VA: ‘Confident we’re going to commercial’ on EHR

The Department of Veterans Affairs (VA) is leaning toward abandoning its troubled legacy electronic health record (EHR) system in favor of an off-the-shelf commercial option, even though the department has spent millions trying to modernize the system and advance interoperability.

At a congressional hearing on IT issues at the VA, the Government Accountability Office (GAO) detailed a report which slammed the Veterans Health Information Systems and Technology Architecture (VistA) as antiquated. The U.S. Department of Defense (DOD) entered into a 10-year contract with Cerner for a commercial EHR system in 2015, and the GAO said “buying is the way to go” for the VA as well.

“DOD is pursuing a commercial solution while (the) VA is attempting to modernize its 30-plus-year-old VistA system. The VA is now considering a commercial electronic health record,” said David Powner, GAO Director of IT Management Issues. “This uncertainty is not acceptable and a decision needs to be made. The VA needs to let go of VistA and go with a commercial solution.”

IT officials at the VA indicated they’re heavily leaning in that direction. Rob Thomas, the department’s acting assistant secretary for information and technology and CIO of the Office of Information and Technology, said he was “confident we’re going to commercial,” though not he can’t speak for the next VA Secretary.

Later in the hearing, Thomas said the VA is definitely looking to change its way when it comes to EHR technology.

“When VistA started out, it was called De-centralized Hospital Computer Program and they hired developers across the nation in all of those VA MCs (medical centers)—that’s been the VA way. That is not going to be the VA of the future,” Thomas said. “We are definitely going to go commercial. We’re going to definitely do software as a service. We’ve awarded cloud. We’re going to start shrinking out data centers to get into the cloud. We are going in a different direction than we have.”

Lawmakers on the House Committee on Veterans’ Affairs seemed to welcome the willingness to take a new direction. Chairman David Roe, R-Tennessee, called 2017 and 2018 “pivotal years” for EHR at the VA, noting the department has made no fewer than three attempts to modernize its system in the past decade.

But Roe also expressed reservations about ditching VistA after so much investment has been made in the system.

“Retaining or replacing Vista is a make-or-break decision for VA. It must be made deliberativelyand objectively,” Roe said.

If the VA goes commercial, there will be questions about interoperability with the DOD’s system. The GAO report said there was “no justification” behind decision to abandon an integrated HER system between the two departments, especially after $564 million had gone to such efforts.

Thomas was asked whether the VA would have to use Cerner as its EHR vendor to guarantee interoperability. He said no, citing a proof-of-concept conducted in 2016 which determined full interoperability with the DOD system could be achieved using HL7 standards.

“We wouldn’t have to be on the exact same commercial EHR, and we could have that interoperability,” Thomas said.