VA’s Long-awaited electronic health record solution hits major milestone


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For years, VA employees, Veterans and community care providers have looked forward to a seamless electronic health record (EHR) solution to improve patient care and support.

Recently, that dream came closer to becoming reality with the successful transfer of 23.5 million Veterans’ health records to a shared data center with the U.S. Department of Defense (DoD). This massive accomplishment sets the stage for the “go-live” of VA’s EHR solution next year.

Go-live refers to the point when the current health record system, called Veterans Information Systems and Technology Architecture (VistA), is “turned off” within a facility, and VA’s new EHR system will be “turned on.” During go-live, all designated systems and services will transition to the new VA EHR platform.

VA Secretary Robert Wilkie shared VA’s community sentiments: “For decades, VA and DoD have been struggling to achieve interoperability and seamlessly share patient records between our health systems — placing an unfair burden on our Veterans and their families. No Veteran, family member or caregiver should have to carry boxes of paper, medical and service records around. This data migration is the first step to solving that problem for good.”

This initial data migration phase, which began in late spring, foreshadows even more exciting improvements to come. When the new EHR completes implementation, it will replace the 130 plus instances of the current VistA system in a streamlined solution that also powers DoD’s Military Health System (MHS GENESIS).

To put the magnitude of this OEHRM milestone into perspective, here are some fun data facts:

  • Collectively, over 78 billion records have been compiled from all VA medical centers to include in this transfer.
  • These records total 50 terabytes (equivalent to about 850,000 hours of music) of data storage.
  • This data spans 21 clinical domains of patient health records, which includes lab results; pharmacy prescriptions; inpatient and outpatient diagnoses and procedures; and other Veteran medical data.

This milestone moves VA one step closer toward achieving an interoperable EHR system that will provide Veterans, service members and their families with a single health record and a lifetime of seamless care. The efficiency and improvements found in the EHR will also make for a more welcoming, customer-centric environment with streamlined messaging and scheduling capabilities, improved interoperability and enhanced self-service options for VA staff, Veterans and caregivers.

For more information about VA’s Electronic Health Record Modernization, visit https://www.ehrm.va.gov/.


Jack Bates is the acting director, Data Migration and Management, Office of Electronic Health Record Modernization

Author

VAntagePoint Contributor

— VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you’d like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

  1. Julie DeMary    

    I hope this fixes some really simple problems so the VA facilities can become entwined. For instance when I was sick in the Pittsburgh VA hospital a social worker came to me and presented me an option to fill out a living will. There were a lot of pages and it took me a considerable amount of time, informations gathering and thought to fill it out. She picked up the next day and told me she was going to scan it into the system. I transfer to a clinic in Fl and they ask me if I have an advanced directive/living will. I told them yes I had filled one out several years and it should be in the system. The doctor said he couldn’t find one and so I was given a new packet to fill one out. So now what if they come up with two. Where in the heck did the one I filled out previously go.
    Another thing that is unbelievable is when I traveled and needed something my primary care doctor couldn’t put in orders for another VA facility to do it. That makes no sense at all.

  2. Bruno Gartman    

    After a time, they want to change what I had to say.

    1. Daniel Elliott Hebb    

      another great steep to word 2030 year. Target date for the VA to go BY BY. 2030 is the target date for the VA to go privet.
      So much for progress

  3. David W. Stephens    

    Then there is the issue of the St. Louis fire which destroyed records. They can recover some of that, but accuracy is not known to be a virtue.

    The biggest change the VA can make is integrating Medical / Dental, Psychological, and Service connected Disability. Currently, Service Connected DOES NOT communicate with VA doctors. They have their own doctors who know nothing about you, which is flawed and a duplication of effort., adding another layer to the beast known as VA. IF this helps streamline the VA, we can greatly reduce the cost and bring better overall healthcare to the veteran. I look forward to their rollout.

  4. Diane Lyn Holowinski    

    I served in the Air Force from 1974-1990 after being medially discharged I have been trying to get my complete Medical Records from when I entered through the time I was discharged. There a lot of individuals like myself who would like to have everything and hopefully this new system will be the answer to all veterans like me who want there records.

