Veterans Affairs Refocuses on Commercial Scheduling, EHR

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The on-again, off-again story of the Department of Veterans Affairs’ $642 million commercial scheduling system is not only back on track, but is likely part of a larger movement by the department to finally adopt a commercial electronic health record system.

Senior VA IT officials assured members of the House Committee on Veterans Affairs Tuesday that the department has restarted its commercial scheduling system pilot project in Boise, Idaho, and will likely follow the Defense Department’s lead by adopting a fully commercial EHR system.

“We’re moving forward with the commercial scheduling capability,” said Acting Chief Information Officer Rob C. Thomas, referring to the Medical Appointment Scheduling System (MASS) contract awarded in 2015 to Epic Systems and Systems Made Simple, a subsidiary of Lockheed Martin. The VA halted the contract last year to evaluate a less expensive home-grown alternative—a move that immediately attracted the ire of members of Congress.

Jennifer S. Lee, deputy under secretary for health for policy and services at the Veterans Health Administration, confirmed the department’s decision to move forward with MASS and said the results of the pilot effort should be available in about 18 months. In the meantime, VA must continue developing an interim system, known as the VistA Scheduling Enhancement project. A “go/no-go” decision on rolling out the VSE nationwide is set for Feb. 10.

A VA official, who spoke to MeriTalk after the hearing on condition of anonymity, said VA’s internal development efforts on VistA enhancements has been “largely successful,” but there remain questions about whether it provides the functionality needed by clinicians nationwide. “There is a buy-first strategy in place, so there’s certainly a preference for going commercial,” the official said.

But VA officials also alluded to making a decision on abandoning the entire VistA electronic health record system in favor of a commercial EHR. A major business case analysis, which started under former VA CIO LaVerne Council, was completed in December, according to Thomas. And while VA officials are waiting for Congress to confirm the nomination of David Shulkin to be the next VA secretary before announcing their decision, Thomas’ comments indicate a decision has likely already been made.

“I’m confident that we’re going to go commercial,” Thomas said. “When VistA started out it was decentralized across the nation. We’re definitely going to go commercial. We are going in a different direction than in the past.”

Although Thomas could not provide a detailed timeline on when a final decision would be announced and how long it would take the department to begin replacing its legacy EHR, he assured members of Congress that the Pentagon’s current experience transitioning to a commercial EHR would likely provide a good model.

The Defense Department awarded a $9 billion EHR contract in 2015 to Leidos and Cerner, which is expected to run through 2022. Although initial deployment was set to begin in December 2016, the contract was delayed and is scheduled to begin this month.

Last April, Shulkin—who at the time was the under secretary for health at VHA—defended the decision he and Council made to pause the MASS contract in favor of an in-house upgrade.

“We want to be certain that continuous modernization of a 40-year-old electronic medical record is an appropriate decision,” Shulkin said.

“The entire VSE rollout will cost taxpayers $6.4 million. If we roll out MASS, which is an absolute option for us, the pilot alone will be $152 million,” Shulkin said, explaining to lawmakers how VA was struggling to balance the needs of veterans with the agency’s duty to be good stewards of taxpayer dollars.

“It will take us 10 months to roll it out in three sites, and that’s if VA stays on schedule with its pilots,” he said. “We have not ruled out MASS. I want to be absolutely clear about that.”

 

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