'It's time to move forward'

U.S. Department of Veterans Affairs Secretary David Shulkin announced that the VA will adopt the same Electronic Health Record (EHR) system as the Department of Defense (DoD) during a news briefing on June 5 at VA’s headquarters in Washington, D.C.

“I had said previously that I would be making a decision on our EHR by July 1, and I am honoring that commitment today,” Shulkin said. “The health and safety of our veterans is one of our highest national priorities. Having a veteran’s complete and accurate health record in a single common EHR system is critical to that care, and to improving patient safety.”

Shulkin said VA’s current VistA system is in need of major modernizations to keep pace with the improvements in health information technology (IT) and cybersecurity, as software development is not a core competency of VA.

This decision on EHR, according to Shulkin, did not come lightly. Shulkin said he has:

• Reviewed numerous studies, reports and commissions on this topic, including the recent commission on care report;

• Spent time talking with clinicians;

• Consulted with chief information officers from around the country;

• Met personally with CEOs from leading health systems to get their own thoughts on the best next-generation EHR for VA;

• Studied reports from management consulting companies and from the Government Accountability Office and the Inspector General on VA’s IT systems; and

• Counted no fewer than seven Blue Ribbon Commissions, and a large number of congressional hearings, that have called for VA to modernize its approach to IT.

“To date, VA and DoD have not adopted the same EHR system. Instead, VA and DoD have worked together for many years to advance EHR interoperability between their many separate applications – at the cost of several hundred millions of dollars – in an attempt to create a consistent and accurate view of individual medical record information,” Shulkin said. “Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the departments remain on two different systems.”

For Shulkin, VA’s adoption of the same EHR system as DoD – now known as MHS GENESIS – will ultimately result in all patient data residing in one common system, as well as enable seamless care between the departments without the manual and electronic exchange and reconciliation of data between two separate systems.

Because of the urgency and critical nature of this decision, Shulkin said he has decided that there is a public interest exception to the requirement for full and open competition in such technology acquisition.

“I have signed what is known as a ‘Determination and Findings,’ or D&F, that is a special form of written approval by an authorized official that is required by statute or regulation as a prerequisite to taking certain contract actions,” he said. “This D&F action is only done in particular circumstances when the public interest demands it, and that’s clearly the case here.”

Shulkin said VA has unique needs, many of which are different from those of DoD. For health reasons and the protection of veterans, he has decided that VA can’t wait years, as DoD did in its EHR acquisition process, to get the next-generation system in place.

“VA will not simply be adopting the identical EHR that DoD uses, but we intend to be on a similar Cerner platform. VA clinicians will be very involved in how this process moves forward and in the implementation of the system,” Shulkin said. “We are embarking on creating something that has not been done before. This is going to take the cooperation and involvement of many companies and [thoughtful] leaders, and can serve as a model for the federal government and all of health care.”