VA replacement of legacy EHR systems could charge as much as $16 Billion

The Department of Veterans Affairs requires Congress to fund IT modernization of VA to keep its legacy EHR systems from failing and to replace its decades-old electronic health records system.

VA officials this month declared that they plan to replace the Veterans Health Information Systems and Technology Architecture (VistA) with the similar commercial off-the-shelf EHR from Cerner that the Department of Defense is presently implementing

“This will finally put all sufferers data in one shared system, enabling seamless care between VA and DoD without the manual and electronic exchange and reconciliation of data that we presently do in our separate systems,” VA Secretary David Shulkin, MD, testified on the day of Wednesday before a Senate appropriations subcommittee.

Although, Shulkin conceded that the department doesn’t yet currently know how much Cerner’s Millennium EHR will cost to replace VistA. As a result, he said the VA did not include a funding request for new legacy EHR systems in the department’s Fiscal Year 2018 budget.

But, Sen. Jon Tester (D-Montana) claimed the VA’s procurement of new legacy EHR systems could cost as much as $16 billion—an estimate attributed to former VA CIO Roger Baker to replace VistA. By comparison, DoD in the year of 2015 awarded a $4.3 billion contract to a Leidos-Cerner team to modernize its EHR. He asserts that the VA’s system has the potential to cost significantly more to serve its 9 million-plus beneficiaries.

While Shulkin wouldn’t comment on Tester’s $16 billion figure nor provide his own specific cost estimates, he told lawmakers that the department “will come in the FY19 budget with firm numbers so that we can have the suitable discussion about whether this is something that you can support.”

Nevertheless, Shulkin pointed out that the VA’s FY18 budget includes $200 million to “start the procedure of change management,” adding that the majority of the cost of the commercial EHR—specifically in the first two years of the procurement—is “going to be all internal change management to get ready for the installation.”

 

Bill would permit use of telehealth treatment for veterans across state lines

A bill that seeks to eliminate current restrictions by permitting VA clinicians to treat veterans through telehealth treatment, regardless of location, is gaining momentum in Congress.

Under the present law, VA physicians can just waive state licensing requirements and give telehealth treatment across state lines if both the veteran and the doctor are situated in a federally owned facility. Although, the Veterans E-Health & Telemedicine Support (VETS) Act of 2017 removes these obstacles and would permit VA health professionals to practice telehealth across state lines, as long as they are qualified and practice within the significance of their authorized federal duties.

Additionally, under provisions of the VETS Act, veterans would no longer be needed to travel to a VA facility and rather could get telemedicine treatment from any location, involving their home or a community center.

The bill was launched this week in the House of Representatives by Reps. Julia Brownley (D-Calif.) and Glenn Thompson (R-Penn.). A companion bill was introduced in the Senate by Sens. Joni Ernst (R-Iowa) and Mazie Hirono (D-Hawaii).

“The VA has seen huge growth and interest in telehealth treatment, and we should continue to seek new ways to link veterans with the providers that they need, no matter their physical location,” stated Brownley in a written statement. “The VETS Act will boost veterans with more options and greater access to the care that they have earned and deserve.”

The proposed legislation has got support from industry groups, involving the American Telemedicine Association and Health IT Now.

“The VETS Act takes commonsense steps to eliminating artificial barriers standing in the way of veterans’ access to healthcare,” stated Joel White, executive director of Health IT Now. “Reps. Thompson and Brownley and Senators Hirono and Ernst rightly identify how technology and telehealth can alleviate geographic burdens on both sufferers and providers.”

For its part, ATA sent a letter in late March to VETS Act co-sponsor Senator Ernst, expressing the strong support of group for the bill, which—among other provisions—would develop a state licensure exemption to permit VA-credentialed healthcare experts to work across state lines to perform telemedicine without having to gain a new license in that state.

“This will permit a VA health professional to serve a veteran with a single state license,” wrote Jonathan Linkous, the ATA’s chief executive officer. “In the year of 2011, Congress, without opposition, provided comparable statutory authority to the Department of Defense for health providers and sufferers. We supported that legislation and have supported comparable authority for the Department of Veterans Affairs and other federal healthcare since then.”

