VA Announces Move to Commercial Electronic Medical Records

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Veterans Affairs Secretary David Shulkin announced on June 5 that his agency plans to move its medical records to the same electronic system currently used by the Department of Defense.

“Having an electronic health record that can follow a veteran during the course of his health and treatment is one of the most important things I believe you can do to ensure the safety and the health and well-being of a veteran. So that’s why this is so important,” said Shulkin. “They’re now going to have a single system from the time they enlist in the military, until, potentially, they die. And so there will never be a need to go back and forth.”

According to Shulkin, using the same system as the DoD, MHS Genesis, will not only ease the medical transition from active service to retirement, but will also increase the service’s adoption speed.

“I think we will be able to do ours even faster than they did,” said Shulkin, estimating that the planning phase for this initiative will likely take three to six months.

Shulkin also said that going with a system already in use with the DoD will reduce risk and improve cybersecurity, as this commercial system has already been vetted by the DoD’s high standards.

“I think by going with the Department of Defense system, we are lowering our risk,” said Shulkin. “The risks are there, but we’re going to make sure that we do this the right way.”

Though the VA has been using in-house electronic record systems, Shulkin said that it was time to move to an off-the-shelf system.

“I did not see a compelling reason why being in the software development business was good for veterans,” said Shulkin.

To be able to execute this transition, the VA will have to get significant funding appropriated by Congress, which Shulkin said could likely be more than $4 billion. However, he was confident that such funding would receive widespread support from both parties.

“This is something that Congress has been asking for, I believe they will support this,” said Shulkin. “I do not expect any major fights on this.”

Though improving the Veterans Affairs health care process has been a priority for many elected officials, Shulkin said that this problem “spans administrations and has been going on for decades,” and attributed the long wait to “a lot of built-in movement to keep things the way they are.”

Shulkin said that VA will also work on integrating disparate systems with the solution they plan to share with DoD, as his agency requires a wider range of solutions that don’t currently work together.

“I think this is going to make a big difference for veterans everywhere and it’s going to make a big difference for Veterans Affairs,” Shulkin said. “The Department of Defense and the Department of Veterans Affairs are together in lockstep on this.”

  1. Anonymous | - Reply
    It is fundamentally flawed to assume that buying a common code base for an EHR system necessarily means that interoperability will be achieved. The Corner (or Epic, VistA, etc) system must be configured with sets of clinical data representing patient problems, vital signs, smoking cessation questions, specimen types, bacteriology results, units of measure, etc. There are literally thousands of large and small code sets to be configured. And in the real world, each vendor customer/site typically configures differently. It does help that the underlying information models will be more similar when you share an underlying code base with at least one big partner (but not, of course, others). Yet without true computability, based on a common configuration of clinical data terms used by the system, human readers still must bridge the gap and interoperability will be limited even within VA (or DoD). One won't be able to easily roll up, for example, hospital infections by bug type or even arithmetically correlate vital sign readings. The lab and the pharmacy can pick different sets of units of measure. This is the exact problem that VistA (which, after all, started as the "Decentralized Hospital Computer System") has long faced. And moving to a COTS solution, by itself, does not address that problem directly. An expensive program of limited, information-lossy mapping can help. But a better solution is to configure the clinical terminology used in the implementations in a comprehensive, controlled, and similar (as much as possible) manner. Unfortunately, VA never had the institutional will to comprehensively do that in VistA. Unless someone at the decider level thinks past the glossy marketing materials and colorful, cyclic PowerPoint slides, it won't happen with a COTS solution either. In that case, VA will discover in five or seven years that it is little more interoperable than it is today. And remember, the Secretary has identified community interoperability as highly important. A few years (or even less) after separation from the service, it is more important for the average patient than DoD interoperability. And only some of those community partners will ever use Cerner. Without comprehensive, commonly held, cross-institutional implementation of national standards, promoted by the weight of VA-DoD in standards bodies and the vendor community, a COTS buy won't move VA off the interoperability dime.
  2. Anonymous | - Reply
    What they really want is a single system of record of a patient accessible from any EHR front-end; DoD, VA, Cerner, others. This follows a model I call the patient Data Custodian, an entity responsible for managing a patient's data. Posts of events can be made by any validate/authorized client such as EHRs, wearables, or any other input to a patient's health. Interoperability between EHRs is just a land grab for patient data. If the EHR accessed a common source of patient data, interoperability comes free.
  3. Anonymous | - Reply
    The comments by anonymous make sense and is really the benefit of having an electronica record. ability to become independent of a physical place, if you need them when you are "x" and then again when you are in "y" in one or more cases where the patient isn't known you aren't starting fro scratch. yes, technical, process, procedural challenges but it is a worthwhile goal.

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