VA expects to add an integrator to health record mix

The Department of Veterans Affairs expects to strike a deal with a commercial electronic health records provider Cerner in about four months, and after that it will begin the process of finding a vendor or vendors to handle some of the tasks of integrating the new system with the VA's homegrown legacy Vista system.

"Right now my issue is getting there quickly," VA Secretary David Shulkin said about the shift to a commercial system. "I've determined the best way to do this is directly with Cerner, and we will be looking for help from what I'd call an integrator through separate procurement," Shulkin said at a June 20 breakfast with reporters hosted by the Christian Science Monitor.

The VA is going to face some tough hurdles in delivering a commercial system to its thousands of locations -- not the least of which will be designing the Cerner record to be interoperable with legacy data and applications.

"We … have a strong need to build back in ties to our current electronic medical records. 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.

The Defense Department entered into a $4.3 billion contract with a vendor group led by Leidos that included Cerner and Accenture to license the electronic health record software and do implementation and training across military facilities worldwide. The VA has a larger patient base and more complex needs, Shulkin noted. While he didn't comment on the price tag of a VA commercial system, it is expected to exceed the DOD contract.

Shulkin said that VA has been working with Pentagon contracting officials to benefit from the two-year DOD Healthcare Management System Modernization procurement that resulted in the adoption of the Cerner record. That experience, the VA chief said "has essentially, I think, carved years off our process" for change management and procurement.

VA has set up a program office for the procurement that includes Christopher Miller, who managed the DHMSM acquisition at the Pentagon.

Leidos is watching VA's planned shift to the Cerner health record closely.

"This is frankly faster than we would have expected VA to move," Leidos CEO Roger Krone said at a June 14 investor conference in Boston hosted by Citi. While there are no formal solicitations or drafts out yet, Krone said he sees a role for Leidos to help VA with the integration.

"We have had some very top-level conversations with folks at VA about the value we have provided and Leidos' ability to reduce the risk of implementation," Krone said. "I'm not sure how that will manifest itself in contracts -- whether we'll be a sub to Cerner or there will be a separate integration contract or we provide advisory services, but we're starting from a position where we had very little presence in [electronic health records] at VA, to where they've made a strategic decision to harmonize with DOD where we have the prime contract, and they picked our set of vendors," he said.

More COTS for VA

Vista permeates the VA enterprise  --  not just in health records but in scheduling, procurement, facilities management and other functions. Shulkin said that he was pushing ahead with plans to go commercial across the VA enterprise. He cited a recent procurement for an off-the-shelf scheduling system and a financial system upgrade.

"You'll see more and more of these types of announcements as we start replacing these systems," Shulkin said.

At the same time, he said that Vista was going to have a long sunset.

"We will be living off of our Vista system for years in the future because you can't essentially make the transition in all these systems all at once," Shulkin said. "It has to be done in a way that we're not dropping any data or dropping any services. This is going to be a slow transition, but what we've done is set the path toward future modernization of all of our IT systems," he said.