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VA Shares Vision for EHR Interoperability, Modernization

VA leadership recently laid out its plans for EHR interoperability and modernization, possibly including a commercial EHR replacement of the VistA EHR.

By Kyle Murphy, PhD

- Department of Veterans Affairs Undersecretary for Health David J. Shulkin, MD, hinted at the possibility of a commercial EHR replacement in the federal agency's future plans for upgrading and building out its health IT infrastructure in a hearing called by the Senate Committee on Veterans' Affairs.

EHR interoperability at VA

"While our efforts to modernize the VA’s EHR and our plans for the digital health platform are not mutually exclusive; the success of the digital health platform is not dependent on any particular EHR," he said in prepared remarks.

As part of his department's plans for developing a digital health platform, Shulkin did not shy away from the possibility of the federal agency opting for a commercial EHR technology, a decision its sister agency the Department of Defense (DoD) made last summer:

VistA Evolution funds have enabled critical investments in systems and infrastructure, supporting interoperability, networking and infrastructure sustainment, continuation of legacy systems, and efforts — such as clinical terminology standardization — that are critical to the maintenance and deployment of the existing and future modernized VistA. This work was critical to maintaining our operational capability for VistA. These investments will also deliver value for Veterans and VA providers regardless of whether our path forward is to continue with VistA, a shift to a commercial EHR platform as DoD is doing, or some combination of both.

According to Shulkin, future EHR and health IT selection decisions will be based on their capacity for making VA's health IT infrastructure more agile and flexible:

Modernization is a process, not an end, and the release of VistA 4 in FY 2018 will not be the “end” of VA’s EHR modernization. VA has always intended to continue modernizing VA’s EHR, beyond VistA 4, with more modern and flexible components.

Technology and clinical capabilities must consistently evolve to meet the growing needs of our Veterans. The VistA Evolution program is just that—an evolving capability that is an invaluable part, but not the end of VA’s EHR modernization.

The VA plan for a digital health platform will have at its core an EHR system, but its architects argue that no  EHR system is sufficiently comprehensive to support all the capabilities necessary for managing the health of Veterans as well as clinical workflows and future health IT innovations, added Shulkin.

Additionally, the VA Undersecretary noted that its current EHR interoperability solution for information sharing with DoD — the Joint Legacy Viewer (JLV) — remains inadequate despite its ability to enable both departments to satisfy EHR interoperability requirements under the National Defense Authorization Act.

"JLV has been a critical step in connecting VA and DoD health systems, but it is a readonly application. Building on the interoperability infrastructure supporting JLV, the Enterprise Health Management Platform (eHMP) will ultimately replace our current read-write point of care application," said Shulkin.

Whatever EHR technology the federal agency ultimately decides on, its plans for a state-of-the-art digital health platform will include moving to the cloud in the name of EHR integration.

"The digital health platform will be a system of systems," he maintained. "It is not dependent on any particular EHR, and VA can integrate new or existing resources into the system without sacrificing data interoperability. One of the digital health platform’s defining features will be system-wide cloud integration, a marked improvement over the more than 130 instances of VistA that we have today."

Is the end likely for the VistA EHR, the most widely used open-source EHR technology today? The door is certainly open to that possibility.

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