 

New Hampshire HIE Establishes links with VA to serve veterans

The New Hampshire HIE or New Hampshire Health Information Organization (NHHIO), which operates a statewide health information exchange (HIE), recently developed a connection with the Veterans Administration (VA) to enable hospitals and other provider agencies to get extra health information about vets they are treating.

Veterans mostly do not get their entire healthcare through the VA, and other providers generally have had to depend on paper-based methods when dealing with VA, claims Jeff Loughlin, a veteran and executive director of NHHIO.

Thus, an electronic link will speed and make better the quality of care, he believes. “This connection assists to remove few of the hurdles in communication and care that veterans face on a daily basis.”

The initiative was started after an outreach coordinator at the Manchester VA contacted Loughlin and they worked to enable an electronic exchange of information. To accomplish their mission, they required establishing and signing several contracts—the project uses the Direct Protocol secure messaging standard for exchange of health information, and VA, which wasn’t utilizing Direct, required contracts written and signed to ensure participants follow certain procedures of the VA.

Most states linked to VA use a shared data repository to exchange information; New Hampshire HIE is one of a handful of states that has shifted to the Direct Protocol, Loughlin says.

Because electronic communication just started 2 weeks ago, it is hard to assess progress thus far. Orion Health is the vendor offering Direct services. 2 other VA offices in New Hampshire HIE are getting ready to enable providers in their regions to exchange data electronically with the VA.

Along with the connections will come educational steps to explain to providers the benefits of electronic connectivity with VA and workflow changes they will require making. The benefits involve improved patient safety and data security, and putting data in providers’ hands quicker, while no longer depending on faxes.

One reason the connectivity came together was because the timing was correct, Loughlin elaborates. Linking with VA wasn’t a priority because providers were concentrated on achieving meaningful use of electronic health records (EHRs), and VA was not ready for Direct during that period, anyway. With meaningful use winding down, VA’s outreach to Manchester was the impetus to get Direct secure messing rolling, with assistance from a Manchester VA board member who was a veteran and served as a patient advocate.

Providers will have the choice of getting PDF files, discrete data elements, a summary of care or a progress note, deployed on the workflows of providers, the technical capability of their staffs or the capabilities of the providers’ vendors.

Direct connectivity is just one piece of improved sharing of health information in New Hampshire, Loughlin contends, as the industry waits for more modern and advanced capabilities like the CommonWell, CareQuality and FHIR interoperability initiatives to mature. “There is no single solution, so we’re attempting to maximize the advantages of all of the solutions,” he further adds.

 

SSA and VA utilize eHealth Exchange for sharing veteran medical records

The Department of Veterans Affairs (VA) and the Social Security Administration (SSA) have started a latest initiative that enables the VA to share veteran medical records electronically with SSA to more rapidly make decisions about disability claims.

For decades, SSA gained veteran medical records through a manual procedure that involved fax and regular mail. Although, the VA claims that the latest national initiative puts in place an automated procedure to get these records completely through electronic sharing.

“VA’s partnership with Social Security will finally make better the quality of life for veterans and their dependents by determining veterans to share their health data within a protective and secure health-related consumer application,” claimed VA’s Under Secretary for Health David Shulkin, MD.

The VA shares health information with SSA through The Sequoia Project’s eHealth Exchange, a national network for safe sharing of veteran medical records, which enables disability processing sites to get the medical records of VA electronically upon request.

“It took much time to get a disability determination from the SSA, significantly due to the slow, snail mail manual procedure of getting medical information,” stated by Michael Matthews, eHealth Exchange coordinating committee member and board chair for The Sequoia Project.

The latest automated procedure basically has 3 steps:

• SSA 1^st receives the veteran consent—good for 1 year from the veteran signature date.


• SSA sends message electronically to VA attesting to the consent, following the standards of national eHealth Exchange.


• SSA then can retrieve the veteran’s continuity of care document in real time.

In accordance to the VA, the capability to share records electronically with Social Security disability processors saves time and money for those veterans and dependents applying for benefits. While the companies have been exchanging live data since the day of October 11, they said it is “too early to verify an actual cost savings as the partnership is in its initial stages of deployment.”

