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GAO Details Failed VA EHR Initiatives as Agency Requests New Interoperability Rule


The VA's pending arrangement with Cerner will be its 4th crack at EHR modernization since 2001.

The Government Accountability Office (GAO) officially released a report late last week about ongoing efforts at the Department of Veterans’ Affairs (VA) to adopt a new, modern electronic health record (EHR) system. The agency has plans to move on from its legacy VistA platform—developed in-house decades ago—to an offering from Cerner.

The new report breaks down how the VA spent over $1 billion since 2001 trying to modernize VistA before finally deciding to move on in the summer of 2017. That number came up during a meeting of the Information Technology Subcommittee of the House of Representatives in December, but the newly-released report provides further insight into where the money went while 3 previous efforts were abandoned along the way.

The first initiative, HealtheVet, began in 2001 and was expected to be completed by this year at a cost of $11 billion. After a 2008 GAO report found serious planning and governance issues, the program was halted in 2009 and terminated a year later.

In early 2011, that was replaced with iEHR, meant to replace separate VA and Department of Defense (DoD) systems with a single shared EHR exchange. The program was to be built with 54 clinical capabilities, delivered in 6 installments between 2014 and 2017. Less than 2 years after it was announced, however, the VA and DoD jointly decided to terminate the program, which was expected to cost $29 billion through a 17-year life-cycle. Only $224 million was allocated before abandonment.

That plan was again replaced in 2013 with VistA Evolution, meant to instead modernize the legacy system at a more modest price of $4 billion. The report actually notes that the program is still running, and has “completed a number of key activities that were called for in its plans,” such as the creation of a real-time EHR data viewer called the Joint Legacy Viewer, as well as interoperability capabilities with the DoD that allow physicians within the health systems to view sensitive data, like abnormal test results.

Other aspects of the VistA Evolution have been abandoned. The unfinished program cost the agency $880 million, $144.5 million of which went to consulting firm ASM Research. HP Enterprise Services, Booz Allen Hamilton, and Systems Made Simple each earned over $50 million off the program.

Electronic Health Records Modernization (EHRM) is the official name of the fourth and, as the agency hopes, final plan. As VA Secretary David Shulkin, MD, announced in 2017, the intent is to get the agency “out of the software business” by switching over to Cerner’s system in tandem with the DoD.

While the DoD’s contract with the vendor is finalized and transitions have begun at some systems, however, VA still hasn’t finalized a deal. The report says that’s “anticipated to occur in early 2018,” and that development of detailed plans should be completed within 90 days afterward.

“The department’s continued dedication to completing and effectively executing the planning activities…will be essential to helping minimize program risks and guide this latest electronic health record modernization initiative to a successful outcome—one which VA, for almost two decades, has been unable to achieve,” the report concludes.

Meanwhile, the agency has proposed a rule to amend data sharing environments imposed on the agency to allow health information exchange (HIE) partners to release VA health records to providers even in the absence of a patient’s physical consent.

According to the proposal, the rule would “facilitate modern requirements for the sharing of patient records with community health care providers, health plans, governmental agencies, and other entities participating in electronic HIEs,” and “ensure that more community health care providers and other HIE community partners can deliver informed medical care to patients by having access to the patient’s VA medical records at the point of care.”

The rule would only apply to VA patients, and is now open for a 90-day comment period.

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