining the status quo with the agency’s legacy Veterans Health Information Systems and Technology Architecture (VistA) is just not acceptable, he emphasized.
“VistA by itself is not a system—it’s 130 different instances of an electronic medical record. That’s insane,” Shulkin noted, adding that the health and safety of veterans is among the nation’s highest priorities. “Critical to meeting that priority is a complete and accurate veterans’ health record in a single common EHR system. Adopting the same EHR as DoD will vastly improve VA services and significantly enhance the coordination of care for veterans, not only at VA facilities but also at the Department of Defense and with community providers.”
According to Shulkin, a single common EHR with DoD will enable the VA to keep pace with health information technology and cybersecurity improvements that VistA cannot achieve. “Upgrading and maintaining VistA to industry standards will cost approximately $19 billion over 10 years,” he revealed, “and we will still not achieve the necessary VA-DoD interoperability that the new EHR system that we’re proposing will provide.”
Shulkin added that because both agencies will implement Cerner’s Millennium platform, they will be able to achieve full VA-DoD interoperability. However, Shulkin would not publicly comment on the total price tag of the EHR, in light of ongoing contract negotiations with the vendor.
John Windom, program executive for Electronic Health Record Modernization at VA, said the agency intends to award a 10-year contract to Cerner for an enterprise-wide EHR that will provide services to about 1,600 of the VA’s healthcare sites nationwide.
Windom said the DoD has so far implemented its Cerner system at four military sites in the Pacific Northwest as part of the initial operating capability phase, and that the VA will shadow those rollouts to take advantage of inherent economies of scale gained by labor efficiencies.
“It’s our intent to deploy also to the Pacific Northwest,” Windom testified. “I can’t speak for Cerner, and I won’t delve overly into the specifics of the negotiation, but by us deploying into the same geographical area, we’ll be able to leverage the resources that are already in that area. If we deployed (in the East), clearly they would have to stand up a full team that would have to support our deployment on the opposite part of the country.”
Shulkin noted that after the contract with Cerner is signed, the VA will be implementing the Millennium system to the agency’s first site within 18 months, with full deployment across the VA completed in seven to eight years. However, he warned lawmakers time is of the essence in funding the VA’s EHR modernization in FY 2018 because the agency has to roll out its system much faster and more aggressively than DoD because the VA has more facilities.
In addition, Shulkin contended that if there is a delay in the agency securing the funds, it would cause a misalignment between the VA’s implementation of its Cerner EHR and the rollout of DoD’s own system, resulting in a 5 percent increase in the total project cost over 10 years.
“We prefer to fund the plan as part of the enacted 2018 appropriations bill. However, we have to do this quickly, as we have achieved substantial discounts by aligning our EHR deployment and implementation with DoD,” he testified. “Absent an appropriation bill by the end of the calendar year funding the plan, we ask Congress to consider approving our transfer request so we can promptly award the contract (to Cerner). This enables VA to avoid cost increases, and allows us to move forward with IT infrastructure modifications and expanding our program management office to provide the necessary oversight and manage implementation.”
Shulkin indicated that he would like to see lawmakers create a separate appropriation account for EHR modernization costs. “That way, we can capture everything in one place for the sake of full transparency and accountability.”
However, Rep. Charlie Dent (R-Penn.), chairman of the House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies, expressed skepticism that the VA has “now found the answer to its electronic health record conundrum.”
Shulkin conceded that “skepticism’s appropriate—I don’t know any other way to interpret history than to say that this has taken way too long and there have been many false starts along the way,” adding that the replacement of VistA with the Cerner system “is the right thing to do and should have been done years ago.”
While the VA is anxious to sign a contract with Cerner, Dent told Shulkin that the committee “will need more information before it’s comfortable with approving this first step down a long and expensive road.”
Likewise, ranking member Rep. Debbie Wasserman-Schultz (D-Fla.) voiced her concerns about the proposed Cerner no-bid contract. “I was not thrilled about getting a $782 million reprogramming (request) at the end of October that needed to be acted on by November with no real details,” she said. “I’m also concerned about how this new system will work with the private sector providers.”
Wasserman-Schultz added that “with veterans taking advantage of community care in significant numbers, we need to ensure that the new EHR system will be able to seamlessly exchange data between the private sector and the VA.”
Shulkin reassured her that the VA is “committed to working with other EHR vendors besides Cerner—and leading technology companies—to create interoperability with our academic and community partners within the communities where our veterans live.”
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