A long slog ahead for VA health record modernization

Congress breathed a collective sigh of relief at the announcement from Department of Veterans Affair Secretary David Shulkin that the agency would be switching from its homegrown electronic health record system to a commercial system from Cerner.

The move, which is expected to result in a multi-billion dollar sole-source contract with Cerner and subsequent integration contracts, is designed to put the VA in line with the software being implemented by the Department of Defense in their MHS Genesis system.

But it could take a decade to get from the announcement to end state, according to public comments from top VA officials, and some members of Congress don't understand what the holdup is.

"Seems like you just go pick it up off the shelf. That's what Secretary Shulkin was talking about," said Rep. John Rutherford (R-Fla.) at a June 21 hearing of the Health Subcommittee of the House Veterans Affairs Committee.

Dr. Poonam Alaigh, currently the VA's acting undersecretary for health, tried to manage expectations and offer context at the hearing.

"This is not something you do with the turn of a switch," she said. "It has to be done very carefully."

Alaigh characterized the move as "one of the largest implementations ever for any health care system," and the time required will help ensure patient safety during the transition and the retention of decades of health data.

Shulkin touched on some of the complexities attending the transition in remarks to reporters at a June 20 breakfast hosted by the Christian Science Monitor. He noted that interoperability with Vista system will be a unique challenge.

"We have 30 years of really useful data, but also innovations that have been developed by our clinicians. I'm not willing to give up on that. DOD did not build back into their legacy systems the way that we're going to need to," Shulkin said.

Alaigh also said VA would not be seeking supplemental funding for the shift to the new system in the near future. She said one the big lessons learned from the DOD's procurement of a commercial system was that, "the first two years is really about change management, going through the specifications and making sure the standards aligns."

The change management includes getting the more than 305,000 health care professionals employed at VA on the same page when it comes to the new work flow that comes with new software. Additionally, Alaigh noted, VA's brand of care with its focus on teams will mean that the agency is "going to have to customize a lot of those standards and specifications." She added that "implementation cannot be at top-down approach; it has to be a bottom-up approach."

From a budget perspective, she said, VA has enough money to support change management, data specifications and field assessments.

"It's going to be in year three that we're going to be asking for additional, and significantly additional funding to be able to implement it," she said.

FCW editorial fellow Ben Berliner contributed to this story.