While Department of Veterans Affairs (VA) officials provided an estimated start date of March 2020 for the agency’s electronic health record (EHR) modernization effort, members of Congress called on VA to fully implement the program earlier than VA’s 10-year timeline during a hearing of the House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies on Wednesday.
Rep. Will Hurd, R-Texas, pushed VA officials at the hearing to provide an estimate of how long it would take to shift medical data from the existing VistA system to the new, commercial-based Healthy Intent Platform, developed with health information company Cerner.
“The only thing that is preventing us from using the Cerner platform is getting the old data into a format that Cerner can view – would that be an accurate way to articulate the problem?” asked Hurd
“I would say that’s one of the heavy lifts,” responded Windom.
While VA officials did not provide an exact estimate, they noted that 22 of the 131 instances of VistA have been mapped to the new system, and around 5 billion records are ready to migrate.
“The reason I ask is, if we’ve already mapped one version of VistA to the Healthy Intent platform, I want to know how long that takes, because that should be what we think it takes for all the other 131 versions, so we get a timeframe on how long it takes to do the transition,” said Hurd. “And I know that time period is not 10 years.”
With three test sites in the Pacific Northwest selected, and records prepared, VA has a date for when the first patient will sit down with a physician using the Cerner platform.
“Go-live is expected in March 2020,” said John Windom, executive director of the Office of Electronic Health Record Modernization at VA.
Windom also noted that the initial rollout will focus on the Pacific Northwest region in “waves,” with different centers moving to the new EHR system over an eight-year period. Speaking to Hurd, he noted that the majority of Texas’ VA facilities would see the system in 2022.
But members of Congress expressed a desire to go faster, which VA remains open to doing.
“Hopefully after IOC [initial operating capability] we’ll have a much clearer picture about the roadmap going forward, and hopefully we can accelerate the rollout and maybe even do it cheaper than the projected $16.1 billion,” said John Byrne, general counsel and acting deputy secretary of VA.
Windom added that the rollout includes $4.5 billion in necessary IT infrastructure upgrades for the department, which will need to be deployed across the VA’s medical centers.
Overall, the hearing appeared to increase trust in the program among the subcommittee.
“I said at the beginning, I hope I feel as good at the end of this conversation as I did at the beginning, and I think I do. I think that we actually have dates, we’re seeing movement, we understand some of the problems – I think all of this is a good thing,” said Hurd.
On the subject of cooperation with DoD, Byrne told the subcommittee that a “purple person” is the likely recommendation to replace the Interagency Program Office, the current mechanism for resolving disputes between VA and DoD. While the recommendation has not been finalized, Byrne said the decision is likely to come in the next couple of weeks.
Members also raised concerns about interoperability issues, a major goal of the modernization effort. Rep. Debbie Wasserman Schultz, D-Fla., raised concerns that the Cerner system would not improve efforts to increase interoperability with the private sector. Rep. Martha Roby, R-Ala., echoed those concerns, and raised the specific concern of VA’s existing system serving as an impediment to cooperation with community care providers.
Windom noted that the VA plans to keep its information sharing platforms, and Byrne noted that the move to Cerner would increase interoperability, as data-sharing will be easier for private providers using Cerner products.
Wasserman-Schultz also raised concerns about the credentials needed to access the data of patients, particularly reservists, who receive care from both the VA and Department of Defense. Currently, DoD health information is classified on the secret level, while VA health information is just at the Public Trust level. Windom noted that a solution is in the works to solve the issue, and for the initial test sites, physicians will need to have both a PIV and CAC card.
In addition to the main topic of EHR, Hurd raised a pet peeve of his – the absence of a working capital fund under the Modernizing Government Technology (MGT) Act. Byrne noted that the department found enough discretionary working capital to meet VA IT’s requirements.