- David Shulkin, MD, will remain in the top post at the Department of Veterans Affairs following a confirmation vote by the Senate late Monday evening.
The Senate voted unanimously in favor of President Donald Trump’s nominee (100-0) who became a top federal official during the Obama Administration. He remains the first non-veteran to serve as the VA chief.
While Trump frequently promised massive firings and privatization of VA during his campaign, Shulkin intends to take a more modest route to modifying the VA, the Associated Press reported earlier this week. Presently, the federal organization has nearly 370,000 employees and an annual budget of almost $167 billion.
As VA Secretary, Shulkin will have several immediate responsibilities heading into his term, including the adoption and implementation of an effective, usable EHR system.
Healthcare Information Management System Society (HIMSS) has weighed in on Shulkin’s confirmation with the following statement:
HIMSS congratulates Dr. David Shulkin on his confirmation as the next Secretary of the Department of Veterans Affairs. In an increasingly complex and mobile healthcare environment, Dr. Shulkin’s leadership and understanding of health information technology’s role in care delivery and career development for veterans will be valuable to VA’s success.
As the VA capitalizes on advancements in interoperability, telehealth, cybersecurity, and care delivery, we look forward to engaging in a thoughtful dialogue with Secretary Shulkin and the VA team to improve access to high-quality care for veterans, caregivers, and providers throughout the VA system.
Presently, VA’s EHR system, VistA EHR, is a point of contention as the federal organization ceased working collaboratively with the Department of Defense (DoD) on a joint integrated EHR system, a setback for EHR interoperability between the two health systems for active and retired military personnel.
“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,” GAO Director of IT Management Issues David A. Powner told the House Committee on Veterans’ Affairs in his opening remarks at a hearing on IT at VA.
The total cost of the abandoned EHR interoperability project amounted to over $564 million.
DoD has since made progress in rolling out a commercial EHR system, GENESIS EHR, at their Fairchild Air Force Base in Washington. The Cerner EHR system is part of a $4.3-billion contract to modernize and standardize DoD legacy health IT infrastructure. Modernizing the homegrown VistA EHR would prove more expensive and less interoperable than adopting an entirely new system, according to GAO.
“DoD is pursuing a commercial solution while VA is attempting to modernize its 30-plus-year-old VistA system,” Powner 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.”
With DoD already on board with a new commercial system, VA is feeling the pressure to adopt one of its own. VA Acting Assistant Secretary for Information and Technology and CIO of the Office of Information and Technology Rob C. Thomas, II, told the same committee that VA definitely plans to go commercial in response to the DoD’s actions. They intend to abandon data centers in favor of getting into the cloud.
Now that Shulkin has been officially confirmed as VA secretary, the push for a commercial EHR adoption and a connection between DoD and VA is likely to gain new momentum.
“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,” said Representative Julia Browney in a clear endorsement of Shulkin’s commitment to modernizing the federal organization’s health information technology system.