Shulkin doubles-down on EHR modernization as price tag swells
U.S. Department of Veterans Affairs Secretary David Shulkin, MD, has been under fire by the Trump administration for more than a month, but the negative headlines haven’t stopped Shulkin from continuing his work to modernize the VA healthcare infrastructure and improve veterans’ care.
“I publicly acknowledge the distraction is something I deeply regret,” Shulkin said during a hearing with the House Appropriations Subcommittee on Military Construction, Veterans Affairs and Other Agencies on Thursday.
“I’ve come here for one reason, and that’s to improve the lives of veterans,” he said. “And that’s what I’m focused solely on doing. There are a lot of people that, frankly, are more interested in politics than I am. I’m interested in getting this job done.”
And that job is to improve the VA’s outdated EHR infrastructure. Shulkin reiterated much of what he told HIMSS18 attendees: that the agency is working closely with the Department of Defense to make sure they get it right.
However, Rep. Charlie Dent, R-Pennsylvania, expressed concern over modeling the VA’s EHR after the DoD MHS Genesis, given the issues plaguing the four pilot sites. But Shulkin said that the lessons learned from those pilots will be applied to the VA implementation.
“We’re using their lessons to make sure our contract reflects the issues that we’ve learned. But also that we’re going to have a smoother implementation,” said Shulkin. “I am confident that we made the right decision here.”
Shulkin has been part of two EHR projects in the past, arguably none of this size, but he explained that he’s also working with clinical leadership and VA clinicians to make sure the project is successful.
Further, VA will roll out one VistA instance at a time, while involving clinicians in the process.
“If you don’t have involvement from your clinicians, you might as well not start at the beginning,” said Shulkin. “That is the absolute key: Having this be driven through our clinical leadership and our clinicians, is going to be the factor that is successful.”
The pause on signing the contract with Cerner -- which was expected to be signed in the fall -- is being used to “make sure we have the interoperability with community providers, since 36 percent of vets receive care in private sector,” said Shulkin.
But the number of veterans receiving care outside of the VA drew ire from Rep. Debbie Wasserman-Schultz, D-Florida.
“Is anyone pushing you toward the privatization of veteran care?” she asked.
“I’ve been clear that I think this would be the wrong decision for our veterans to privatize VA care,” said Shulkin. “I’ve also been clear that VA can’t do this alone: So we have to have a rational system that allows veterans to be able to understand what the choices are… [to] be able to get the best care that they can from the VA.”
“We have problems that I acknowledge and that we have to fix,” he added. “The right choice here is a system that allows for a strong internal system that’s working properly, along with taking advantage of working with the private sector, when veterans can benefit from those services as well.”
Another notable point brought up by Shulkin and Congressional members was the price tag. Up until recently, the cost of the project was estimated at $10 billion. But Wasserman-Schultz threw out a figure of $16 billion during the hearing and House VA Chairman Rep. Phil Roe, R-Tennessee, mentioned a $15 billion budget on Monday.
Just last month, Roe balked at just a $10 billion price tag for the project, especially given the amount doesn’t cover maintenance or the cost to update the infrastructure necessary to support the new EHR.