  5. Paul Evans    

    I don’t imagine this will include your records from the military, just the health records you have from being treated at a VA medical facility after the military.

    1. John Petrichella    

      From the first paragraph “system that will allow VA and DOD to share patient data seamlessly” that means military health records too.

  6. J. Stasiak, MD    

    As a former military physician who has worked with VistA, AHLTA, and CERNER, I have the following remarks:
    1. VistA, the current VA EHR, is a good system: It is not fancy, it is somewhat old, but it is very reliable, useable and works worldwide. It was designed as a comprehensive medical record and patient management system for clinical use. In that regard it has served its purpose well. I know of no one who hates it. The VA offered VistA to the DoD for free in the early 2000s. The DoD declined the VA offer. That was a big mistake. At the behest of the DoD, VistA is being replaced with CERNER.
    2. AHLTA (aka CHCS-2 and pGUI), the EHR used by the DoD since the early 2000s. It was designed principally to gather population health metrics and enforce compliance with regulations, NOT as a medical record system. It has always been difficult to use and crashes often. Unlike VistA which includes inpatient and outpatient records, AHLTA covers outpatient medical records only. The immunization tracking system in AHLTA is so clumsy that the DoD uses a separate system (MRRS) for that purpose. The dental corps tried it and abandoned it. An old DoD text based (CHCS-1) EHR system never went away because AHLTA was never good enough to replace it. The interoperability between VistA and AHLTA was never adequate. It would have been much better if the DoD used VistA at the outset. Anyway, the DoD finally gave up on AHLTA and is adopting CERNER instead.
    3. CERNER is an EHR that has been used in the civilian sector for about 13 years and is being adopted by the VA and DoD. I have used it extensively in civilian practice. Like AHLTA, it was designed primarily to collect metrics and enforce compliance with regulation rather than as a clinical communication tool. It is non-intuitive and frustrating to use, especially when searching through old records. Entering orders is difficult; It is easy to make mistakes and hard to correct them. It is so difficult and excessively time consuming to use, that medical assistants called “scribes” are often hired to accompany providers during patient encounters to enter data into CERNER for them. A system that requires more, not fewer, people to operate makes no economic sense. Some patents dislike the presence of a scribe.
    3. In general, different EHR systems from different vendors do not talk to one another. Practically all civilian electronic records that are transmitted outside of the generating facility are via hard copy and FAX, not electronically. That is the sad truth: The “Tower of Babel” is a reality. For that reason, I am pessimistic that CERNER will be able to functionally access old VistA and AHLTA records. The talk is that VistA and AHLTA will be kept as legacy systems to access old records. That would be a nightmare for healthcare providers.
    4. While CERNER has been around for 13 years, it has been phased into DoD and VA facilities in the Seattle area for almost two years. It has made everyone—doctors, nurses, patients, staff—frustrated, unhappy, and much less efficient. “Useability ratings” remain very poor if not outright unsatisfactory. After 13 years, you would think that the kinks would be worked out, but that is not the case. Most of us would be much happier and more productive if the VA stuck with VistA. VistA isn’t fantastic, but it is a whole lot better than CERNER or AHLTA.

  7. James Tobleck    

    Its been weeks since i sent letters to IG, Wilkie, local Michigan VA Director, not one has responded. Seems they dont care, won’t fix past VA mistakes or give a damn. No wonder 22 vets give up fighting the beauracrates that are never held accountable. If 22 VA BEAURACRATES died today perhaps Wilkie himself would get off his ass. The INSPECTOR GENERALS malfeasance is legendary. I question just how far back the records will be computerized. 43 years will prove my case of malpractice, corruption that ive continued to shoulder by myself against the Incompetence of the VA.

  8. Michael Mellen    

    Glad to hear that the VA is arming itself with the best technology available for record keeping. Will make the doctors more knowledgeable and our lives better in treating us.

  9. Roger Varvel    

    Good evening,
    Will outside medical hospitals & Dr. now have access to our records? It would be a giagantic step in the right direction for our health care. I always wanted my civilian Dr. to have access to the VA’s records. It would make life sooooooo much easier.

    Roger Varvel
    Lebanon, MO.

