VA Secretary Promises Decision on Whether to Go to Commercial Health Records

Newly confirmed Veterans Affairs Secretary David Shulkin promised Tuesday his department would decide by July whether to move to a commercial health records system.

It’s a decision Shulkin said should have been made years ago.

“From my perspective, I wish this decision had been made by a prior secretary,” said Shulkin, speaking at an event hosted by Politico. “It’s been kicked down the road. If I could back up time, I believe it’s a mistake to not have made a decision with [the Defense Department] at the time. I’m not saying who made the mistake.”

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But, Shulkin said, for VA to not have decided on its health records future when DOD opted to pursue a health records platform from a commercial provider in 2014 “was a mistake.”

For years, the two agencies wasted over $1 billion attempting to make health record data from soldiers and veterans interoperable. VA’s system, called the Veterans Health Information Systems and Technology Architecture, and DOD’s legacy health records system, eventually managed workarounds to achieve a semblance of interoperability, but not until after DOD pursued its own system.

In 2014, DOD awarded Leidos and EHR developer Cerner its Defense Healthcare Management Systems Modernization contract worth up to $9 billion, and pilots of the new system began rolling out early this year.

“The VA knows who its customers are, and its customers come from one source: the Defense Department,” Shulkin said. “To not have an integrated system was a mistake.”

VA is carefully weighing its options, he said. Its VISTA system, which revolutionized health care decades ago, is outdated. Either VA will stick with VISTA and make potentially significant investments to improve it or it will begin the process of moving to a commercial product this summer, Shulkin said.

VA is conducting cost reviews to gauge what a modernization of VISTA might run, and Shulkin declined to say whether estimates ranging from $8 billion to $16 billion for a commercial offering to service its 9 million-plus beneficiaries were accurate.

“I’m not approaching this decision-making this summer purely or largely from the financial point of view,” he said. “My No. 1 goal is to come up with a strategic direction that makes sense for VA, and then worry about the financial cost. If we run a strict management process and take change management seriously, we’ll be able to do it for a lot less.”

In any case, Shulkin clarified the July decision will only be the beginning of “a lengthy process,” whichever direction VA takes. Once the decision is made, the acquisition portion of the process will come into play, and law states it must be an open, competitive process.

“[Deciding which way to go] is not the same as deciding what system we’ll use,” Shulkin said when asked whether VA ought to pursue the same EHR as the Pentagon. “We’re not going to rush into things. I’m not going to be backed into a time frame.”

Yet, VA is watching DOD’s EHR rollout intently. Shulkin said VA has “a lot to learn from what they’re doing in change management, let alone technology.”