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VA Opts for Same EHR System Used by DoD Healthcare

by U.S. Medicine

June 13, 2017

Lawmakers Applaud Shulkin Decision

By Sandra Basu

L to R, Chief Master Sgt. Willard Armagost, 92nd Medical Group superintendent, Col. Meg Carey, 92nd MDG commander, Navy Vice Admiral Raquel Bono, Defense Health Agency director, and Lt. Gen. Mark Ediger, U.S. Air Force surgeon general, pose with a plaque in honor of the MHS Genesis “go-live” earlier this year at Fairchild Air Force Base, WA. Now, the VA has announced it will adopt a similar system. Air Force photo by Airman 1st Class Ryan Lackey

WASHINGTON — Saying that he was not willing “to put this decision off any longer,” VA Secretary David Shulkin, MD, announced that VA will adopt the same EHR system as DoD, now known as MHS GENESIS.

“The adoption of the same system between VA and DoD is going to allow all patient data to reside in a common system so you will have this seamless link between the departments without the manual or electronic exchange of information,” Shulkin explained earlier this month.

The decision by VA comes after DoD and VA announced in 2013 that they were embarking on separate paths for individual EHR solutions, much to the chagrin of lawmakers. VA had said it would continue to use VistA as its platform and would modernize it, while DoD decided to seek a commercial solution, MHS Genesis.

“We each have separate systems, and each are supporting separate electronic systems,” Shulkin said. “And while we’ve been able to advance interoperability at the cost of hundreds of millions of dollars to the taxpayers, today we still have separate systems that do not allow for the seamless transfer of information.”

Speaking about the limitations of the current EHR situation, he said that DoD and VA are able “to reach each other’s records right now” but that “what you’re not able to do is actually work together to plan a treatment, to be able to go back and forth between the Department of Defense and VA.”

EHR Solution

Photo By  Grant Campbell, (left), project manager for the Leidos Partnership for Defense Health (LPDH) Training, presents a training requirement workshop to administrative personnel at Naval Hospital Oak Harbor in Oak Harbor, WA, last year. The workshop was part of a model systems review conducted, by 75 LPDH experts in support of the hospital’s transition to the DoD’s new electronic health record, MHS GENESIS. The facility was the first military treatment facility scheduled to transition to MHS GENESIS in late 2016. Navy photo by Patricia Rose

Several key lawmakers voiced their support for the decision.

“We have often stated that the VA and the Department of Defense should adopt the same electronic records system to create a seamless transition for those transferring from active duty to veteran status, and we believe this move will improve the continuity of information and timeliness of care for our nation’s veterans,” said Senate Committee chairmen Sens. Johnny Isakson (R-GA) and John McCain (R-AZ) in a joint statement.

            House Committee on Veterans of Affairs Chairman Rep. Phil Roe (R-TN) said he was “encouraged by the announcement the department will finally move toward a 21st century health records system.”

“As chairman, my top priorities will be to ensure a seamless transition for veterans to ensure there are no delays in care, and to provide oversight so that tax dollars are spent wisely,” Roe said.

Meanwhile, Paul Rieckhoff, founder and CEO of Iraq and Afghanistan Veterans of America, pointed out that making the announcement “is the easy part.” He said his organization’s members “look forward to seeing regular updates and will be in regular touch when and if they see improvements on the ground.”

“The hard part is actually getting it done,” said.  

 

Considering All Options

In the weeks before the announcement, Shulkin had told lawmakers at a budget hearing that a decision would be made by the next month about what VA would do with its EHR. He told lawmakers that the agency was considering all options, from adopting a commercial off-the-shelf (COTS) EHR to retaining an enhanced and standardized VistA, the current system.

“VA has to get out of the business of becoming a software developer. This is not our core competency … We are going to get out of that business,” he emphasized. “We will either find a commercial company that will take over and support VistA, or we will go to an off-the-shelf product. That is what we are evaluating now.”

He explained at that hearing that deciding how to proceed with an EHR is “a complex issue.”

“I can assure you that we are exploring all options,” Shulkin said at the time. “As we get more veterans out to the community, out into the private sector hospitals, we have to be very concerned about interoperability with those partners as well.”

In his recent announcement of a decision, the VA secretary said that the decision to use the same EHR solution as DoD was only the start of the process and that VA has “unique needs” that are different from DoD. VA, he said, would need “additional capabilities to maximize interoperability with our community providers. “

“We’re going to be embarking upon something that’s never been done before that is an integrated product, using the DoD platform, but it’s going to require this integration with other vendors to create a system for veterans so that they can get care both in the community as well as in the Department of Defense,” he said.

He said VA clinicians would be very involved in how they develop and implement the system.

“Because in many ways, the Department of Veterans Affairs is actually well ahead of the Department of Defense in clinical IT innovation, and we’re not going to discard all the things that we’ve done in the past.  And in fact, that’s how we’re going to help DoD get better.  So, this is a system that’s going to strengthen care for veterans and our active servicemembers.”