  10. Petra Wagner    

    Robert Lake, the advice to get a VA competent attorney is sadly one of I’d give you, too. Although it is criminal, unethical, and absolutely WRONG that veterans have to fight with legal help for their disability ratings! And this new, allegedly superior, streamlined electronic records system is a great idea – only, will it actually be an improvement and make life easier for veterans to receive competent care, and for physicians to provide it? Who is running the planning, fielding, and training if personnel of this new system? I’m hoping it will not be another one of VA’s “improvements” that look good, sind good, but whose execution and application is a huge fail. With critical veterans’ records lost forever, a convenient way for VA to further deny and delay claims….. And something that cost a boatload if taxpayer money but doesn’t deliver what it promised? I am by now so wary if all VA improvements because until they truly fix the many SYSTEMIC faults and inefficiencies, even this will only be another Optical action but not much more.
    Hope you’re finding assistance to help you with your records Veterans Law Group came up in my draufhauen for help, check out their reviews from veterans. Many blessings to you and all veterans!

  11. Vanessa Simmons    

    I have had several appointments at a new VA center and the caregiver has no idea what I am being treated for or what meds I’m taking! Like I have the mg of each one memorized! I finally created a spreadsheet of the meds and have it available in my cloud to show them…then they question why I’m taking it! Well if you had my records you’d know! This past year of moving and trying to get established in a new facility has been VERY FRUSTRATING.
    VA says once in you are in…then why did I have to GO TO THE FACILITY and FILL OUT PAPERWORK TO REQUEST CARE and wait 3 months to get an initial appointment for assessment! Would I have to do this if it was an emergency? “Fill out this locally produced paper that has been copied so many times it is barely readable with all the specks and lines and we’ll let you know in 3 months if we can see you.” I’m 80% rated…what’s to figure out?

  12. J. T. Stasiak, MD    

    As a former military physician who has worked with VistA, AHLTA, and CERNER, I have the following remarks:
    1. VistA is a good system: It is not fancy, it is somewhat old, but it is reliable and very useable. It was designed principally as a comprehensive medical record and patient management system for clinical use. In that regard it has served its purpose very well. The VA offered VistA to the DoD for free in the early 2000s. The DoD declined the VA offer. That was a colossal blunder.
    2. AHLTA (formerly CHCS-2 and pGUI), the EHR used by the DoD since the early 2000s is a TERRIBLE system. It was designed principally to gather population health metrics and enforce compliance with regulations, NOT as a medical record system. It has always been unreliable and difficult to use. Unlike VistA which is comprehensive, AHLTA covers outpatient medical records only. The immunization tracking system in AHLTA is so bad that the DoD uses a separate system for that purpose. The dental corps was unable to use it. The old DoD text based CHCS-1 system never went away because AHLTA was never good enough to replace it. The interoperability between VistA and AHLTA was never adequate. It would have been much better if the DoD used VistA from the start.
    3. CERNER is AWFUL; even worse than AHLTA. It likewise was designed primarily as a bureaucratic and not a clinical tool. It is unintuitive and frustrating to use, especially when looking up old records. Entering orders is a nightmare. It is easy to make mistakes and hard to correct them. Some physicians with clout refuse to use it.
    3. In general, different EHR systems from different vendors do not talk to one another. Practically all civilian electronic medical records are transferred via hard copy and FAX. Yes, that is the sad reality. For that reason, I am pessimistic that CERNER will be able to functionally access old VistA and AHLTA records. The talk is that VistA and AHLTA will be kept as legacy systems to access old records. That would be a nightmare for healthcare providers.
    4. CERNER has been in use in DoD and VA facilities in the Seattle area for almost two years. Nobody likes it. It has quintupled the wait times at pharmacies.

  13. Douglas J Steiger    

    Good to hear! We should relish any and every improvement to the “system”. This move should also allow us to seamlessly go to any VAMH facility for treatment when traveling or movement. Thanks BA! We love you and all you do!!

  14. Jane    

    Now they want to moderste what I had to say.

