Massive VA Reform Bill Looks to Improve Interoperability with Private Sector

Memorial Day proceedings at Arlington National Cemetery in 2007. Image courtesy the Department of Veterans’ Affairs Flickr page.

The VA MISSION Act of 2018, as the major Department of Veterans’ Affairs (VA) policy, funding, and reform legislation passed yesterday is officially titled, contains a lot to unpack. The sweeping $50+ billion bill orders a review of the agency’s infrastructure, endorses its growing telehealth program, changes the way veterans are reimbursed for VA care, and requires the health network to participate in a national prescription drug monitoring program.

It also represents an expansion of—or, a more permanent replacement for—the VA Choice program, first passed in 2014 to give veterans more latitude to seek care from private providers. Widening that program, however, raises questions about interoperability.

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Andrew Cohen, MD, a VA doctor and former administrator in Rhode Island, told Healthcare Analytics News™ earlier this month that the agency’s legacy electronic health records (EHR) system—Vista—is difficult for non-VA entities to access. “If you’re not at the VA, [it] requires going through a number of complicated security barriers—for reasons that are self-evident, but the VA might make it more difficult than it should be,” he said.

The new legislation requires the bureaucratic burdens be eased. It amends the agency’s consent for release of medical records to allow simpler sharing with non-VA entities “for purposes of providing health care, including hospital care, medical services, and extended care services, to patients or performing other health care-related activities or functions.” The previous wording was narrower, and stipulated that such sharing could only be done “as authorized by the Secretary.”

Health information firm leaders quickly applauded that change—and the bill as a whole. Sequoia Project CEO called it “an important fix” that will “unlock veteran health records to enable the providers who care for veterans to make better informed decisions” regardless of whether they’re being treated outside the VA. eHealth Exchange Vice President Jay Nakashima said that success in improving interoperability with the VA “was limited by an outdated congressional mandate—until now.”

David O. Barbe, MD, president of the American Medical Association, said that his organization “believes every veteran deserves timely, accessible, high quality health care — whether within or outside the VA system,” saying that the new legislation is “a bill that is worthy of our veterans.”

Of course, these changes come as the VA is about to tackle an unprecedented interoperability challenge: The largest-ever EHR implementation project. After months of delays and confusion, the agency finally came to terms with EHR provider Cerner this month to adopt its custom MHS Genesis program. That news came as the company fought back against reports of serious issues with its implementation at Department of Defense facilities.

The deal is meant, in part, to ensure interoperability between the agencies, allowing active duty military members to transition from one phase of their service to the next without fear that important health information will be lost along the way.

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