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The interoperable healthcare our Veterans deserve 4

Veterans and active service members have served our country with honor. We owe them respect, gratitude and an effective healthcare system that delivers seamless care to them and their families, no matter where they see a healthcare professional.

Under the leadership of Secretary David Shulkin, the Department of Veterans Affairs (VA) has taken important steps to advance its core system. In June, the VA announced its decision to replace its homegrown electronic health record (EHR), called the Veterans Information Systems and Technology Architecture (VistA), with a commercially available, current EHR system.  

We welcome the VA’s modernization efforts because it will be good for our Veterans as patients. The VA has been using the VistA platform since the 1970s, and it has proven to be very limited in its capabilities when it comes to interoperability. A move to a commercially available, current EHR system promises to provide a solid foundation to better manage the continuity of care.

Looking beyond the EHR

The VA is aware that delivering high-value, informed care to Veterans is going to require a strategy that looks beyond the EHR. It must address the challenge of connecting whatever EHR system is ultimately installed, VistA and the DoD’s current EHR to each other and community physicians seeing active and retired personnel as part of the CHOICE program. This strategy is particularly critical when it is projected that up to one-third of Veterans receiving care in the VA health system today soon could be receiving care from those private providers outside of VA facilities, and this number will only continue to grow in the coming years. There is a very real community care coordination challenge facing the VA and DoD today.

There are literally hundreds of certified EHRs in use today in the United States. Veterans and their families need to know that medical information from the many diverse sources outside the VA – other commercial EHRs, HIEs, military, private hospitals and practices – is also available to VA clinicians in a timely and clinically-relevant manner.

There are three main capabilities the VA must prioritize as its leadership strategizes to advance healthcare for Veterans so that it is just as effective as the care our civilian population receives:

  1. Combine and share patient data in a meaningful way – An interoperability solution must be implemented to aggregate, normalize and semantically harmonize data from the VA, DoD and private providers using a wide range of EHRs. Once transformed into a single comprehensive view, the data should be available in an actionable format to VA clinicians at the point of care. This enables seamless, API-powered care coordination, which over the next five years must also include data around mental health and precision medicine (e.g., genomics).
  2. Discover and manage care for at-risk Veterans – Clinicians need to be able to stratify Veterans by risk, identify gaps in care and monitor each Veteran’s health via digital dashboards that include data from their own EHR and those across the Veteran’s Community Care team (CHOICE providers, for example).
  3. Enable two-way digital engagement – Veterans deserve a secure, bidirectional, EHR-agnostic digital access point to their data so they can more effectively engage in their own care. They should have access to enhancements that include built-in self-scheduling features, outreach and preventive engagement functionality, and telehealth for on-demand and rural visits. Veteran-generated data can then flow back to the VA EHR and automatically update records to help the care team monitor progress toward a more productive, healthy outcome.

The VA is headed in the right direction; it is striving for an actionable, community-aware health solution. Its new EHR will be an important first step, but the capabilities that will magnify the power of that new EHR should also be fast-tracked, in parallel to the EHR, to all caring for our nation’s Veterans on existing platforms. 

We owe it to our Veterans to speed the transformation of the care process, because as the Iraq and Afghanistan Veterans of America said in June, “Seamless electronic record-keeping has vexed the government for far too long.”  Now is exactly the right time to change that.

4 Comments

Comments (4)

James Rossiter

Well stated Paul. The COTS EHR is an important long term element for an affordable and interoperable Healthcare Record. It should not be overlooked that there is already a tactical interoperable layer that is available for veterans, active military and Medicare patients alike with the open Bluebutton and Direct standards. These can enable important exchange of CCDa information from this vast set of patient information. The reality is that our interoperability strategy for healthcare will be a complex hybrid set of solutions for many years to come. But bringing these archaic and proprietary source systems into the modern standards based era is an important step that will greatly improve the cost and accessibility of this important group of patients.

Joe Case

I don't have a problem with buying a more modern system. I also think it's possible with health a care system as large as the VA they could justify a build their own project. I would not be surprised if they have more users of their product then all combined users and customers of the some of the many certified systems. I think you are correct their system was built many years ago and they have not chosen to integrate with the rest of the nation, they are not integrated they are stuck on an island. I think the biggest loss in changing systems is that most companies in the market today don't want to convert their data they want to start over build from scratch and then staff have to navigate 2 systems for many years and productivity and decision making is slower and slower. You have a system and a process that is slow and now you add a second system and it gets slower. Consider doing what you have not done, add a bidirectional interface to your current system, let data flow out of and into other systems, including whatever company you plan to buy. Submit new and old orders, submit new and old results. Plan on converting 10 or 20 years of historical data so you have something to work with when you go live. I hope the VA chooses a good product and I hope they convert their data.

Steve66

"Paul spent more than 13 years with Cerner Corporation in various executive positions, retiring as Cerner’s chief operating officer in 2007. " That totally explains his "advatorial".

Leigh Burchell

Thanks for your comment. Paul is supportive of the VA's decision to modernize its health IT system because a new EHR is the first step to doing the right thing for Veterans and their families. The point of the article was not the EHR implementation itself, however, but rather the interoperability components that will need to be layered on top of the new EHR for Veterans to achieve the benefits of connected care. There is important work to be done outside of the work implementing the EHR.

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