VA secretary announces decision on next-generation electronic health record



Today U.S. Secretary of Veterans Affairs Dr. David J. Shulkin announced his decision on the next-generation electronic health record (EHR) system for the VA at a news briefing at VA headquarters in Washington.

Secretary Shulkin’s full prepared statement is below:

I am here today to announce my decision on the future of the VA’s Electronic Health Record system, otherwise known as EHR.

I wanted to say at the outset that from the day he selected me for this position, the president made clear that we’re going to do things differently for our Veterans, to include in the area of EHR.

I had said previously that I would be making a decision on our EHR by July 1st, and I am honoring that commitment today.

The health and safety of our Veterans is one of our highest national priorities.

Having a Veteran’s complete and accurate health record in a single common EHR system is critical to that care, and to improving patient safety.

Let me say at the outset that I am extremely proud of VA’s longstanding history in IT innovation and in leading the country in advancing the use of EHRs.

  • It was a group of courageous VA clinicians that began this groundbreaking work in the basements of VA’s in the 1970s that led to the system that we have today, known as the Veterans Health Information Systems and Technology Architecture, or VistA.
  • It has been this system that led to the incredible achievements made by VA clinicians and researchers and resulted in VA’s ability to perform as well or better than the private sector in patient safety and quality of care.

That said, our current VistA system is in need of major modernization to keep pace with the improvements in health information technology and cybersecurity, and software development is not a core competency of VA.

I said recently to Congress that I was committed to getting VA out of the software business, that I didn’t see remaining in that business as benefitting Veterans.  And, because of that, we’re making a decision to move towards a commercial off-the-shelf product.

I have not come to this decision on EHR lightly.

I have reviewed numerous studies, reports and commissions, on this topic, including the recent commission on care report.

  • I’ve spent time talking with clinicians, and I use our legacy VistA system myself as a current practicing VA physician.
  • We have consulted with Chief Information Officers from around the country, and I’ve met personally with CEO’s from leading health systems to get their own thoughts on the best next-generation EHR for VA.
  • We’ve studied reports from management consulting companies and from the GAO and the IG on VA’s IT systems.
  • I can count no fewer than 7 Blue Ribbon Commissions, and a large number of congressional hearings that have called for VA to modernize its approach to IT.

At VA, we know where almost all of our Veteran patients are going to come from — from the DoD, and for this reason, Congress has been urging the VA and DoD for at least 17 years — from all the way back in 2000 — to work more closely on EHR issues.

To date, VA and DoD have not adopted the same EHR system. Instead, VA and DoD have worked together for many years to advance EHR interoperability between their many separate applications — at the cost of several hundred millions of dollars — in an attempt to create a consistent and accurate view of individual medical record information.

While we have established interoperability between VA and DOD for key aspects of the health record, seamless care is fundamentally constrained by ever-changing information sharing standards, separate chains of command, complex governance, separate implementation schedules that must be coordinated to accommodate those changes from separate program offices that have separate funding appropriations, and a host of related complexities requiring constant lifecycle maintenance.

And the bottom line is we still don’t have the ability to trade information seamlessly for our Veteran patients and seamlessly execute a shared plan of care with smooth handoffs.

Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the Departments remain on two different systems.

For these reasons, I have decided that VA will adopt the same EHR system as DoD, now known as MHS GENESIS, which at its core consists of Cerner Millennium.

VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems.

It’s time to move forward, and as Secretary I was not willing to put this decision off any longer.  When DoD went through this acquisition process in 2014 it took far too long.  The entire EHR acquisition process, starting from requirements generation until contract award, took approximately 26 months.

We simply can’t afford to wait that long when it comes to the health of our Veterans.

Because of the urgency and the critical nature of this decision, I have decided that there is a public interest exception to the requirement for full and open competition in this technology acquisition.

