Shulkin sets summer deadline for VistA decision, tempers expectations of switch to commercial EHR

Department of Veterans Affairs Secretary David Shulkin confirmed that he will make a decision about whether to ditch the VA’s existing EHR for a commercial product by this summer, but didn’t offer any hints as to whether the agency is leaning toward a commercial solution.

At an event hosted by Politico, Shulkin appeared willing to consider either option, adding that he isn’t pinned to a strict deadline to decide whether to stick with VistA, but that he’s “targeting the July time frame.” If the VA elects to pursue a commercial system at that time, senior leadership will begin the task of identifying a vendor.

“Quite frankly, I wish this decision had been made by a previous secretary,” he said. “This has been going on for a long, long time. It is a very, very difficult decision, so it’s been kicked down the road, and if I could back up time, I believe it was a mistake not to have made a decision with the DOD,” he added. The Department of Defense recently implemented MHS Genesis in one hospital, after awarding a contract to Cerner, Leidos and Accenture in 2015.

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Shulkin’s comments were a departure from what he told the House Committee on Veterans’ Affairs earlier this month, when he seemed to indicate the VA would transition to an off-the-shelf EHR system.

“I’ve come to the conclusion that VA building its own software products and doing its own software development inside is not a good way to pursue this—we need to move towards commercially tested products,” Shulkin told the committee at the time.

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But Shulkin was far less decisive at yesterday’s conference, indicating his “number one goal is to come up with a strategic decision that makes sense for the VA.” He also said that the VA would continue forward with its Digital Health Platform that offers more functionality to users and acknowledged that the VA needs an open-architecture EHR system that can interface equally with veterans, community providers and VA physicians. He added that change management would be the most important factor that would influence cost, regardless of whether the VA sticks with VistA or selects a commercial product.

“I don’t think there is a commercial system today that we can go to the store and buy it and put it in for the VA,” he said.

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Other panelists at the Politico event argued that VistA was too siloed, pointing out that 132 iterations of the system exist within each of the VA’s hospitals. But Kenneth Kizer, M.D., director of the institute for population health improvement at UC Davis Health, who helped deploy VistA as under secretary for the VA from 1994 to 1999, argued that VistA is “the most unsiloed electronic health record out there” and its failures are the result of poor management rather than the technology itself.

“Where VA has been slow is superimposing modern languages on top of that as other systems have done,” he said.