VA chief talks commercial Vista

Oversight officials in Congress -- in both chambers and on multiple committees -- are vexed, perplexed and frustrated by the seeming inability of the Department of Veterans Affairs to make its electronic health record system work seamlessly with systems deployed by the military and the private sector.

"You could be the best VA secretary of all time if you solve this one problem," Rep. Thomas Rooney (R-Fla.) told VA Secretary David Shulkin at a May 3 appropriations subcommittee hearing.

"I don't want to have another hearing on interoperability," said Rep. Nita Lowey (D-N.Y.), the ranking member of the House Appropriations committee.

Shulkin has heard it all before. At the hearing, he commiserated with members who have been waiting for a fix to this problem -- one that affects veterans in every congressional district. But as a two-year veteran of the VA system and a private-sector hospital administrator, he understands the difficulties of uprooting and changing medical IT systems.

"If there was an easy solution here, it would have been made already," Shulkin said. "This is a highly complex issue. I've lived through electronic medical record conversions at hospitals I've led. These are not easy projects at single hospitals." A change at a system the size of the VA, he warned, would be several orders of magnitude more difficult.

But one way or another, the system is going to change, if Shulkin has his way.

The VA should be proud of inventing the Vista system, Shulkin told lawmakers, "but frankly that's old history."

The secretary is planning to issue a decision in July about the future of the VA's electronic health record systems. Either VA will opt for an off-the-shelf system, as the Department of Defense has done with the Cerner health record, or else it will "find a commercial company that will take over and support Vista."

The idea of commercializing Vista is the subject of two recent solicitations. One asks how the core Vista code might be corralled into a single cloud-based instance and taken over by a private company; the other seeks information on how VA's digital health platform could work with multiple health records including commercial systems and Vista.

"VA has to get out of the business of being a software developer," Shulkin said. "This is not our core competency, and I don't see how it serves veterans."

Shulkin also pledged to lawmakers to improve the way the veterans agency and DOD work together. He said he has discussed more and better cooperation with Defense Secretary Jim Mattis.

"You have asked DOD and VA to work together probably for 10 to 15 years. We've always found ways not to do that," Shulkin said.