It took the Department of Defense four years to roll out its EHR upgrades. Department of Veterans Affairs Secretary David Shulkin believes his agency can do it faster.
Shulkin said he'll have all of the DOD's resources at his disposal as he navigates the transition from VistA to an off-the-shelf system. During a White House press briefing, hours after announcing the VA would move to Cerner's MHS Genesis system, Shulkin said the VA is already using the DOD’s planning materials and change management tools from its recent conversion to the same platform.
Some of the DOD's key executives that were part of that transition are now assisting the VA, he added.
“We have institutional knowledge from them,” he said. “That’s considerable.”
But Shulkin also cautioned that the VA’s transition will be more complex for several reasons. First, change is hard, particularly for a system that has relied on its home-grown EHR system for more than 30 years.
Second, the VA’s EHR system needs to communicate with the DOD as well as various community healthcare providers and academic medical centers that care for veterans, but use systems other than Cerner.
“We’re creating something that is taking the best of what is off the shelf, but also creating something that doesn’t exist today,” Shulkin said.
"Undoubtedly, this decision will impact health systems nationwide as many veterans receive care through the CHOICE program outside of the VA," College of Healthcare Information Management Executives (CHIME) President and CEO Russell Branzell said in a statement. "We look forward to working with the VA and DOD to ensure that all patients can benefit from Secretary Shulkin's decision."
In a statement emailed to FierceHealthcare, DirectTrust President and CEO David Kibbe, M.D., noted that Cerner “has been a champion of Direct as a national standard for ubiquitous, easy, secure, interoperable health records exchange” and the VA’s decision to go with Cerner makes “it that much more convenient and economical for Direct exchange and messaging to become a major source of interoperable health information exchange” between federal and private healthcare providers.
The VA is moving ahead with an accelerated process that has already begun hashing out a detailed contract with Cerner, a process that Shulkin expects will take 3-6 months. That will include negotiating the cost of the new system, which will likely cost more than $4 billion, according to Shulkin.
“I would love to do it for less, but I think that would unrealistic,” he said, noting that the DOD spent $4.3 billion on its system, but the VA is a much larger organization.
That’s where Congress comes in. Last week, Shulkin said the VA would require additional funding in 2018 to implement a new EHR system. On Monday, he said the agency had begun engaging with appropriation leadership in the House and Senate, adding that he doesn’t expect “any major fights on this” since interoperability between DOD and VA is something that lawmakers have requested for years.
“I can count four times when they’ve asked DOD and VA to get in the same room and I can count four times that VA and DOD left doing separate things,” he said. “So, this one is going to be different.”
Throughout Monday, lawmakers on both sides of the aisle came out in support of Shulkin’s decision.
Shulkin also argued that the cost of an off-the-shelf system is significantly less than the cost of maintaining VistA—which was one of the factors that went into his decision. Ultimately, better integration with DOD means veterans will be on a single system for the entirety of their military life.
“The systems are getting older and the band aids are getting harder to hold the system together,” he said. “Each year, I believe, will get more and more expensive to modernize our own system.”