Accordingly, under my authority as Secretary of Veterans Affairs, I have signed what is known as a “Determination and Findings,” or D&F, that is a special form of written approval by an authorized official that is required by statute or regulation as a prerequisite to taking certain contract actions.

The D&F notes that there is a public interest exception to the requirement for full and open competition, and determines that the VA may issue a solicitation directly to Cerner Corporation for the acquisition of the EHR system currently being deployed by DoD, for deployment and transition across the VA enterprise in a manner that meets VA needs, and which will enable seamless health care to Veterans and qualified beneficiaries.

Additionally we have looked at the need for VA to adopt significant cybersecurity enhancements, and we intend to leverage the architecture, tools and processes that have already been put in place to protect DoD data, to include both physical and virtual separation from commercial clients.

This D&F action is only done in particular circumstances when the public interest demands it, and that’s clearly the case here.  Once again, for the reasons of the health and protection of our Veterans, I have decided that we can’t wait years, as DoD did in its EHR acquisition process, to get our next generation EHR in place.

Let me say what lies ahead, as this is just the beginning of the process.

  • VA has unique needs and many of those are different from the DoD.
  • For this reason, VA will not simply be adopting the identical EHR that DoD uses, but we intend to be on a similar Cerner platform.
  • VA clinicians will be very involved in how this process moves forward and in the implementation of the system.
  • In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work.  And our work will help DoD in turn.
  • Furthermore VA must obtain interoperability with DoD but also with our academic affiliates and community partners, many of whom are on different IT platforms.
  • Therefore we are embarking on creating something that has not been done before — that is an integrated product that, while utilizing the DoD platform, will require a meaningful integration with other vendors to create a system that serves Veterans in the best possible way.
  • This is going to take the cooperation and involvement of many companies and thought leaders, and can serve as a model for the federal government and all of health care.

Once again, I want to thank the president for his incredible commitment to helping our Veterans and his support for our team here at the VA as we undertake this important work.

This is an exciting new phase for VA, DOD, and for the country.  Our mission is too important not to get this right and we will.

Author

Media Relations

The Office of Media Relations serves as the interface with news media representatives from newspapers and electronic media for the Department. OMR arranges interviews, provides press releases and answers media queries.

Comments

  1. Mark Stephen Toney    

    So which companies will make multi millions doing redundant, worthless, computer hacking into our personal information ? Again, millions spent on the Private sector while Veterans are homless, unemployed, and recieve substandard care.
    I almost died at the Atlanta VA having to wait 9 hours with a hernia that had cut my blood supply. The pain was so horrible only laying in the floor brought any relief. I was made to get in a chair or be thrown out of the hospital. How does millions spent on redundant computer files address this and the real problems of the VA.
    I voted for Trump but he has backstabbed Veterans …

    1. Kristin Morgan    

      You may have been seen by one of their “non-doctors”: a physician assistant, or a Nurse Practitioner. They use a software logic program to diagnose you- that’s why after they’ve given you a cursory exam, they always leave the room with their clipboards “I’ll be back in a moment” they go to a desk, and click Yes or No to a series of questions. That is the extent of their work.
      In Arizona, our Governor Flake had a “great idea to replace “costly anesthesiologists” (you know, the very individuals that keep you alive on the operating table? the very skilled MDs who recognize your oxygen levels and heartbeat?) with, get this, NURSES. Yes. Let’s replace doctors with nurse “anesthetists”! That’ll put an end to the long waiting times for our veterans, won’t it? Let’s give them sub-standard care under the ostensible reasons of “quick care”.

      And, if you think for one second your electronic health records are only to make things easier, oh I envy your youthful ignorance. I beg every reader to just do some basic research on the Human Genome Project and electronic health records. A brilliant woman by the name of Vicky Davis has extensively researched this very topic- which see- look up Senator John Glenn was the Chairman of the Governmental Affairs Committee and his request for the GAO for a study on “the potential benefits and the factors that would impede their use” with the EHR. I do hope more posts are noted on this article regarding. Thank you.

