The Department of Veterans Affairs (VA) is following in the footsteps of the Department of Defense (DoD) and the Military Health System (MHS) in adopting a commercial EHR technology that is nearly identical to the latter's Cerner platform.
On Monday, VA Secretary David Shulkin announced that the federal agency will abandon its VistA EHR after decades of development and support.
“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,” he stated. “And, because of that, we’re making a decision to move towards a commercial off-the-shelf product.”
Shulkin provided a lengthy explanation Monday for his federal agency’s decision, which was based on internal and external feedback as well as a need for EHR interoperability between VA and DoD:
At VA, we know where almost all of our Veteran patients is 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 share plan of acre 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.
Furthermore, Shulkin is expediting the process by opting for a public interest exception that eliminates the need 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 healthcare 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.
A will not adopt the same exact system as the DoD MHS but a similar Cerner platform. According to Shulkin, VA clinicians will have a significant say in the Cerner EHR development and implementation process. A main goal of the new EHR system will be an integrated EHR with DoD that also ensures interoperability with the private sector.
“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,” he concluded.
UPDATE (June 5, 12:34 PM): Cerner has released the following comment on today's VA announcement:
Earlier today, the Department of Veterans Affairs announced its decision to modernize its existing health records platform by choosing Cerner’s commercial off-the-shelf Millennium EHR solution.
We are honored and humbled to be selected to lead the VA’s important project. We believe this project, in concert with ongoing progress towards implementing the Department of Defense’s MHS Genesis system, will lead to ongoing innovation, improved interoperability and the creation of a single longitudinal health record that can facilitate the efficient exchange of data among military care facilities and the thousands of civilian health care providers where current and former service members receive health care.
We look forward to sharing more information as we build the team of innovative and experienced partners that will join us to complete this vital work.
UPDATE (June 6, 8:14 AM): Cerner's chief competition for the DoD EHR modernization project, Epic Systems, issued a statement late Monday evening.
“As the largest electronic health record vendor in the United States, covering two-thirds of the nation’s patients, we are proud to serve our veterans both through the VA scheduling project and through our customers that care for millions of veterans across America. These customers are the top health systems in America and we stand with them, committed and eager to ensure veterans get the very best medical care regardless of where they receive it,” an Epic spokesperson said.