Veterans ask, VA answers: Questions on electronic health record modernization


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Over the next several years, VA will transition to a new electronic health record (EHR), a system used by health care providers to store and track patient data. This transition will begin in spring 2020 at Mann-Grandstaff VA Medical Center in Spokane, Washington. As VA shifts to the new EHR, the Office of Electronic Health Record Modernization took the chance to answer your most frequently asked questions.

What is an electronic health record?

An EHR provides a digital version of a patient’s health record. VA was one of the first health care systems to implement an EHR and continues to be a leader in this area.

What is the Electronic Health Record Modernization program?

VA’s Electronic Health Record Modernization (EHRM) program is an effort to unite VA and the Department of Defense (DoD) on a single, common and commercial EHR system. Cerner Corp. was selected as the EHR vendor. EHRM will replace VA’s current EHR solution, the Veterans Health Information Systems and Technology Architecture (VistA).

What does EHRM mean for Veterans?

Modernizing VA’s EHR is expected to improve the department’s ability to deliver care to Veterans and enhance the patient and provider experience across all facilities. It will also improve the sharing of health data between VA, DoD and community providers.

Will VA and DoD share a Veteran’s record?

Yes. VA and DoD will share health records in the new system. A shared system means patient information entered into the record from different doctors, pharmacies, labs and other points of care will be stored in the same place and in a format that is quickly and easily accessible by all providers. This will eliminate the need for manual transfer of records when Veterans transition from active duty.

Protecting Veteran health information is a top priority for VA. Cerner and VA established a secure process between VistA and the Cerner data center, which is compliant with national cybersecurity standards to ensure Veteran health information is protected.

What precautions were taken to ensure VA kept Veteran data secure during data migration?

Protecting Veteran health information has always been a top priority for VA. During the process of migrating Veterans’ data into the new EHR system, VA and Cerner used state-of-the-art and federally compliant safety measures, and VA personnel maintained constant supervision of the data throughout.

When will EHRM impact me?

The new EHR will be installed at VA facilities nationwide starting in 2020 and is anticipated to continue until 2028. VA Puget Sound Health Care System and Mann-Grandstaff VAMC in the Pacific Northwest will be the first sites to receive the system. Mann-Grandstaff VAMC is anticipated to deploy the EHR — or “go live” — in March 2020, followed by Puget Sound in fall 2020. For more information on timeline, check back to this page often.


Established in June 2018, VA’s Office of Electronic Health Record Modernization manages the preparation, deployment and maintenance of VA’s new electronic health record system and associated health information technology tools. For more information about the Electronic Health Record Modernization program, visit https://www.ehrm.va.gov.

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. Ezra Hinds _______ 1074    

    Having problem reaching my provider electronically need help with my heathy vet,not computer savy,I do have cell phone

  2. Richard Clarence Zacke    

    I’m told by the VA that all my medical records can not be found so how are they gonna put my records in this new system? I lost my claim with social security because the VA could’nt find my records. Well I don’t trust the VA to keep my records on this new electronic system so if they do find my records can I request them sent to me instead of being shreded? I believe I can be a better steward of my own records since I did’nt lose them in the first place.

  3. trei Folger    

    Still waiting for an answer VA.

    Corrections:

    How often and what idepentdent auditor is doing:

    Penatration testing
    Red Teaming
    Malware Detection/removal
    Threat modeling
    Full-Aspect Breach Testing
    Forensic Investigation
    Information Security Instruction

    Are they capable of Ransomware recovery?
    Does the VA use a virtual protected network (VPN) to transmit information?
    Are the Vendors to the VA required to have, implement and do the same as above?
    If the VA or its vendors are not doing the above why not?

    IT is not cyber security. If the VA does not have people that know the answers to all of the above then the VA system has know security.

    Is the VA still selling Veterans information? If so then the VA is wrong, negligent and can not secure any information.

  4. George D    

    I still don’t understand – and can’t find anyone who can tell me: Are our federal medical records protected by the Federal Privacy Act (5 U.S.C. § 552a) or not??
    A reading of §552a clearly says that medical records ARE protected.
    So even though HIPAA says that sharing for the proverbial “treatment, payment, and healthcare operations” is allowed, Title 5 would clearly prohibit such a free exchange of our private medical records, no matter how well-intentioned.

