There is one thing all parties agree with when it comes to the Department of Veterans Affairs Electronic Health Record (EHR) program — modernization is needed and must happen. This is a critical aspect of digital transformation the entire agency is progressing through on its way to becoming a high reliability organization.
The public focus of EHR modernization has been on configuring a commercial off-the-shelf (COTS) solution that blends all the requirements that are unique to the VA, with a system that is widely used in the commercial sector, and at the same time is able to transmit data with the newly deployed EHR used by the Department of Defense.
After more than 5 years, $10 billion spent, and only five smaller VA hospitals using the new system, there have been significant challenges. Congressional hearings, Government Accountability Office and VA Inspector General reports have highlighted patient safety issues, an expected $50 billion lifecycle cost, poor user adoption and clinician dissatisfaction with the new COTS system.
With the expiration of the first five-year contract for the new EHR system, the VA suspended its deployment to any further medical centers for the remainder of this fiscal year to conduct an exhaustive review before the next implementation scheduled in March 2024. It also converted its new agreement with the vendor to five one-year contracts to allow for an annual review of the system’s reliability and readiness for further deployment.
Lost in all the reporting on this project is the fact that the VA needs to continue to invest in, maintain and upgrade its current EHR – the Veterans Health Information System Technology Architecture (VistA), which will remain a vital backbone to VA operations. VistA supports many other functions across the VA other than the EHR and will continue to be the only system used in VA medical centers across the country waiting for the new COTS EHR. The last of the VA’s 171 hospitals that would receive the new EHR through 2036 would still rely upon VistA to support veteran care.
This includes some of the system’s busiest facilities, based in Florida and the growing Southeast. VistA must be upgraded to meet technology standards and operations that will change over the next 10-15 years if the VA is to maintain its focus on patient safety, system reliability and user satisfaction.
The VA has a long and proud history of leadership when it comes to EHR technology. More than 30 years ago, it invested in a system that was designed by VA medical professionals for the unique needs of the world’s largest integrated medical system and based on an open architecture platform that was and remains accessible to all commercial vendors, large and small.
Just ask the nation’s medical experts, who use electronic medical records daily, what they think. In a 2014 Medscape survey of more than 18,000 physicians, the VA’s homegrown Computerized Provider Record System (CPRS), the EHR component of VistA, rated first among all the nation’s EHRs, scoring first in seven categories, including ease of data entry, physician satisfaction, staff satisfaction, connectivity and reliability. Two years later, Medscape surveyed 16,000 physicians with the same result – the VA CPRS ranked first in the nation again.
Investing in both the new EHR and VistA is a wise policy to ensure veteran safety and continuity of care. It would be considered a best practice for any IT enterprise transitioning to a new ecosystem. Any organization, especially one as large and complex as the VA health care enterprise, needs to maintain the existing ecosystem until the transition to a new EHR is complete and fully tested.
The VA has asked its vendors to provide a menu of options they would recommend to upgrade VistA to meet the VA’s near and long-term needs. These system updates will cost a fraction of the overall deployment of the new EHR and will be needed over the next decade or more to maintain the VA’s standard of operating as a High Reliability Organization.
Two of the major recommendations of industry to the VA are:
Ensure that the VA’s pharmacy system has an easier-to-use, more functional interface and VistA-integrated e-prescribing solution for community pharmacy orders. Investing in modernizing VistA can yield a better graphical user interface for VistA Pharmacy that does not disrupt ongoing daily operations or patient safety.
Improve the VA’s ability to import outside episodes of care in the community into the veterans’ medical records. This allows clinicians to manage the continuity of care better, regardless of where that care is provided.
The VA can help in this effort by providing Congress with a clearer picture of the funds it has budgeted for sustainment and upgrading of VistA, including the real-time movement of patient records to the cloud.
The VA has provided Congress with a revised estimate of the funding it will need in fiscal 2025 to support the continued deployment of the new EHR. This new estimate is $500 million less than the President requested earlier this year. Some of these savings should be invested in the needed VistA upgrades.
Continued investment in VistA minimizes cost, risk, time and operational disruption while preserving and extending the VA’s own innovative open-source VistA platform. This is as true today as it was six years ago when the decision was made to adopt the COTS EHR solution.
Veterans, and the clinicians dedicated to serving them, deserve access to the best healthcare technology possible. The VA should be proud of its work more than 30 years ago to create the nation’s first electronic medical record, deploying it throughout the VA, and using it to foster innovative solutions from companies large and small.
The VA can continue to depend upon the health IT vendor community to ensure its mission success and fulfill its responsibility to deliver the highest quality care to our nation’s heroes.
David Whitmer, FACHE, is vice president for federal operations at DSS Inc., and is a board-certified healthcare executive with 30 years of public health experience at the National Institutes of Health and the Veterans Health Administration, including 20 years in C-suite positions, and 10 years as member of the Senior Executive Service.