      1. Paige Kosderka -ServConnDAV    

        No backstabbing by our CIC. VA will always suck. It always has. We get lucky some days and receive outstanding care which makes us think it may happen again. I am also disappointed in this system as well as most local, county, state and federal systems. They have too many chiefs and not enough Indians, to much human and too may conditions. Empathy would be the only program is impliment if given such a blessed opportunity to run the programs.

    2. Peter Dunn    

      Are you kidding me your going to try and reinvent the wheel when Epic program has done dumb.

      1. David H Deckert    

        I was a patient at the Phoenix VA from 93 to 09, never had a problem getting treated. Am now at the Madison WI VA and other than the 140 mile round trip, I love it. I have found that most of the Vet’s knocking VA treatment, are Vets that don’t have a primary care doctor which they would only have to see once a year in order to maintain enrollment with that primary care doctor. Having that primary care doctor gives you a point of contact for other specialized services which that primary care doc would put in a consult for, which prompts the specialty clinic to contact you to set an appointment. Just like the military, there is a system to get things done, understand and follow the system and you should not have problems. If you just show up and want treatment, the first question that you will usually get asked in the ER, is do you have/who is your primary care doc. I have always had caring friendly nurses, clinic clerks and doctors at both VA’s.

    3. Ed Dierkes    

      For those of us that are fighting for herbicide exposure benefits, the DOD seems to always have the answer to deny those benefits. This is my question……Camp Lejune water contamination, chemical exposure was granted benefits by the DOD. Is there a reason that Wright Patterson AFB isn’t being afforded the same? WPAFB is on the EPA High Priority list, it would be nice to get an answer. The system is broken!

    4. Richard L. Nolan    

      How does one get a note to the Secretary of the VA by email?? I am writing on behalf of a fellow veteran who was arrested and charged with a crime while trying to get some medical treatment recently at VA Hospital in Texas. This is not the way that veterans who are only trying to get the care that they deserve should be treated. Any assistance would be appreciated.

      1. Gary Hicks    

        Send it to newmedia@va.gov and we’ll forward it to his staff

  2. Danette Onofrio    

    The Cerner bid was awarded IN 2015 for DoD under President Obama with a seamless transition announced by the Pentagon. The system allowed for ongoing interoperability with the VA. It was designed to provide seamless accessibility by the DoD and VA. The award was announced in July 2015 to Leidos Partnership for Defense Health, which included Cerner, Accenture Federal and Leidos, a government contractor based in Reston, VA. It was awarded for 10 years, with a potential to expend to 18 years ($9 billion). The Pentagon had the vision for the new system and worked on it for two year. Frank Kendall, undersecretary of defense for acquisition, technology and logistics should be thanked and POTUS and Shulkin should give credit where credit is due.

    1. Sharon Gamble    

      This is not true! While i ache fir your suffering.i do think president Teump & his administration are taking very very seriously the needs of alk vets. ! they are doing as much as,is possible. They most certainly are doing more than the past president.Oboma did nothing period.

  3. Mark Best    

    Readjustment Counseling Service (aka Vet Centers) have a wholly separate system known as RCSnet to maintain health records of their patients.

    This prevents the VA from assisting with health care because VA cannot see the records. Prevents VA Benefits from using records because they are NOT part of the patients normal VA records.

    It is time to bring all VA health and mental health records under on management system. This is as good as a time as any.

  4. Cindy    

    How about holding the doctors responsible for incompetence, rudeness, dereliction of duty? I would LOVE to see that !!!!

  5. Roger Rutherford    

    Please make sure Vendor Choice providers also have the ability to pull records from and push records to this new system electronically…right now the left hand doesn’t know what the right hand is doing and vice-versa regarding Catscans, MRIs, procedures, etc. done at Vendor Choice providers and Dr. notes and vitals recorded, appointments, etc. All have to be hand delivered to be incorporated into one another’s record systems.