    This is just another reason I won’t accept a CHOICE/MISSION ACT referral. VA promptly provides the required information to the outside provider (including our SSAN), but that provider will then enter THEIR treatment into Epic! Which is then available to any other doctor, hospital, insurance company, pharmacy, law firm, hacker, who likewise has access to Epic. Or Cerner.
    HIPAA requires medical entities to allow us to request restriction of our records. But it also says that the provider doesn’t have to agree to it! And NONE WILL!
    How do we stop this?

    BTW, the reason the switch to Cerner is taking so long, and costing so much, is that it evidently will only run on Windoze 10, which in most cases is requiring the replacement of ALL of the current desktops at many facilities.
    Our tax money at work.

  5. DeadManWalking    

    I hope the VA can do a better job retaining my medical records than the Military Records Center does.

    When I got out of the service in 67 my medical folder was 3-4 inches thick.

    When my records were finally located in Portland they had been reduced to 27 pages.

    Don’t trust the Military or VA to protect your records.

    Order a complete copy for your own records, before you out, and every year updates from the VA.

    It could make the difference between a sc claim or none.

  6. William Elmore    

    Why is VA destroying the actual paper records after they are scanned (by contractors) into this electronic system? How will veterans/families be able to update, correct, amend, add to, revise, etc. their records? What are the assurances that these records will be readable, findable and usable in 10-20-30-40 years or more down the road when the veteran and the memories will have faded. Will this turn out to be like fortran and cobal in the future with few of no experts available to be able to retrieve or update or run reports?

  7. Doc    

    The choice of Cerner for the VA was based on the earlier choice of Cerner for all DOD health records, a poor decision made 6 years ago (2014). After several years of debate, DOD finally made the decision to buy a COTS solution – after DOD and SAIC completely mishandled development and implementation of the AHLTA system (the current EMHR for DOD). AHLTA was funded in 1997 but could not actually run in clinical settings until 2005. To this day it is clunky, klugey, prone to down time, and a general pain in the ass for DOD physicians. VistA was rejected because it was an “in-house” system, although many of us wanted DOD to adopt and improve VistA rather than buy a commercial system. The VA did a good job developing and running VistA – DOD total failed their implementation their EMHR implementation – so their fear of another DOD in-house failure lead to their flawed choice of Cerner. Epic is a superior system and the commercial market leader – but Epic wanted a 10 year contract to implement and manage all DOD records for about $10 billion. Cerner was willing to accept a 5 year contract for less than half the money – knowing that they would get the follow-on work and ultimately lead to more than $10 billion in revenue. DOD took the bait and will be stuck with Cerner well into the 21st century. Early installs of Cerner in the Pacific Northwest have not gone well – behind schedule, over budget, and technologically poor product. So, the VA then took the bait as well – and bought Cerner to replace VistA, so it would be compatible with the DD system.

    Frankly, all current EMHRs are not very good, but Epic is the best commercial product currently available. They are cloud-compatible (Amazon and Microsoft) and have reasonably mature software that runs reliably. All the who-ha about data security is bogus – all our records will be vulnerable to attack – no matter which system was chosen. Cerner has already been hacked at the DC VA two years ago and at multiple commercial sites. Welcome to the 21st century..

    1. Corby S Rogers    

      Act now and get paper/electronic copies of your records, health and service.

  8. Doc    

    The choice of Cerner for the VA was based on the earlier choice of Cerner for all DOD health records, a poor decision made 6 years ago (2014). After several years of debate, DOD finally made the decision to buy a COTS solution – after DOD and SAIC completely mishandled development and implementation of the AHLTA system (the current EMHR for DOD). AHLTA was funded in 1997 but could not actually run in clinical settings until 2005. To this day it is clunky, klugey, prone to down time, and a general pain in the ass for DOD physicians. VistA was rejected because it was an “in-house” system, although many of us wanted DOD to adopt and improve VistA rather than buy a commercial system. The VA did a good job developing and running VistA – DOD totally failed their implementation their own EMHR implementation – so their fear of another DOD in-house failure lead to their flawed choice of Cerner.
    Epic is a superior system and the commercial market leader – but Epic wanted a 10 year contract to implement and manage all DOD records for about $10 billion. Cerner was willing to accept a 5 year contract for less than half the money – knowing that they would get the follow-on work and ultimately lead to more than $10 billion in revenue. DOD took the bait and will be stuck with Cerner well into the 21st century. Early installs of Cerner in the Pacific Northwest have not gone well – behind schedule, over budget, and technologically poor product. So, the VA then took the bait as well – and bought Cerner to replace VistA, so it would be compatible with the DOD system.
    Frankly, all current EMHRs are not very good, but Epic is the best commercial product currently available. They are cloud-compatible (Amazon and Microsoft) and have reasonably mature software that runs reliably. All the who-ha about data security is bogus – all our records will be vulnerable to attack – no matter which system was chosen. Cerner has already been hacked at the DC VA two years ago and at multiple commercial sites. Welcome to the 21st century..

