VA secretary: Cerner EHR choice brings big clinical gains
Veterans Affairs Secretary David Shulkin, MD, said he was speaking as a physician when he said choosing Cerner to replace VistA was "the right thing to change veterans' healthcare."
Addressing reporters at the White House daily briefing on Monday, Shulkin said that "having an electronic health record that can follow a veteran during the course of his treatment is one of the most important things you can do to ensure their safety, health and well-being."
For 17 years, Congress has called on VA to "not only modernize its system but work more closely with the Department of Defense," he said – but still each agency has forged ahead with different EHR systems.
"We've been able to advance interoperability – at the cost of hundreds of millions to the taxpayers – but today we still have separate systems that do not allow for the seamless transfer of information," said Shulkin.
After "years and years, we're able to read each other's records," he added, "but what we're not able to do is be able to work together to plan treatment – to go back and forth between the Department of Defense and VA."
By making the decision to not put the EHR project out to bid and instead "do a direct acquisition of the EHR currently being deployed by the Department of Defense," Shulkin said speed and efficiency were among his top motivations.
"I'm not willing to put this decision off any longer – 17 years has been too long," he said. "I don't think we can wait that long with the health of of our veterans."
In moving the Cerner Millennium-based MHS Genesis system, patient data for active-duty service members and veterans alike can "now reside in a common system, so you will have this seamless link between departments without the manual exchange of information," said Shulkin.
Such seamless interoperability will have many clinical benefits.
By enabling one single lifetime record from the time a service member enlists, "there will never be a need to go back and forth and say, 'Records aren't there for me,' or, 'My doctor isn't able to have input into what the Department of Defense is doing,'" he said.
Shulkin hopes to improve quality and care coordination for one area in particular.
"My top clinical priority is to reduce veteran suicide," he said.
"One of the areas we've identified is a gap in the transition – when you leave the military, and all of a sudden you no longer have that structure you were used to," he said. That liminal period, after active duty but "before you get enrolled either in VA healthcare or community healthcare," can be dangerous to vulnerable veterans.
"That no longer is going to happen," he said. "We're going to have a seamless ability to know if the information is there. So to a veteran who is experiencing emotional disorders, when they reach out for help, it's going to be easier to get them help. To other people with physical problems, that same information is going to be there so you can develop a coordinated care plan."
Other vendors called upon to join in
For all the critical similarities in their patient populations and clinical imperatives, "VA has unique needs that are different from the Department of Defense's," said Shulkin. "And for that reason, VA, while it's adopting an identical EHR to DoD, needs additional capabilities to maximize interoperability with our community providers."
One-third of VA patients receive care out in the community, after all. So it's "critical," he said, "that we have the same interoperability with our community providers."
That's going to "require integration with other vendors," he said, "to create a system for veterans, so they can get care within the community as well as at the Department of Defense. That's going to take the active cooperation of many companies and thought leaders, and it will serve as a model – not only for the federal government but for all of healthcare, which is trying to seek this type of interoperability."
From the early stages, Shulkin said, "we're going to have our VA clinicians very involved in how we design this system, and how we implement it. Because in many ways VA is actually well ahead of DoD in clinical IT innovation, and we're not going to discard all the things we've done in the past."
In fact, he said, "that's how we're going to help DoD get better. This is a system that's going to care for veterans and our active service members."
Shulkin thanked President Donald Trump (whose administration has done well "eliminating silos and turf battles"), the DoD (Defense Secretary Michael Mattis has shared some key DoD execs who are already at the VA and sharing institutional knowledge to help smooth the transition, he said) and Jared Kushner's American Office of Innovation for helping the project along.
There are "no guarantees," he said. "This is high-risk." But by working with DoD, "we are lowering our risk," he added. "This is the most cost-effective way to go to an off-the-shelf product.
"This mission is too important for us not to get right," said Shulkin.