The Sequoia Project asserts that its eHealth Exchange is the “greatest health data sharing network of its kind.” In addition to SSA and VA, the national network also serves data sharing by the Centers for Medicare and Medicaid Services (CMS) as well as the Department of Defense.

Fed expenses for health IT services reach $6.5B in 2015 year

Expenses on IT services by federal health agencies reached $6.5 billion in the year of 2015, up primarily from $2 billion in the year of 2011, in accordance to research firm Govini.

Not astonishingly, the Department of Health and Human Services—specifically the Centers for Medicare and Medicaid Services (CMS)—led spending from the time period of 2011 to 2015 with almost $13 billion in prime contract obligations.

Govini points out that, with $6.8 billion in complete prime contract obligations, CMS accounts for over half of HHS’ expenditures on IT services during that time.

“The agency has been making preparation for advancement by making foundational contributions in call centers, IT infrastructure and data centers,” claims Govini’s report.

However, federal health IT services grew 27% yearly despite of sequestration-driven budget constraints,  in accordance to the findings of the report.

“The Department of Health and Human Services grew at 34% compound yearly growth rate and the Department of Veterans Affairs (VA) grew at 25% CAGR,” claims the report. “Defense Health Agency (DHA) expenses decreased during this period at -6% CAGR amid sequestration constraints and the reorganization of the Military Health System.”

The report of Govini also summarizes that the outlook in the Fiscal Year 2017 budget proposal of President is powerful, with technology contribution geared towards systems advancement, EHRs, networks and cybersecurity.

In specific, the firm claims VA and DHA in FY17 are “planning huge Information Technology investments that opponent HHS’s in scope.” In particular, Govini mentions that the DHA is heading towards the path in EHR advancement through its Defense Healthcare Management System Modernization (DHMSM) program. Previous year, the Pentagon granted a $4.3 billion contract award to the Leidos-Cerner team to advance the EHR system of DoD.

Nevertheless, in accordance to the report, CMS sustains to drive HHS Information Technology modernization. “Its huge initiative is to make better the usability and functionality of the Marketplace by making better the eligibility, plan management and payment functions,” asserts the firm. “In the intended FY17 budget, $333 million is committed to make advancement in the claims processing systems and call centers,” while “the department of security and network is driving the VA contribution.”

 

VA EHR Optimization Attempts an Uncertainty for Congress

A House subcommittee is looking a GAO research of the EHR optimization attempts underway or planned at VA.

The Department of Defense (DoD) is not the only federal agency in the midst of a huge EHR modernization project, with the Department of Veterans Affairs (VA) also working to upgrade its present EHR technology called as the Veterans Health Information Systems and Technology Architecture (VistA). And it is the latter that is raising concerns among members of Congress.

In a letter to the head of the Government Accountability Office, Representatives Will Hurd (R-TX) and Robin Kelly (D-IL) of the Committee on Oversight and Government Reform Subcommittee on Information Technology inquired the federal agency to study the VA's EHR modernization project of VistA.

"Given the importance of VA's electronic health record information system to the performance of its health care mission, and in light of VA's repeated attempts to modernize VistA, the Subcommittee is requesting data on the attempts to modernize VistA," wrote Hurd and Kelly.

"In specific, we would like to get data on the history of VA's efforts to modernize VistA, involving the prices and results of the efforts, the key contractors that have been involved, and the work that these contractors performed," the letter continued. "In addition, we inquire that the study determines VA's current plans and estimated costs for modernizing VistA."

Are mHealth Kiosks is attempting to comeback?

The VA and a Washington-based health system are testing mHealth kiosks, and a new company is touting its self-enclosed clinic as an alternative to the urgent care center.

mHealth enthusiasts take note: The kiosk is not dead yet.

While HealthSpot’s assets – involving hundreds of the bankrupt company’s room-sized kiosks – were disposed of in an online auction over the Memorial Day weekend, smaller versions of the self-serve booths are showing up in health systems across the nation.