  9. Robert Shaw    

    I just hope maybe after this, the VA can FIND my medical records, been trying to find them for over 15 years, and constantly getting the run around about where they are. While having surgery after surgery on my own dime, but can’t get into the VA System because I don’t exist in their records.

    1. Brian coffman    

      Sir, this system will not locate records. If a SF180 (archive request), a VA FOIA request and or visit to the facility last seen while in military you may be out of luck. Sadly your prior military personnel may have not done their job and records could be lost. No digital file can be created if there is nothing to scan in (old documents).

  10. Temple Gregory Matthews    

    How far back will medical records be integrated into this new system? I have medical care records that begin in 1963 and extend to the present day in 2020.

    My medical records include service overseas and temporary assignments for short periods of time at some locations. Wil all of those records be included in this?

    In addition, some of my medical care has included care that was contracted out to a civilian provider. Will that care be included?

    NOTE: My medical care includes active military service as well as VA care.

  11. Tom Hartsfield    

    Conversion of large scale integrated information technology system is a very complex project. It is a nation wide system that interfaces with other internal and external systems as well as the systems at each location which are changing as new locations are converted. The data integrity and successful conversion questions being asked seem to be answered by the schedule. Eight years is a long time but it also could indicate careful planning. It would seem to be prudent to take ones time and do it right rather than rush through it and cause severe problems all in the name of efficiency. Again, perhaps we should leave it to those professionals who are on the ground and familiar with the intricacies of this project. They are off to a good start by keeping us informed about what they are doing.

  12. Jose Amalbert    

    What about the records that burned in a fire in one of your records facility. How are you going to research what illness of labor or active duty-related accidents happened during 1974 – 1980.

    [Editor: More info on the NPRC records fire, here: https://www.blogs.va.gov/VAntage/22133/the-nprc-records-fire-of-1973/%5D

    1. Tom Hartsfield    

      It is unfortunate that a fire destroyed records. It is hard to see how that question relates to this project other than the project will allow for digitizing records in a standard format. That will facilitate redundancy and should include professionally managed disaster recovery procedures that may prevent any veteran experiencing such loss of records in the future. That would seem to be a step forward.

  13. Tom Hartsfield    

    A system that will facilitate the automated sharing of records between the VA and private providers will certainly help veterans who utilize the new choice benefits. Both in terms of ease of record transfer and accuracy. That results in improved health care. This is a project being managed by professional information technology and management personnel of the VA. I have no desire to micromanage their efforts nor should you. They are on site and are charged with running this program. Perhaps you should wait for implementation to judge how it affects you rather than transplanting your judgement for theirs. I appreciate that they are sharing this information so we stay informed. They are making decisions for the VA as a whole not your particular situation.

  14. John Nemecek, P.h.D.    

    Regarding EHR adoption by the VA. Why did they not select EPIC, one of the most widely used EHR’s being used by civilian healthcare systems nationwide? EPIC can be used for every aspect of healthcare from Primary Care to Surgery and everything in between. More importantly, EPIC is already a known and approved HIT platform by the Federal Government, meeting all required HIT standards that have been established for the civilian healthcare industry. I have never heard of Cerner? Is anybody in the civilian sector using their product? This appears to be a typical government buy, lowest bid, for an unproven product. Big mistake!

    John Nemecek, Ph.D.
    U.S. Navy Medical Service Corps (Retired)

    1. Thomas    

      Cerner was founded in 1979 the same year EPIC. They are one of the pioneers of EHR.

      1. Randall A Farr    

        That said; please tell us, why not EPIC?

  15. Frank Vincent    

    Ditto to Norman’s comments above.
    The biggest benefit for the Veterans would be to free up the doctors time with patients. Not have the doctors trying to type on the lap top and discuss your medical conditions at the same time. This process is what caused doctor burnout and vast turnover.

  16. Virgil R Kaufman    

    Will our records be lost or are they guaranting that our records will transfer without a problem? Since my records went from paper to digital, they lost or didn’t transfer some important MRI Reports and other documents, is this going to happen again?

