Commission on Care, lawmakers want commercial EHR for VA

The leaders of the Commission on Care, which recently offered recommendations for improving the Department of Veterans Affairs' delivery of health care, told a House committee on Sept. 7 that the VA should abandon its homegrown electronic health record system in favor of a commercial solution.

Dr. Toby Cosgrove, vice chairperson of the commission and CEO of the Cleveland Clinic, said VistA is too decentralized and poorly maintained.

"There are now 130 versions of that electronic medical record across the system, and it has fallen behind in its capabilities and also has not added the sort of capabilities you now see commercially available," Cosgrove said during a hearing of the House Veterans' Affairs Committee. "It is time to do the same thing that many other organizations have done and abandon the homemade project simply because there's not enough IT expertise within the organization to keep updating [VistA]."

Cosgrove said many prestigious health institutions, including Massachusetts General Hospital and the Johns Hopkins Hospital, designed their own systems when EHRs were still something of a novelty, but as commercial products matured, those organizations migrated to new systems.

"Many people around the country have learned that you can't maintain an electronic medical record in an individual facility," Cosgrove said. "It is moving too fast. And that's why the commercial aspects of this have kept up with the changes and made them uniform across the country."

Rep. Jeff Miller (R-Fla.), the committee's chairman, said he did not know whether VA was moving toward acquiring a commercial product. "We are still trying to find that...out," he said.

However, the VA has apparently considered the possibility of phasing out VistA in favor of a commercial product. Dr. David Shulkin, the agency's undersecretary for health, has said the VA's planned "digital health platform" is not dependent on any particular EHR system.

In a letter to Congress, President Barack Obama backed 15 of the 18 recommendations made by the commission to improve service delivery at the VA, which include creating a CIO position at the Veterans Health Administration that would report to the chief of the proposed VHA Care System, with a "dotted-line" to the VA's CIO. The move would to some extent roll back the centralization of technology duties at the agency, which spends more than $4 billion annually on IT.

The report also states that the VA should have a "comprehensive electronic health care information platform that is interoperable with other systems and other health care providers; enables scheduling, billing, claims and payment; and provides tools that empower veterans to better manage their health. Creating a single, uniform, integrated IT platform will promote care continuity, cost savings, and consistent care delivery and business processes."

In their testimony to Congress, Cosgrove and Commission Chairperson Nancy Schlichting, CEO of the Henry Ford Health System, said VistA makes it difficult for outside providers to bill the VA for care provided to veterans. They added that a modern EHR system would generate better metrics about service delivery and performance.

"Years ago, the VHA was a leader in the field of electronic health records," Cosgrove said in his opening statement. "Unfortunately, this is no longer the case. Therefore, the commission believes that the VHA should transition to the same type of commercial off-the-shelf electronic health records as other providers. By using a proven product, many of the scheduling and billing problems would be resolved."