VA feeling pressure to move to commercial provider for health record system

Editor's Note: This article originally appeared on FCW.com

Congress is once again looking to the Department of Veterans Affairs to decide whether to keep and improve its home-grown, open source Vista heath record system, or move to a commercial provider.

"Retaining or replacing Vista is a make-or-break decision for VA. It must be made deliberatively and objectively," said Rep. Phil Roe (R-Tenn.), the chairman of the House Veterans Affairs Committee, at a Feb. 7 hearing.

Vista Evolution, a five-year plan to improve the VA's system, is set to be completed in 2018.

"VA must judge [Vista evolution] realistically against concrete goals," Roe said. "If it falls short, moving the goal posts is unacceptable."

Dave Powner, who leads coverage of IT issues at the Government Accountability Office, agreed, and suggested that an off-the-shelf solution is the right answer for the agency.

"This uncertainly is not acceptable and a decision needs to be made," Powner said. "VA needs to let go of Vista and go to a commercial solution."

Rob Thomas, VA's acting CIO, said that improvements to Vista were essential regardless of the agency's future path.

"These investments will also deliver value for veterans and VA providers regardless of whether our path forward is to continue with Vista, shift to a commercial EHR platform as DOD is doing, or some combination of both," Thomas said in his written testimony.

In response to member questions, Thomas said he couldn't provide a timeline for how long it might take to shift to a commercial system, once a decision was made. Any decision would have to wait for the confirmation of Dr. David Shulkin to head the VA. The Senate Committee on Veterans Affairs unanimously backed Shulkin's nomination to head the agency at a Feb. 7 meeting, and he appears headed to the full Senate.

"My goal is to go commercial to the greatest extent possible," Thomas said.

A move to a commercial system will also be contingent on the success or failure of the Department of Defense, which is in the midst of a transformation from multiple electronic health records systems to a single system from software provider Cerner. Congress and the VA are watching the multiyear rollout of DOD's new system closely, both because VA systems must interoperate with the DOD system known as Genesis, and for lessons learned in shifting a large government enterprise to a commercial system.

Coincidentally, Genesis celebrated its go-live date at its Fairchild Air Force Base test site on Feb. 7.

Rep. Tim Walz (D-Minn.), the Veterans Affairs Committee's ranking Democrat, worried that even if plans were made to improve technology across the board at VA, implementation could pose challenges.

"You are not exempt from the hiring freeze," Walz said. "Even if we get the money to upgrade the infrastructure, we can't get you the people you need in there to do that," he said.

Shulkin said at his Feb. 1 confirmation hearing that some 35,000 VA openings have been exempted from the hiring freeze, but it's not clear if IT jobs are among those vacancies -- or if exemptions could be secured for additional hires. Currently the IT workforce at VA is about 8,000, according to testimony from Thomas. He said that salaries cost the agency "north of $1 billion" annually.

Powner noted that turnover in the senior level of IT ranks at VA was also an issue. The VA CIO is one of the few in government that requires Senate confirmation. Former CIO LaVerne Council exited the agency with the close of the Obama administration. Thomas, her top deputy, stepped into the acting CIO role. Powner said that he hoped all the policy that had been driven by Council and former VA Secretary Bob McDonald wouldn't be scrapped by the next team at the VA Office of Information and Technology.

"Too frequently we get new folks, new strategy, new thoughts," Powner said. "We've got a strategy. We've got governance. We've got processes. Now we need to deliver."