VA still unclear about long-term path for records approach

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The Department of Veterans Affairs will continue to modernize its legacy electronic health record system through fiscal year 2018. But, beyond that, the VA’s plans for its long-time records system are still in flux.

However, some of those familiar with the VA and its EHR say that long delays in modernizing the records system have caused it to become outdated, and that the program faces long-standing risks and technical issues that have not been surmounted in past efforts.

The VA is on track to complete the next step in updating its Veterans Health Information Systems and Technology Architecture (VistA) system, said LaVerne Council, VA's CIO and assistant secretary for IT, at a hearing last week before the Senate Appropriations Subcommittee on Military Construction and Veterans Affairs.

At the hearing, to review the status of the VA’s VistA system, Council told the committee the agency will achieve the next iteration of the VistA Evolution Program—VistA 4—in fiscal year 2018, resulting in improvements in efficiency and interoperability.

“VA takes seriously its responsibility as a steward of taxpayer money,” Council testified. “Our investments in VistA Evolution continue to make our veterans’ EHR system more capable and agile.”

VA has designated approximately $510 million in IT development funds to build critical capabilities into VistA since Fiscal Year 2014, when Congress first provided specific funding for the VistA Evolution program. In addition, VA has spent $151 million in IT sustainment funds and $110 million in VHA funds for VistA Evolution.

Council tried to reassure lawmakers that these investments will “deliver value for veterans and VA providers regardless of whether our path forward is to continue with VistA, a shift to a commercial EHR platform as DoD is doing, or some combination of both.”

Despite the fact that the VA plans to complete VistA 4 in Fiscal 2018, the department is currently assessing how best to meet its future EHR needs. Among the options it is considering is following the lead of the Department of Defense, which last year awarded a $4.3 billion contract to Leidos to procure a commercial EHR system from Cerner.

“We’re obviously very interested in the direction VA is heading in terms of modernizing VistA,” said Sen. Jon Tester (D-Mont.), ranking member of the subcommittee. “Whether we’re talking about going to a commercial off-the-shelf system or developing a hybrid of the two, whatever decision is made we will have not only long-range ramifications for the VA and veterans but also for the American taxpayer who will have to foot this bill.”

That’s exactly what concerns Valerie Melvin, director of information management and technology resources issues at the Government Accountability Office.

“VA’s electronic health record system, VistA, is essential to the healthcare of veterans, and the department has been taking steps over many years toward modernizing the system,” testified Melvin. “However, while the department has made progress in these efforts, significant IT challenges have contributed to our designating VA’s healthcare as high-risk.”

According to Melvin, a recent independent assessment of health IT at VA reported that lengthy delays in modernizing VistA had resulted in the system becoming outdated. In addition, she said the study questioned whether VistA’s modernization program can overcome a variety of risks and technical issues that have plagued prior VA initiatives of similar size and complexity.

Just as challenging an undertaking are joint efforts by VA and DoD to share EHRs, an initiative that Melvin contends has been hindered by their inability to identify “outcome-oriented goals and metrics to clearly define what they aim to achieve” through interoperability. “We have not seen clear planning across VA and DoD,” she said.

Nonetheless, according to Council, the VA in April certified its interoperability with DoD in accordance with the National Defense Authorization Act, “well ahead of the December 2016 deadline.”

While VA has been working with DoD to advance EHR interoperability between their respective systems for almost two decades, GAO’s Melvin testified that a modernized VA EHR system that is fully interoperable with the military is still years away—a timeline that does not sit well with lawmakers.

“Whenever a soldier, sailor, airman or marine leaves active duty and becomes a veteran, we should have 100 percent seamless transition of their health record to the VA,” said Sen. Mark Kirk (R-Ill.), chairman of the Senate appropriations subcommittee.

“About 250,000 service members leave the DoD and become veterans every year—that works out to about 700 per day, a data flow which is well within the possibility,” observed Kirk. “With the combined size of the DoD and VA, these agencies should drive the marketplace to a worldwide standard for electronic medical records, encompassing 27 million people.”

According to Kirk, DoD and VA should be using open source tools—including analytical data—to bring these EHR systems to the “next level” to better treat veterans.

“Using these analytics, we could reach a new 21st Century level of care for veterans,” he concluded. “I want to make sure analytics are a deep part of this electronic health record revolution.”

Tester added that “we live in the 21st Century and our IT systems should reflect that.”

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