He stated during his announcement that cost negotiations have not begun yet.

 “We know the Department of Defense had a $4.3 billion contract.  VA is a bigger organization.  But we have not begun those negotiations,” he said.


2 Comments

  • S. Gompf, MD says:

    The one thing VA has gotten right consistently in my 18 years of practice here is VA-CPRS. Speaking for many VA docs, we have profound concerns about destabilizing the one thing that works and works well for veterans and healthcare professionals. CPRS permits a “One VA” integrated VA health system, where veterans can even correspond electronically with me via Secure Messaging and have those discussions saved as CPRS progress notes. “Medscape EHR Report 2014” is among the few surveys assessing *physician* opinion, rather than administrators and IT professionals: “The highest-rated EHR, with a score of 3.9, is the Veterans Administration EHR: VA-CPRS. It’s regarded as one of the best overall by our physician respondents” for hospital/health network use, independent office use, satisfaction, connectivity, and usefulness as a clinical tool: http://www.medscape.com/features/slideshow/public/ehr2014?trendmd-shared=1&src=trendmd_pilot#9

    Veterans aren’t suffering from lack of fully integrated DOD records: “VHA Compares Well to Other Health Systems for Patient Safety, Care Quality”http://www.usmedicine.com/agencies/department-of-veterans-affairs/vha-compares-well-to-other-health-systems-for-patient-safety-care-quality/

    Many DOD records are accessible on VistaWeb, where VA systems share CPRS information. Given the push to “Veterans Choice” private providers the last few years, accessing DOD records is nothing compared to the volume and variety of private hospital and physician offices’ paper records VA now scans into Vista Imaging & DocSearch–IF we can get those records at all. Not to mention the reduced productivity of physicians coordinating care with several private providers and facilities, even for one veteran.

    Contrasting with CPRS, almost every off-the-shelf EHR was designed with a priority on monetary reimbursement and administrative documentation, divorced from a clinical understanding of the meaning and purpose of the medical record. Most electronic notes have devolved into a long catalog of low priority data that obscures the medical history, pertinent findings, and course, and complicates providing care. Furthermore, the time required for recording medical notes has tripled even with CPRS, and it has severely eroded face-to-face care and the morale of health professionals. From personal experiences, several off-the-shelf EHRs are extremely user-unfriendly and worsen the problem.

    I (we) respectfully urge our leadership and representatives in Congress to engage those of us “in the trenches”. As a VA career doctor, I hope these changes leave us our bragging rights to the best EHR in the nation, in addition to the highest quality of care and patient safety, as One VA.

  • S. Gompf, MD says:

    The one thing VA has gotten right consistently in my 18 years of practice here is VA-CPRS. Speaking for many VA docs, we have profound concerns about destabilizing the one thing that works and works well for veterans and healthcare professionals. CPRS permits a “One VA” integrated VA health system, where veterans can even correspond electronically with me via Secure Messaging and have those discussions saved as CPRS progress notes. “Medscape EHR Report 2014” is among the few surveys assessing *physician* opinion, rather than administrators and IT professionals: “The highest-rated EHR, with a score of 3.9, is the Veterans Administration EHR: VA-CPRS. It’s regarded as one of the best overall by our physician respondents” for hospital/health network use, independent office use, satisfaction, connectivity, and usefulness as a clinical tool: http://www.medscape.com/features/slideshow/public/ehr2014?trendmd-shared=1&src=trendmd_pilot#9

    Veterans aren’t suffering from lack of fully integrated DOD records: “VHA Compares Well to Other Health Systems for Patient Safety, Care Quality”http://www.usmedicine.com/agencies/department-of-veterans-affairs/vha-compares-well-to-other-health-systems-for-patient-safety-care-quality/

    Many DOD records are accessible on VistaWeb, where VA systems share CPRS information. Given the push to “Veterans Choice” private providers the last few years, accessing DOD records is nothing compared to the volume and variety of private hospital and physician offices’ paper records VA now scans into Vista Imaging & DocSearch–IF we can get those records at all. Not to mention the reduced productivity of physicians coordinating care with several private providers and facilities, even for one veteran.

    Contrasting with CPRS, almost every off-the-shelf EHR was designed with a priority on monetary reimbursement and administrative documentation, divorced from a clinical understanding of the meaning and purpose of the medical record. Most electronic notes have devolved into a long catalog of low priority data that obscures the medical history, pertinent findings, and course, and complicates providing care. Furthermore, the time required for recording medical notes has tripled even with CPRS, and it has severely eroded face-to-face care and the morale of health professionals. From personal experiences, several off-the-shelf EHRs are extremely user-unfriendly and worsen the problem.

    I (we) respectfully urge our leadership and representatives in Congress to engage those of us “in the trenches”. As a VA career doctor, I hope these changes leave us our bragging rights to the best EHR in the nation, in addition to the highest quality of care and patient safety, as One VA.


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