  6. Vicky Davis    

    The purpose of the EHR is for medical research – specifically genetic manipulation behind the warm and fuzzy term “personalized medicine”. With the EHR, they will be able to select their research populations in a distributed way so that the “mistakes” won’t be connected in a geographical way. To verify that what I’m saying is true, just go back to 1990 when Senator John Glenn was the Chairman of the Governmental Affairs Committee when he asked the GAO to do a study on the potential benefits and the factors that would impede their use. From that point, follow the history forward and you’ll see an evidence trail that is mile wide.

  7. Christopher Mateo    

    This is precisely why I didn’t vote Republican. If you’re a Veteran and rich, then yes by all means vote Republican otherwise you’re screwed.

  8. Thomas A. Colaizzi    

    I have been getting outstanding care for CAD, DM2, and an amputation of the hallux(big toe), my diabetes is finally getting under control, and the Medical staff have call been efficient and Professional.
    The Telehealth program is exceptional in it’s help, and I love having access to my medical records, and prescription ordering, with the HealthEVet account.
    Hopefully, with this new system that will all still be available?

  9. Gary Johnson    

    How about stopping the draconian laws that allow the V.A. to “recoup” monies paid out for 1151 claims? You’re turning the people whom you’ve disable into debtors. And how about stopping the ex post facto laws of attainder that you are now enforcing on Veterans to steal their monthly benefits.

  10. Eric    

    Care needs to be a priority for all veterans. We need to use civilian providers and the uploading of documents. It should be addressed with the back log of claims and the time it takes to receive a decision . When the VA makes a mistake the VA should correct this and not push your file to the left only to start this process all over again. More processing staff is need to reduce the overwhelming back log of claims
    Waiting months and year is just unacceptable.

    1. Sally Reed    

      How about mentioning about taking away disability payments who are getting SS to veterans that fought for this country who still suffer from these wars! Putting them into poverty! Nice of congress who some never seen boots on the ground!!

    2. Jerome Rodgers    

      Why not put all of us on Medicare and elimate VA medical care? That way we could go to the civilian doctors of our choice!

  11. CHRISTINA MARIE MESSINA    

    Skulkin is just a Trump puppet.A showman that will take photo ops over keeping Senior aged Vets benefits, just to expand a Choice program that is a mess to begin with. He does not care!

  12. Randall S Brandt    

    Thank you for this huge step in making the transition from active duty to veteran status much, much smoother! I’m a disabled vet and have been a VA patient for nearly 20 years, so I appreciate having an accurate and up-to-date medical record. This has been of special importance whenever I’ve used our co-venture DOD/VA hospital and the treatment notes weren’t always forwarded or were very slowly sent (This was especially the case when I received emergency room care.) to my VA care provider for their edification and inclusion in my record. Having a single medical record keeping system should, hopefully, lend itself to also improving the frame of mind on the part of the active duty medical staff toward the veterans using the joint venture treatment option. At least, when they use a familiar system in which to enter their treatment notes, providing care won’t be seen as burdensome as it has apparently been up to now.

  13. Millard Waugh    

    Well I hope they get paid….Im still waiting on them to decide on my claim on Camp Lejeune,just received a letter from the V.A. that my claim is in Utah and still 377 days til I hear something.thats what the V.A. calls fast tracking I suppose,as usual the same ol bull,make it look good for the press,but in actuality,were not going to really do anything.just give everyone the run around.

  14. Alan Gottesman    

    Interesting that there’s no mention of adapting the new system so that it is easier to use by veterans; there are many fairly obvious inadequacies in the MyHealtheVet system — which is linked into the EHR system — that should be fixed as part of this “upgrade.”