  17. Trei Folge    

    How often and what idepentdent auditor is doing:

    Penatration testing
    Red Teaming
    Malware Detection/removal
    Threat modeling
    Full-Aspect Breach Testing
    Forensic Investigation
    Information Security Instruction

    Are they capable of Ransomware recovery?
    Does the VA use a virtual protected network (VPN) to transmit information?
    Are the Vendors to the VA required to have and implement do the same as above?
    If the VA or its vendors are doing the above why not?

    IT is not cyber security. If the VA does not have people that know the answers to all of the above then the VA system has know security.

    Is the VA still selling Veterans information? If so then te VA is wrong, negligent and can secure any information.

  18. John R Stark    

    Too many shared data bases broadens a hacker’s ability to surf your data and then sell it to the highest bidder. Data miners are a reality that this article does not address. Having went 30 years without a VA Disability Rating while having to endure a medical malpractice event,my life has been altered in such a way that I am highly sceptical of how federal agencies shuffle Vets information without taking actual responsibility for the outcome of failures to serve all aspects of a Veterans needs over their lifetime. The apathy,the dis service,and underhanded skull surgery has cost me over$3M since 2010. Being given medications containing harmful compounds while my teeth literally fall apart ,decay at accelerated levels,and I directly show my care team my real concerns and they do nothing to address the severity of the side effects I am going through. The legacy of mis-deeds,ignorance and greed are rampant in a structured environment that pays a doctor stipends for the data of the resulting empirical studies that have been quantified from all of our data markers. This is just a fancy way to Express that all Vets are being profiled with leaving the government a plausible deniability of owning their actions and how it impacts each Veteran in their care.The apathy will become the angst of my care that undermines my stability as a human being, While the drug companies pay out stipends to Care providers who gain their empirical long term data that provides companies outside the VA justified results of how well their medications performed. The compromise is Health Care Data changing hands to make the almighty dollar the expense of each and every Veteran who utilizes the VA healthcare system. Start treating us as human beings with long term outcomes..And for christ’s sake it’s been 30 years with a deadly virus at least the VA could provide me a Disability Rating better than 0% and leave me hanging literally in debt and financial ruins based upon no one taking responsible actions to be accountable for how it affects my mortality and quality of life and family members.

  19. Randy Marsh    

    I as a Veteran since 1993 NEVER asked for this!!! Who’s bullshitting who? Lay off the ENTIRE VA and give me a Visa/Mastercard!!!! I am an adult idiots and not a 17 year old E1 who was innocent of the USN!!!!

    AKA, let’s waste more money and resources to get the same, useless results in real veteran health care. It’s the good ol $20k hammer or $30k toilet seat. #smokeandmirrors. What:blessed contractor has benefited from the US taxpayer???

    When are you going to ask a Vet like me what Vets ljke me really want and need??? You guys think you’re god’s gift to healthcare…BULLLLLLLSHTTTT!

  20. joe la may    

    has anyone looked at the mess, sign in to VBA sites has been turned into!! or how the usefull information on VBA sites has been reduced to stupid statements like” we sent you a letter”

  21. Paul L Jowers Jr    

    I forsee a lot of misplaced or lost veterans records during this process. And for some once that record is lost its gone for good. What system is in place to protect the veterans

  22. Peedee Wyre    

    I do not know enough about computer technology to debate the merits of upgrading the old system vs. the new system, but I must observe that it starts in 2020 and concludes in 2028… that seems like an inordinate amount of time, and makes me wonder how efficient it will be in the interim, being a piecemeal endeavor, and if it will be outdated before it is fully implemented.

  23. Jon    

    I agree with Norman’s comment. Just another waste of federal funds on another bill of goods. The VA has already compromised my PII once before. Here we go again. Sad.

  24. Ronni Gabriella Salpino    

    Sure would be nice if the VA health and VA personnel computers talked to each other. I have updated my information through the VA, but my medical records still have my old information. I can’t take time off to go sit in line all day at the VA hospital just to start over again.
    This is 2020! Let’s get our act together and tie these systems together!!!

  25. Shirley Redmond    

    I am a VA employee and to date no provider in our health care system has had the opportunity to provide input.

  26. Norman    

    I don’t like this moving from open sourced based code to proprietary technology which you can’t predict or control the costs on, nor can you predict the stability of it. VISTAS may be clunky but it’s open source and dozens of other countries have adopted records based on this old program. What is Cerner’s track record? How much more will this cost? What are the actual practical benefits of modernization? Will it save providers time? Will it make their jobs easier? If not, it will not help veterans so stop while you are still ahead.

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