EHR tension heats up between VA and Congressional Appropriations Committee over modernization plans

Claiming that it was 'startled' by VA officials' recent testimony, the committee put strict conditions on full funding that a Senate committee already approved.
By Jack McCarthy
08:15 AM

A U.S. House committee has made funding the Department of Veterans Affairs VistA electronic health record contingent on a number of points, including proving interoperability with the Defense Department.

Expressing concern about recent testimony before the House Veterans Affairs Committee, the House Committee on Appropriations has made VA funding contingent on a series of requirements to achieve interoperability.

VA CIO LaVerne H. Council clarified in her testimony before the House Veterans Affairs Committee (HVAC) that the Department is evaluating plans for a holistic, state-of-the-art digital healthcare platform that is not limited to an electronic health record.

“If VHA is going to provide health care in the future and today, it needs to move into a digital platform, and that’s what we laid out,” she said. “The EHR today is just the heartbeat of the organism. A digital health platform has the world-class tools and technology we need to manage priorities like community and specialized care. It is responsive. It is agile. It encourages innovation on behalf of public health.”

The committee, in its draft report on the Military Construction, Veterans Affairs, and Related Agencies Appropriations Bill of 2017, said that while disappointed that Department of Defense and the VA chose to develop two different health record systems, it was reassured by both agencies that the records will be interoperable.

Recent testimony by VA officials of plans to move away from the VistA EHR system, however, has raised eyebrows.

"Committee members were startled to learn during the recent hearing with the Secretary that VA is rethinking the approach it previously chose (to modernize its VistA electronic health record) and is now considering other options, including purchasing a commercial off-the-shelf product," the report said. "The Committee is concerned about what implications this detour will have on the completion time for the project (previously promised for 2018), its cost, and the usability of the VistA modernization products already completed."

VA Undersecretary for Health David Shulkin, MD said in a Congressional hearing last week that the department is facing a choice between ongoing modernization of the 40-year old VistA or to evaluate options for future healthcare technology.

Council testified in the same hearing that the partnership shared by Shulkin and herself resulted in the plans for a digital health platform that will bring capabilities VistA doesn’t have today, notably clinical management, hospital operations, patient experience and predictive analytics.

Council described the particular EHR as leveraging the emerging FHIR (Fast Healthcare Interoperability Resources) standard for interoperability, bringing a user interface that resembles Facebook and Google, and existing as a cloud-based service.

This week the House Appropriations Committee also expressed doubt about those plans.

"Especially with the uncertainties VA has now introduced regarding the development, timing and cost of its electronic health record, the Committee continues its practice of including language requiring VA to provide information on cost, timeline, performance benchmarks, and interoperability capacity of whichever electronic record system it ultimately chooses before release of the funding provided," the report authors noted.

If it changes its EHR platform, the VA, to get full funding must show it has met the interoperability required in the 2014 National Defense Authorization Act by December 31, 2016; provide the business case for VistA Evolution that is guiding VA's considerations; provide a strategic plan, lifecycle cost estimate and master schedule for any system chosen; and describe the implementation plan for the transition from the Project Management Accountability System to its new project delivery framework, the Veteran-focused Integration Process.

Until then, the committee said it wanted to continue requirements "to fence a portion of the funding ($168 million) provided for the electronic health record until VA provides requested information listed in the bill language."

This story has been updated to reflect the fact that the VA does not currently intend to purchase a commercial, off-the-shelf EHR.

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