Will Cerner rollout at VA advance interoperability? Maybe
When U.S. Secretary of Veterans Affairs David J. Shulkin, MD, made the decision to transition the VA away from its self-developed VistA electronic health record system and onto the same one being rolled out by the Department of Defense, he said he had a big reason for simply picking Cerner instead putting the contract out for bid.
"VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems," said Shulkin.
Cerner has the same expectation, and said implementing the VA system in tandem with DoD's MHS Genesis "will lead to ongoing innovation, improved interoperability and the creation of a single longitudinal health record that can facilitate the efficient exchange of data among military care facilities."
Other interoperability leaders also cheered the news. David C. Kibbe, MD, president and CEO of DirectTrust, said the choice represented a "banner day" for data exchange, since "Cerner has been a champion of Direct as a national standard for ubiquitous, easy, secure, interoperable health records exchange via Direct."
VA's Cerner pick makes it "that much more convenient and economical for Direct exchange and messaging to become a major source of interoperable health information exchange between the federal agencies," he said, "particularly the Defense Department and the VA medical facilities, and hospitals and medical clinics in the private sector using Direct exchange through their own EHRs."
In fact, Cerner's reputation for embracing interoperability – not just its support of Direct but its founding membership in groups such as the CommonWell Health Alliance – was also one of the big selling points when the DoD chose it over its close competitors back in 2015.
The company has been "one of the more proactive EHR vendors on the interoperability front," said John Moore, founder of Chilmark Research. "Years ago they partnered with a third party HIE vendor, Certify Data Systems, to support interoperability between Cerner instances and those of other EHRs."
Based that history, Moore said Cerner will be "more than capable in supporting interoperability between its system at VA hospitals and the disparate EHRs among community healthcare providers outside the VA system."
The VA's choice of Cerner "will greatly simplify interoperability with the DoD, something that has long been a both a real problem and political headache for both the VA and DoD," said Moore.
But it may not always be quite as "seamless" as Shulkin seems to expect. Cerner has earned high marks from groups such as KLAS, especially when it comes to connection across complex interfaces, for instance. But it's also been dinged for challenges related to internal exchange.
In a 2015 report that ranked Cerner third for interoperability, KLAS noted that the company is nonetheless "rated lower by clients for higher integration costs and the lack of a simple switch to turn on sharing with other Cerner clients." It said that resonance – the ability to query and retrieve data between Cerner customers – is "not taking off."
Whether or not that's improved over the past two years will be up to the DoD and VA to see for themselves. But in the meantime, Moore thinks the Cerner choice may be something of a missed opportunity for interoperability more broadly speaking.
"While decision makes sense, if VA picked a different vendor, Interop may have advanced further," he tweeted when the Cerner selection was announced earlier this week.
It's a point Moore made earlier this spring, when he told Healthcare IT News that, given the VA's sheer size, it's in a unique position to push the needle on interoperability industry-wide.
"Choosing another vendor besides Cerner may actually force leading industry EHR vendors to truly address interoperability at a far deeper level than what has been done to date," he said.
That was certainly one of the hopes back when DoD embarked on its own EHR modernization project. At the time, Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, said the move "allows us to pivot toward the future – but also forces others to pivot toward the future," and would hopefully help nudge "the private sector to be able to exchange information in a very efficient way, in a very timely way."
In announcing the choice of Cerner this week, Shulkin emphasized that the vendor was just one of many who would have to make this large-scale endeavor work.
Given that more than one-third of veterans get care at providers outside the VA system, the EHR overhaul "is going to require this integration with other vendors to create a system for veterans so that they can get care both in the community as well as in the Department of Defense," he said.
"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, of federal agencies working together, but for all of healthcare that is trying to seek this type of interoperability."
That would be ideal, of course. But some have raised concerns that the size of the combined DoD-VA deployment – in parallel with other vendor hegemonies in the private sector – may simply lead to more large-scale networks with easy interoperability within themselves, but not with each other.
After all, shortly after the Cerner choice was made its rival, Epic, released a statement touting its own work on the VA scheduling project – and reminding us that it is "the largest electronic health record vendor in the United States, covering two-thirds of the nation’s patients."
Epic and Cerner are called the "Coke and Pepsi" of EHRs for a reason. In a world of consolidation (now accelerated, arguably, by the fact that who-knows-how-many providers may soon be fleeing eClinicalWorks for other vendors), it will bear watching to see what deployments of this scale will mean for larger data exchange efforts.
(Healthcare IT News Associate Editor Jessica Davis contributed to this story.)