Congress offers $65M as down payment on Vista replacement

House appropriators are budgeting $65 million for the Department of Veterans Affairs to launch its plan to acquire a commercial electronic health record system, but the funding comes with conditions.

The Appropriations Committee released the 2018 VA and Military Construction Appropriations bill on June 11, and a markup of the legislation is expected to be held on June 14.

The $65 million, according to a committee release, "will ensure the swift implementation of the plan for the VA to use an identical electronic medical record system as the DOD."

VA Secretary David Shulkin plans to shift the agency from Vista, its homegrown electronic health record system, to  a commercial solution from Cerner to provide interoperability with the Defense Department and with community providers.

There's no timeline yet on the project. Shulkin said he expects to have a plan in place to launch a formal acquisition process within three to six months.

Shulkin is also facing workforce challenges as the procurement goes forward. At a June 14 hearing of the Senate Veterans Affairs Committee, the secretary said that candidates for the CIO and the CFO positions had pulled out of consideration. While he praised the people in the acting roles, he said it was critical to have political appointees in place for key positions.

Sen. Joe Manchin (D-W. Va.) wanted assurances from Shulkin that the VA wasn't going to get "taken for a ride" on the sole-source procurement with Cerner.

"We certainly know the price that DOD paid, and we know the price we are currently paying to maintain our systems," Shulkin said. "We're seeking the best way to do this for taxpayers."

In July 2015, the Department of Defense awarded a group including Cerner, Leidos and Accenture a $4.3 billion contract to supply a commercial electronic health record system. The VA health system is much larger, and estimates for a commercial replacement to Vista have ranged as high as $16 billion.

House appropriators are eager for the project to go forward.

"The implementation of an effective electronic health record system that provides integrated service between the Departments of Veterans Affairs and Defense has been a bipartisan priority and goal for a long time," said Rep. Charlie Dent (R-Pa.) who chairs the appropriations subcommittee that funds the VA.

The planned funding for the VA does have some conditions. The committee wants detailed explanations of the solicitation to Cerner and information on how the company's electronic health records system would replicate and interact with the MHS Genesis System fielded by the Department of Defense as well as achieve interoperability with community health care systems. Lawmakers also want details on how the transition from Vista to Cerner will work, including cost estimates, training and change management.

VA will have to meet those conditions in order to obligate or spend more than 25 percent of $418 million in planned IT modernization funding.

On the Senate side, Jon Tester (D-Mt.), the ranking member of the Veterans Affairs Committee and also an appropriator, cautioned the secretary not to wait on his request for supplemental funding for the new electronic health record system.

"You need to be asking us to plus that money up," Tester said.

Shulkin has a wish list of his own. He's seeking new authority from Congress to increase the threshold for transferring funds between IT project accounts from $1 million to $3 million. He told senators June 14 that the move would "increase the department's ability to apply agile program management techniques to the dynamics of modern information technology development requirements." Shulkin assured lawmakers in his written testimony that Congress would "maintain visibility of proposed changes," through a certification program.