  15. Jane    

    7-26-2019 Jane Vogel. 1966 Ft. McClellan the WAC trng base now tocic dump. Mine were redacted bc the perp was the doctor! I got 50% in stead of 100% based on the PTSD. But the criminal Doc got swept under the table. The excuse was back then they didn’t want women in the WAC’s and didn’t think they were going to stay anyway. So they justified not kerping records on us. The report to my female superiors was push off to I didn’t report soon enough. Today you can go back 40 -50 years thus was 1-2 weeks out if total fear. I’ve never given up. It robbed most of my life on levels I didnt know were there and was a nieve, ignorant not stupid19 yr. old. AND the original lie when I was told by the recruiter I would get an apartment and travel the world. Ha!

    1. loren follette    

      Ft. McClellan was home to the Chemical Corp in 1966. Dupont chemical plant was dumping toxins in River upstream from the Fort. Anniston Alabama sued due to residents being exposed and won. Army and families were excluded from damages as it was up to Govt to take care of military members. There exists a map of Fort and where major toxins were used and stored. It was rumored that chemical material was even stored in buildings exposing GI”s. The ranges, grounds, and water to the Fort were considered to be toxic. Some parts of Fort are briefly used but tome is limited and water must be brought in. VA is aware of exposure and GI may submit exposure data to VA.
      A democratic House or Senate member has tried to introduce (more than once) a bill to have a study made considering the military exposure and effects. The bills were killed by GOP before ever reaching the floor.
      I was there and exposed to it all in 1966. I have submitted my exposure to the VA .

  16. JC    

    Prayerfully increased cyber security is a part of this platform. Our information breached throughnumerous federal formats over the past few year is of high concern.
    Having a record system available/acessible for active & Vet records (and hopefully deployed Military) will be awesome.

    Thank you!

    Cannot insert answer to multiplication problem below…only accepts 2 digits. Product is 3 digit number. New problem is 2 digit =20

  17. Patrick B Adams    

    Since I left the US Army back in 1982 I struggled to get my health records and spoke to VA staff about why there was not some kind of computer based record system. Now this is a reality so good job and make sure the system is hack proof.

  18. Robert Lake    

    I’ve tried for about 30 YEARS to get my military medical records from 1967 to 1971. I’ve been given many excuses why I have been unable to get them from “they were burned up in a fire to they can’t be found to they were transferred to another agency to they have to have the doctors names “redacted” before they can be supplied to me.” There is some hope today that some of my records will be sent today but when I inquired about which records they were I was told that there were two manila envelopes and that was all. I am anxious to see what the envelopes contain when they arrive in a week or two.

    I have lost many opportunities to file for a disability because of the incompetence of all the people who have been in charge of the veterans health records and the acquisition of those records. I have been currently fighting an incompetent VSO whose main concern in his job is to mislead and, YES, outright lie to me about what can be done and what can’t be done. This is the worst instance of harming a vet as I have ever heard of and, in spite of numerous complaints by me and many many more vets, he still has his $30,000 plus job with the county and it appears that he is being “protected” instead of being reviewed instead of being fired.

    If there is going to be a new system whereby a vet can get their record by a simple online request, then I say it’s about time! I hope this system works out!

    1. Larry Johnson    

      Try getting a attorney who is certified to practice before the VA appeal board, there are many to choose from. Many are well versed in the VA regs and Federal Laws, more so than a VSO. If you are really done and frustrated with your vso get a attorney. Look on the internet also the VA provides a list of Attorney. The best of luck to you. I have an attorney.

      1. WILLIAM EDWIN WILSON    

        I never used a VSO. I am very well informed on my illnesses ratings enough to recognize a couple of men who once worked for me had illnesses that would give them 100% ratings. After I convinced they applied and were given that rating. Even so, I authorized the DAV to work on my behalf and they were successful. If you haven’t tried them I recommend that you do so.

  19. Keith Bodi    

    Some of we older vets will certainly appreciate this bold move!

    1. Richard W Maresh    

      You should get in contact with a DAV field officer. I have been with DAV for years and they are great and were extremely helpful in assisting me with a disability claim.

      1. S M Wallace    

        Of course they were, you are a MALE veteran. The DAV sure didn’t give me the help they wanted to pretend they were.

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