The new CIO of the US Department of Veterans Affairs (VA) said the agency plans to focus heavily on digital transformation efforts, rely on more cloud-based applications, continue its push toward telehealth and strengthen your internal IT staff.
During a media roundtable Thursday, VA CIO Kurt DelBene said his goal is to transform the agency's technology landscape to help deliver a consistent, unified experience for veterans through digital transformation.
In 2018, the VA began the process of migrating its 40-year-old Veterans Health Information and Technology Systems Architecture (VistA) system to a new Identify electronic health record (EHR) system. (In December, Oracle announced plans to buy Cerner for $28.300 billion.)
VA's VistA EHR provides clinical, administrative and financial functions to more than 1,700 Veterans Health Administration hospitals and clinics. VistA consists of 180 clinical, financial and administrative applications integrated into a single transactional database.
VA's new Cerner Millennium EHR system is a standardized platform that stores health information and tracks all aspects of patient care. It should be fully in place by 2028.
The new EHR system will connect VA medical facilities with participating U.S. Department of Defense, Coast Guard and community health care providers, allowing physicians to more easily access a patient's complete medical history. veteran in one place. The VA Electronic Medical Records Modernization (EHRM) Program Integration Office manages the implementation of the new system.
In 2020, implementation of a new EHR began on the West Coast with a pilot at the Mann-Grandstaff VA Medical Center in Spokane, WA. He immediately got into trouble; Patient safety concerns and disruptions prompted the agency to pause deployments for a while.
The problems with the new EHR also cast doubt on the viability of the original decade-long timeline.
“Electronic medical record systems are difficult to implement. I don't think anyone in the industry wouldn't say that,” said DelBene, who took over as CIO in December. “I think we could do better by making sure everyone is trained, on board and fully aware of how the system works.
“I think we had infrastructure problems at the beginning. So I think our overall level of preparedness could have been higher," DelBene said. "I also think that the clear criteria of what we should meet before launching could have been more specific."
Based on the lessons learned from the Spokane pilot, VA is better prepared for its next deployment, to the agency's medical center in Walla Walla, WA, he said. "We've done a much better job in terms of establishing those criteria."
Still, Rep. Cathy McMorris Rodgers (R-WA) this month asked the VA to delay the implementation of Cerner's EHR in Walla Walla. "More than a year after the Mann-Grandstaff system went live, most of the impacts on productivity, patient safety and morale remain unresolved," Rogers said in a statement. "While system outages have improved somewhat, fundamental issues have not been addressed, particularly in pharmacy. Veterans in my district continue to struggle with late and incorrect prescriptions, as well as bottlenecks in referral to specialists or community care .
"The bottom line, the EHRM modernization transition always makes life more difficult for Veterans and VA providers, not easier, and until those issues are resolved, their continued implementation should be late," he said.
DelBene said her agency will continue to support VistA as it transitions to a new EHR. For example, VA migrates data from VistA to cloud providers, such as AWS, to ensure continued performance.
Last week, DelBene told lawmakers he wanted to lead an agency-wide digital transformation effort to modernize IT systems and improve in-house software development offerings, including low-code and no-code. DelBene said the VA needs to focus on how to develop software and services under heavy outsourcing to outside contractors.
In the past, the VA may have relied too heavily on third-party contractors without a strong set of standards for reviewing those providers and tracking them, said DelBene, a former Microsoft executive and senior adviser to Healthcare.gov. As Microsoft has learned to do, VA will create standards to manage the work of contractors to strengthen its internal IT staff.
"We should know when to hire an outside contractor versus what can be done in-house," he said.
DelBene said there will always be a reliance on contractors, as they can be cheaper than full-time staff. But he also wants to bolster VA's IT staff by bringing in more developers and technicians.
DelBene now leads a workforce of approximately 16,000 government and contract employees who help provide health care and benefits to more than nine million veterans.
The VA has worked to connect with two major Health Information Exchanges (HIEs), where doctors, nurses, pharmacists, other health care providers, and patients can securely access and share medical information. The Veterans Health Information Exchange (VHIE) launched in 2020; connects to two private sector HIEs: eHealth Exchange and CommonWell. Through this HIE network, 60% to 65% of private health systems can exchange data with the VA, according to Neil C. Evans, MD, VA CIO Special Counsel.
The VA also wants to continue pushing telemedicine. “We have seen an incredible increase. Before the pandemic, we had 40 visits a month and now we have 000 telehealth visits a day,” DelBene said. "The opportunity for telehealth to transform the veteran experience, especially in rural areas, is enormous."
During the pandemic, more than 230,000 veterans were able to schedule COVID vaccinations via text message, according to VA CTO Charles Worthington. Earlier this year, the VA began a soft launch of a new flagship mobile app, "which is getting good traction and reviews from veterans," he said.
The VA has also quadrupled its network bandwidth to support the telehealth initiative during the pandemic, according to Todd Simpson, VA deputy assistant secretary for DevSecOps.
Since 2019, the agency is also moving towards the cloud. It expects to have around 50% of all cloud-based apps by 2024.
As EHR software becomes the industry standard, not all health offices have fully transitioned to digital record keeping. In fact, within the VA, the fax machine continues to be an important part of health care information exchange, according to Neil C. Evans, MD, special counsel to the VA CIO.
The new EHR system is "a way of bringing the fax machine into the legacy of technology," Evans said.
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