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VA Might Yet Move to Commercial EHR System

by U.S. Medicine

March 10, 2017

By Sandra Basu

While VA said last year that it would release VistA 4 in FY 2018 – as depicted in this graphic — that the system might not be the electronic health record it uses in the future, according to current information.

WASHINGTON — After years of working to modernize its electronic health record internally, a senior IT official indicated last month that a shift to a commercial EHR is the likely path forward for VA.

“It is going to be my goal and my charge that we go commercial to the greatest extent possible, because we have not had a great track record on developing software,” said Acting Assistant Secretary for Information and Technology and CIO Rob C. Thomas.

VA and DoD decided to use different EHRs back in 2013. At the time, VA said it would modernize VistA while DoD said it would buy a commercially-available system, which it rolled out at its first medical facility last month.

Last year, VA appeared to shift directions when officials said that, while it would release VistA 4 in fiscal year 2018, the system might not be the EHR that it uses in the future.

Thomas told lawmakers at a House committee hearing that VA completed a cost-benefit analysis of continued development of VistA as well as other EHR options, completed at the end of December of 2016.

While he said he was “confident” the agency was “going to go commercial,” he cautioned that he “cannot speak” for then-VA Secretary nominee David J. Shulkin, MD, who was awaiting confirmation at the time of the hearing.

“I’ve worked with him the past 18 months; he’s very decisive,” Thomas explained.

New EHR?

Thomas made his comments at a hearing held by the House Committee on Veterans’ Affairs on VA’s major IT projects. Committee chairman Rep. Phil Roe, MD (R-TN), pointed out to VA officials that VA is in its “third major attempt to modernize VistA in the past decade.”

Asked by Roe whether he agreed with the statement that VistA “lacks the tools and extensive analytics capabilities of a modern commercial EHR,” Thomas said he did.

Roe then wondered aloud why VA would “continue down that road [of modernization]” when DoD “swallowed the bitter pill” and opted to use a commercial EHR, adding, “I’ve been sitting here for eight years listening to how it’s going to get better and so forth.”

Lawmakers also had questions about the timelines of VA’s different IT projects. If VA uses a commercial EHR, Rep. Julia Brownley (D-CA) asked how long it would take to implement and whether a timeline exists.

Thomas did not have an exact timeline, but said, once the decision is made, VA will get back to lawmakers with some answers.

Brownley suggested that the VA’s IT timelines never seem clear to her.

“It always feels like the goal posts are moving, and I can’t keep track of the movement on those goal posts. It’s testified in one committee that says this, and then we go to the next meeting and then [VA] says, ‘Oh, well we had some delays,’” she said.

Other lawmakers also appeared frustrated by the pace of progress. Rep. Tim Walz (D-MN) said that he continues to have concerns that, if DoD and VA are using two different EHRs, interoperability of records won’t fully occur.

“I cannot talk to a veteran and justify why we are going to spend countless dollars for two systems that may not communicate, that do not improve the veterans’ experience, that do not make it more secure and that do not guard taxpayer dollars,” Walz said.

‘Unacceptable Uncertainty’

Also testifying at the hearing was David Powner, the Government Accountability Office’s director for IT Management Issues.

When it comes to the EHR, Powner bluntly told lawmakers that “VA needs to let go of VistA and go with the commercial system.” He said that the “uncertainty” regarding this decision is unacceptable.

“Further, we see no justification for VA and DoD pursuing separate systems,” he added.       

Powner also told lawmakers that VA spends a large portion of its IT budget on maintaining older IT systems.

“Of the $4.5 billion, only about $500 million goes toward developing or acquiring new systems. The remaining goes primarily toward operational systems, many of which are old, inefficient and difficult to maintain,” Powner explained.

He pointed to older systems, such as a 53-year-old system that automates time and attendance for VA employees, as well as VA’s 51-year-old system that tracks claims filed by veterans as well as eligibility and dates of death. VA has plans to retire both systems.

Powner also made note of VA’s plans to modernize its patient-scheduling system and a need for a decision on the approach forward for that.

For his part, Thomas sought to reassure lawmakers that VA has been embarking on a transformation of its IT strategy over the past 18 months to provide modernized systems.

“We lacked a coherent strategy. We lacked the right processes and procedures,” he said. “For the past 18 months, we have been going through an incredible transformation. … Now we need to get on with it, which is what we aim to do.”

Thomas also agreed with GAO that current IT spending is “out of kilter from industry” and that VA needs to be able to spend fewer dollars toward maintenance of its systems and more toward new systems.


