VA may abandon VistA as its long-term electronic health record solution

The Veterans Affairs Department said Wednesday that it is now reassessing whether its existing VistA system still has a place in the long-term future of VA electronic health records, and has paused certain elements of VistA’s ongoing modernization. Members of Congress were not happy, seeing the move as one more setback on the arduous path to integrate military and veteran health data.

As recently as 2014, VA was so confident in VistA’s long-term viability that it was publicly lobbying the Defense Department to adopt it as the military health system’s own EHR. But times have changed. Almost all of VA’s senior leadership positions have switched hands since Robert McDonald became VA secretary, and a business case analysis ordered last year by LaVerne Council, the new assistant secretary for information and technology, and Dr. David Shulkin, the new undersecretary for health, called VistA’s future into question.

“We want to take a step back and look at what we really need an EHR and a health care system to do,” Council told the House Appropriations Committee. “There are multiple needs that are different than in 2014 around the area of women’s health, the Internet of things and how we manage private sector care.”

Those factors, Council said, led VA to request $40 million less for VistA modernization in its 2017 budget compared to what the department had planned to spend one year ago. The funding plan will focus more resources on making VA’s existing systems interoperable with DoD than investing in VistA’s long-term future. She said the department will request more funding for electronic health records once it’s finished devising a new long-term strategy.

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Several lawmakers expressed displeasure at yet another shakeup in the long saga involving DoD and VA’s plans to modernize their EHRs. In 2013, the two departments abandoned their joint strategy to build a single, integrated record. DoD later decided to purchase a commercial-off-the-shelf system, eventually awarding a $4.3 billion contract to a vendor team led by Leidos last year.

“We’ve been at this for 10 years and we’ve given you billions of dollars,” said a visibly agitated Rep. Hal Rogers (R-Ky.), the chairman of the House Appropriations Committee. “I’m hearing muckety-muck here. I don’t know what you’re saying. Apparently, you’ve not made your mind up yet about whether you’re going to replace VistA with something off the shelf. Is that right or wrong? Yes or no?”

VA has not made up its mind, Council said, and blamed the current indecision on what she said was the lack of an adequate long-term plan for health records prior to her appointment as assistant secretary and chief information officer.

“The fact is we need to ensure we have laid out the plan and strategy so that everyone can understand exactly what we’re doing and why we’re doing it,” she said. “There was no plan laid out before Dr. Shulkin and I came into these roles. If we’re going to say that we’re good stewards of millions of taxpayer dollars, we need to have a plan in place and that’s what we’re going to do. It’s not going to stop anything that’s currently being done, none of that’s being done in a wasteful manner, but we’re going to lay things out in a manner that allows Congress to see exactly what OIT is spending their dollars on.”

Both DoD and VA have argued strenuously that health record interoperability between the two departments is a separate topic from the individual technologies each department is using in their respective hospitals and clinics. Indeed, DoD declared last year that it’s now in full compliance with congressional mandates to become interoperable with VA, and VA expects to make a similar certification by August 2016.

That’s due in part to projects like the Joint Legacy Viewer, which allows clinicians in both departments to view most patient records for any individual patient encounter, whether that patient was seen in a DoD facility or VA clinic.

“The interoperability is about the data,” Council said. “We’ll continue to build on JLV and our enterprise health management platform, which is what we’re using to pull data from the DoD record and align their data with ours as an integrated grouping so that our data is fully interoperable. By the end of this month, we’ll have well over 35,000 users and well ahead of our goal. But anytime anybody needs a record at this point, they can get it and understand how that veteran was treated outside of the VA system.”

Council said it’s possible that VA’s ultimate decision on its way forward for electronic health records could still include VistA. She also sought to reassure lawmakers that the billions of dollars they’ve already approved to improve the existing VistA system has not gone to waste.

“Those funds included some critical investments in systems and infrastructure, supporting not only interoperability but networking, infrastructure sustainment, security and ensuring that we had standardization of our clinical terminology,” she said.

Separately, VA may also revise its plans for a new patient scheduling system. The current Medical Appointment Scheduling System (MASS), first deployed in 1985, is entirely text-based, doesn’t let scheduling staff look for appointments at more than one facility at a time and was one factor in the waiting time scandal that ultimately led to the resignation of the previous VA secretary, Eric Shinseki.

The department has been working on a $690 million replacement for MASS, but as a quick fix to its most immediate problems, it’s been deploying a more user-friendly graphical user interface that layers on top of the current system.

That interface, called VistA Scheduling Enhancement (VSE), is scheduled for deployment to all of VA’s medical centers by April, and Shulkin said it’s possible that it will lead to the cancellation of the MASS procurement. Initial plans to pilot the updated version of MASS at the first test site in Boise, Idaho have been put on hold.

“Our schedulers are in such desperate need of trying to meet veterans’ needs that we want to get them tools right now,” he said. “We don’t want to hold that up. If it turns out that VSE meets the majority of needs of our schedulers, probably the right decision is to not spend another $663 million on MASS. The pilot we’re doing right now is going to be very, very important for us to understand that.”

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