Electronic Health Records

Selection & Replacement News

GAO Calls for VA to Adopt Commercial EHR, VA Likely to Do So

GAO has called for a commercial EHR replacement for VA's VistA EHR and VA leadership agrees with that approach.

VA EHR replacement likely to occur

By Kyle Murphy, PhD

- During a recent House Committee on Veterans’ Affairs hearing, a representative from the Government Accountability Office (GAO) minced no words when recommending the EHR implementation plan that the Department of Veterans Affairs should take moving forward.

In his opening remarks to the hearing on IT at the VA, GAO Director of IT Management Issues David A. Powner listed VA EHR technology as a major area where the House committee needs to provided “continued oversight.”

Particularly, Powner on behalf of GAO called into question the work abandoned by VA and the Department of Defense in developing a joint integrated EHR system and its consequences for interoperability between the health systems for active military personnel and veterans.

“It is well known that interoperability is needed between VA and DoD in that 2013 a plan was abandoned to pursue a single approach. In GAO’s view, this is duplicative and we see no evidence that separate approaches will be cheaper or quicker,” he told the committee in his opening remarks.

In a GAO report accompanying yesterday’s testimony, the federal agency put the price tag of those abandoned EHR interoperability efforts at $564 million and noted that the two agencies subsequently decided to move forward with separate plans to “modernize their respective electronic health record systems.”

In his comments to members of the House Committee on Veterans’ Affairs, that decision is unwise:

“DoD is pursuing a commercial solution while VA is attempting to modernize its 30-plus-year-old VistA system,” he explained. “VA is now considering a commercial electronic health record. This uncertainty is not acceptable and a decision needs to be made.  VA needs to let go of VistA and go with a commercial solution. Further, we see no justification for VA and DoD pursuing separate systems.”

The $9-billion contract for commercial EHR replacement technology at DoD famously went to Cerner Corporation, whose bid led by Leidos beat that of its chief rival Epic Systems. (This past October DoD officials confirmed a delay to the initial phase of its EHR modernization project until February 2017 based on findings from early testing.)

Powner’s later comments put GAO’s recommendations to VA more simply. “Buying instead of building is the way to go.”

In response to a question posed by Chairman Phil Roe, MD, (R-TN) about the high costs of sustaining VistA as compared to a new EHR system, VA Acting Assistant Secretary for Information and Technology and CIO of the Office of Information and Technology Rob C. Thomas, II, pointed to the department’s efforts to modernize its EHR infrastructure:

We definitely agree that our numbers are out of kilter from industry. You would like to see 60 percent or so in maintenance and 40 percent in development. As have been communicated, we’re running a 85 to 90 percent in sustainment. We have to shrink that footprint. We have to shrink that sustainment. And we do have a legacy modernization now that we’ve stood up to go after that sustainment dollars to reduce that footprint. 

Thomas also agreed with the statement that VistA lacks many of the capabilities of off-the-shelf EHR technology.

As for the what the future holds for EHR technology at the VA, Thomas laid out his expectations in two separate instances. The first was in response to questions from Rep. Julia Brownley (D-CA):

I’m confident we’re going to go commercial. I can’t speak for Dr. Shulkin. I hope for a speedy confirmation so that he can come on and help us work through that. I can tell you that knowing his background in industry, he’s done that in his experience being a doctor at leading hospitals in the past. I have worked with him in the past 18 months — he’s very decisive.

The other, more forcefully, in response to questioning by Rep. Jodey Arrington (R-TX):

When VistA started out, it was called De-centralized Hospital Computer Program and they hired developers across the nation in all of those VA MCs [medical centers] — that’s been the VA way. That is not going to be the VA of the future. We are definitely going to go commercial. We’re going to definitely do software as a service. We’ve awarded cloud. We’re going to start shrinking out data centers to get into the cloud. We are going in a different direction than we have.

If the testimony from Tuesday’s hearing bears out, the beginning of the end for the VistA EHR in underway.

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