10 Comments

  • Bill McGuirt says:

    I agree with Mr. Powner. There are numerous deficiencies when trying to transition from the DOD system to the VA system. The VA takes care of the same patients that transition from the DOD. Why then would there be a system in place that does not make communication smoother with easier accessibility to information? As a reservist, I have encountered this problem. I practically need to have a hand delivered copy of all my medical records during any time I have been deployed.

  • Bill McGuirt says:

    I agree with Mr. Powner. There are numerous deficiencies when trying to transition from the DOD system to the VA system. The VA takes care of the same patients that transition from the DOD. Why then would there be a system in place that does not make communication smoother with easier accessibility to information? As a reservist, I have encountered this problem. I practically need to have a hand delivered copy of all my medical records during any time I have been deployed.

  • Eric P Cohen, MD says:

    The VA CPRS clinical computer system is by far better than any commercial EHR.

    Let’s keep what works well.

  • Eric P Cohen, MD says:

    The VA CPRS clinical computer system is by far better than any commercial EHR.

    Let’s keep what works well.

  • Anissa Litwin says:

    I am a pharmacist at the VA. I’ve started working more closely with the veterans who bring us prescriptions from Choice program providers. I called one provider’s office the other day to request a prescription be faxed to my office for the veteran. The person from the Choice program provider’s office said they don’t even do faxes anymore and all they do are “e-prescribing” and she was extremely surprised that we didn’t accept prescriptions that way. I’m really hoping that whatever new system we get is also capable of interacting with the non-VA providers’ systems. We should be able to operate just like any other retail pharmacy in that regard by accepting electronic prescriptions from outside providers. And we should be able to work across VA systems to fill prescriptions from other VA’s. Right now that is also something that frustrates the veterans when they have to travel away from their home station.

  • Anissa Litwin says:

    I am a pharmacist at the VA. I’ve started working more closely with the veterans who bring us prescriptions from Choice program providers. I called one provider’s office the other day to request a prescription be faxed to my office for the veteran. The person from the Choice program provider’s office said they don’t even do faxes anymore and all they do are “e-prescribing” and she was extremely surprised that we didn’t accept prescriptions that way. I’m really hoping that whatever new system we get is also capable of interacting with the non-VA providers’ systems. We should be able to operate just like any other retail pharmacy in that regard by accepting electronic prescriptions from outside providers. And we should be able to work across VA systems to fill prescriptions from other VA’s. Right now that is also something that frustrates the veterans when they have to travel away from their home station.

  • Rae Stoddard says:

    I am a pharmacist at the VA. I work with veterans frequently that have to travel to larger VA’s for specialized services. They will then return back to their main facility and want to refill prescriptions from the larger specialized provider/facility and do not understand why we can run the refill through for them. Our system is not set up to do this, we are only linked to look. Unlike outside retail pharmacies that linked together and can fill from town to another town or even another state. This can be a frustration for our veterans.

  • Ashraf El-Meanawy says:

    The commercial EHR systems currently available are obscenely expensive and each has it’s major flaws. It has been shown that physician’s productivity dropped by up to 20% with EPIC care (even after they became proficient). It does not talk to any imaging package available an integration with labs system leaves a lot to be desired. I can give example for all. The current VA EHR system is not perfect but it is efficient and can be improved by hiring a team of programmers and physicians to have this as their full time job. Out academic affiliate spent more than 250 million on EPIC so far and it is not complete. the dollar bleeding will continue.

  • Ashraf El-Meanawy says:

    The commercial EHR systems currently available are obscenely expensive and each has it’s major flaws. It has been shown that physician’s productivity dropped by up to 20% with EPIC care (even after they became proficient). It does not talk to any imaging package available an integration with labs system leaves a lot to be desired. I can give example for all. The current VA EHR system is not perfect but it is efficient and can be improved by hiring a team of programmers and physicians to have this as their full time job. Out academic affiliate spent more than 250 million on EPIC so far and it is not complete. the dollar bleeding will continue.

  • Rae Stoddard says:

    I am a pharmacist at the VA. I work with veterans frequently that have to travel to larger VA’s for specialized services. They will then return back to their main facility and want to refill prescriptions from the larger specialized provider/facility and do not understand why we can run the refill through for them. Our system is not set up to do this, we are only linked to look. Unlike outside retail pharmacies that linked together and can fill from town to another town or even another state. This can be a frustration for our veterans.


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