Although, in today’s news cycle, it may feel like a decade, it wasn't that long ago that President Donald Trump was praising Department of Veteran’s Affairs Secretary David Shulkin, M.D., for his work at the agency, joking that he would never have to use his Apprentice catchphrase “you’re fired” on the cabinet member.
“We’ll never have to use those words on our David,” he said last June during a bill signing. “We will never use those words on you. That’s for sure.”
Of course, as everyone knows by now, that’s exactly what happened when Trump took to Twitter to announce Shulkin would be replaced by White House physician Ronny Jackson, M.D.
I am pleased to announce that I intend to nominate highly respected Admiral Ronny L. Jackson, MD, as the new Secretary of Veterans Affairs....— Donald J. Trump (@realDonaldTrump) March 28, 2018
That nomination has drawn plenty of concern from veterans’ groups who see Jackson as a perfectly capable physician, but one that lacks the requisite leadership experience to oversee the largest health system in the country.
For the health IT world, much of the focus has revolved around the impact on a massive contract to replace the VA’s current EHR with an off-the-shelf solution from Cerner. And while VA officials had initially expected to finalize the contract by November, several roadblocks—including concerns about the system’s ability to meet the VA’s interoperability demands—have left the deal treading water.
Shulkin’s firing adds a new layer to the uncertainty since he was a chief proponent of the switch. Given that White House aide Jared Kushner, who leads the Office for American Innovation, was part of the decision to select Cerner, it seems likely the contract will be signed at some point. However, some analysts believe there may be a significant delay if the acting VA Secretary Robert Wilkie decides to hold off until Jackson is confirmed.
Regardless of whether that contract is signed, the bigger concern is what happens next.
Shulkin’s career was built on a bedrock of healthcare management during a time when providers were migrating to digital records, and while he clearly believed the transition away from VistA was the right decision, he seemed very aware of the Herculean task of transitioning more than 100 hospitals onto a new system, a process that was scheduled play out over the course of a decade.
Even before he announced his decision to move to Cerner, Shulkin said change management would be the most important factor by far, and he reiterated that point during several congressional hearings. Once the decision was made, he set aside two years to focus exclusively on its approach to change management.
Any hospital executive that’s led an EHR install or overhaul knows this well. EHR implementation is not a plug-and-play procedure and the initial planning can make or break the long-term viability of the project. Health systems far smaller than the VA have experienced a tumultuous period in the months after an EHR go-live. Late last year, after it’s own Cerner implementation, Banner Health reported scheduling delays and longer wait times, in what one executive described as a “painful period.”
I personally know and greatly respect Ronny Jackson....as a terrific doctor and Navy officer. However, he has neither the experience nor the credentials to run the very large and complex VA. This is a terribly misguided nomination that will hurt both a good man and our veterans— John O. Brennan (@JohnBrennan) March 29, 2018
We’ll never know whether a Shulkin-led Cerner implementation would have failed or succeed, but he at least had the management experience to steer the ship. The same can’t be said for Jackson, who now faces that same Herculean task with virtually no management experience to speak of. And even if, for some reason, he decides not to follow through on the Cerner contract, he’ll still need to come to terms with updating a legacy EHR that has been plagued with problems. Neither option offers an easy way out.
So as we wait for the final word on the contract, remember that the aftermath might be even rockier. – Evan