VA wants new budget line for commercial health record

The Trump administration plans to establish a $1.2 billion budget account for modernizing the electronic health record management system at the Department of Veterans Affairs.

The budget line goes beyond simply paying to adopt the Cerner EHR system to sharing infrastructure and common software with the Department of Defense, as was announced by VA Secretary David Shulkin in June 2017.

The Cerner deal is expected to be wrapped up by the end of February, according to VA CTO John Short. On a budget call with reporters, Short said that a report on interoperability between the Cerner system and existing commercial products made at Shulkin's request was completed and has been shared with Congress and the Office of Management and Budget.

John Windom, the program manager for the new health record acquisition, is headed out to Cerner's Kansas City headquarters to "finalize those changes over the next couple of days," Short said. After that, leadership will have its input, and Congressional appropriators will approve a requested fund transfer of fiscal year 2018 money to begin work on the project.

The 2019 budget line puts the modernization project outside the Office of Information and Technology, the entity created in 2005 to try to standardize and unify authority over IT spending across the sprawling hospital system and multidepartmental bureaucracy.

According to VA budget documents, the $1.2 billion for the new office includes $675 million for the Cerner contract, $120 million for program management and $412 million for infrastructure support.

The office is headed by Windom, a retired Navy captain who once led the Pentagon's open procurement of an EHR system, which resulted in a $4.3 billion 10-year deal with Cerner.

The new office is taking on a major role in preparing VA's infrastructure for the Cerner system -- to handle the bandwidth demands and to adopt Department of Defense security standards.

According to the budget document, the modernization of the present homegrown VistA system also falls under infrastructure support. As Vista is phased out over the 10-year project, it will be standardized. The budget document notes that "standardized VistA improves communication across the VistA ecosystem [and] reduces training time and costs … during the period of several years when EHRM and VistA are both operating simultaneously."

The administration is requesting $4.185 billion for VA's OI&T, a slight dip from the enacted 2017 allotment of $4.270 billion.

According to VA chief financial officer Jon Rychalski, OI&T still has to support the onboarding of a planned 7,000 new employees and upgrades to agency financial management systems, which is why the addition of health record related funding to the new budget line doesn't result in a steeper cut at OI&T.