  15. Robert Winford Taylor    

    My name is Robert W Taylor. I served in the Navy
    From 1956 until 1960.
    My duty was a boiler tender the whole time.
    Due to the noise,heat and asbestos I’m now suffering from tenidus, hearing loss and lung problems.
    I was onced on VA but a couple years ago they shut me off saying I made too much money.
    My wife and I live on social security benifits. In today’s standards we live below the poverty level. But but they say because there was no war going on I don’t deserve bennifits.
    What say you?

  16. Richard G McHenry    

    How about the new VA Budget…? In which it is proposed to take away the Unemployability benefit from all veterans over the age of 62 who are now receiving it? Obviously, the VA does not REALLY care about older veterans!! Trump says he cares about veterans…what a laugh. This change will dramatically impact the lives of over 200,000 Vietnam Era vets…again those Vietnam Vets get screwed by our government.

  17. nene    

    This has been in the works for the DOD for a long time coming. The VA jumping on board will improve continuity of care as veterans transition from active duty. This will give the VA access to records from active duty time and should help speed up the claim process because now the veteran isn’t hunting down records. It’s a good thing.

  18. Stephen D. Hargrove    

    I have serious concerns as a disabled Veteran about the benefits surrounding a Veteran’s Spouse. Currently if a spouse suffers the loss of their Veteran and the disability income was a contributory to virtually all if even only half the household income unless the Veteran was rated as 100%, the income stops. This places the surviving spouse at a significant disadvantage in their continued life. These folks have “served” as well as the Veteran in different ways and should be protected also. They didn’t wound the Veteran but they were there to care for them in their time of need. I don’t see the VA suffering lamenting the loss. I don’t see the VA picking up the destroyed family as a result of the loss. There are programs for these survivors only if the death was service connected or if the vet was 100% for 10 years. Tell me if Veterans were, upon enlisting, to find out that their family would not be taken care of in their loss what would be the incentive to serve? Why would any patriot accept this an acceptable outcome for their families? Where is the VA after their hospital stay or treatment? Are they the ones that wipe the pain tears away? Are they the ones that change the bed sheets or clean up the mess on the floors after treatment? Are We going to ignore this as has been done for decades? We as a country provide a great many benefits in support of a great number of other people’s problems, let’s take care of our own!

  19. Emory Charles Wheeler    

    The VA system is BROKEN and the ONLY fix is PRIVATIZE. Eliminate thousands of federal double dipping jobs; provide the healthcare afforded Veterans. If CONGRESS can have Special Healthcare, we deserve better THAN THEM. Of the 435 + congressional legislators, less than 10% or a number lower; have never served in COMBAT. With more than 1/3 of the Total US population having served in the military approximately 240 million, 70,000+ are Alaskan Veterans. Approximately 17,000 reside in RURAL “bush” cities and villages , The lack of dependable internet service , lack of health services, and expensive air travel to obtain medical services. Many visits to ALASKA by officials of the VA , action to better have FAILED. Therefore, there is JUSTIFICATION to PRIVATIZE the ENTIRE VA . That is the…..FIX.

  20. Earnest Warren Eakins    

    VA has provided me with good care after I retired in June, 2014. However, the Army and VA are disjointed. The Army forced me into medical retirement for my right shoulder and ancle. The VA accepted my ancle but not he shoulder, the Army rated it at 20%. How can VA rate me, 0%?
    As for the choice program, I am not impressed. Unless they get the contractors off their ass it is a disaster. I am waiting for an appointment from them 2 weeks.

  21. Dale bouthiller    

    I was sexually asullted during my ships hazing program I was 16 . That ended my desire to be in the service I was 16 . It has taken me 40 years to finally swallow my pride and say something .this was over a year and a half ago . They sent me to a outside shrink who spent 10 min s with me and next thing you now I was denied . My phsyc at the va was shocked . I have appealed but nothing else has been done I call and all I get is they are so backloged that they can’t even give me any type of date. This incident ruined my life I had every intention on spending 20 years of my to serve my country not one. So because of red tape and a system that is in need of a major overhaul my kids will be the ones collecting my disability pay.

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