The Veterans Administration is utilizing the kiosks in rural parts of the country as an alternative to new clinics or VA hospitals, former U.S. secretary of Veterans Affairs James Peake, MD LTG (Ret.) said during the recent American Telemedicine Association conference in Minneapolis. In Washington, the 48-hospital CHI Franciscan Health system has just launched a “virtual urgent care concierge program,” using kiosks to help sort through the mix of high- and low-acuity patients at its clinics and EDs.

Military Veteran Seeks a Mission Nursing Fellow Vets at the VA

Nursing assistant Tom Alligood wears camouflage scrubs during his emergency room shifts at the Dorn VA hospital because he claims that it helps other veteran patients realize they have "walked over the same dirt," the 62-year-old former Army tanker says.

And he does not just mean the desert sands of Iraq.

Alligood means homelessness, job loss and the mental anguish of being a long-time military veteran trying to adjust to the trials of a dog-eat-dog, backstabbing civilian world he says nearly ate him alive.

"I require being around veterans like me. That's where I get my strength, my 'positiveness' from," says the burly former first sergeant who now sports a long, gray braid on his back.

Alligood says he has discovered a new mission - working in the sprawling Columbia VA hospital and helping as many of his one-time brothers and sisters in arms as he can.

And the VA is looking for more persons like Alligood.

Veterans Choice now offering Texas vets more healthcare choices

Access to health care has become a greater challenge for veterans nationwide. In the state of Texas, few veterans wait months to schedule an appointment through the VA system.

Seton Healthcare Family, one of the greatest health care providers in Central Texas, is now taking on the Veterans Choice Program. The program debuted in the year 2014 to help decrease delays by scheduling appointments with private facilities when the VA could not give treatment quickly.

“It is not merely getting to the appointment,” Jesús Garza, President and CEO of Seton Healthcare Family said. “It is what happens after the appointment.”

The Veterans Choice Program got a lot of criticism shortly after it began; with few saying the program has not resolved the backlog of veterans waiting to get care.

Despite the issues, Seton Healthcare Family has chose to opt into the program. Garza said Seton hopes to lead the charge for other health care systems to do the same across the state, but certain veterans are claiming it may be too late.

“If it is a necessity that they end up as an admission, they are closer to home, their support network is closer to home,” Garza stated, “so that their home network is able to give them the support that they need.”

VA Receives $233M from Congress for EHR Update with Conditions

Congress has given $233 million in its last fiscal year 2016 omnibus bill for sustained modernization of the Department of Veterans Affairs’ VistA EHR network. Although, the appropriation—signed into law by President Obama—comes with few conditions and restrictions.

The EHR enhancement attempt, called the VistA Evolution program, calls for the addition of an Enterprise Health Management Platform (eHMP)—a set of latest modular-based sections—to replace the Computerized Patient Record System, which is the existing user interface that clinicians utilize while delivering care. Among other functions, the latest eHMP platform will enable the VA to meet several of the 2014 Edition Meaningful Use certification criteria for HIT sections.

Although, legislative language bounds the use of congressional funding until VA indicates functional improvements in the interoperability of the network to seamlessly exchange veterans’ medical information among the VA, Department of Defense and the private sector.

Not more than 25% of the funds can be obligated or spent until the VA Secretary submits a report to both House and Senate appropriations committees giving specifics on the scope and functionality of projects within the VistA Evolution program, involving proposed alterations to the program as well as the milestones and timeline linked with acquiring interoperability.

Lawmakers are specifically fascinated in the definition being utilized for interoperability between DoD and VA EHR networks, the metrics to measure the extent of interoperability, and the growth toward establishing and implementing all components and levels of interoperability involving semantic interoperability.

However, DoD and VA have devoted to acquiring interoperability between their separate EHR networks, the 2 departments sustain to miss significant deadlines and have yet to develop outcome-oriented targets and metrics for measuring their growth toward interoperable EHRs, in accordance to an August 2015 audit by the Government Accountability Office.

In accordance to GAO, DoD and VA missed an Oct. 1, 2014, deadline developed by Congress in the National Defense Authorization Act (NDAA) for Fiscal Year 2014 to certify that entire healthcare information in their networks complied with national standards and were computable in actual time.

Auditors also disclosed that a number of important activities in the departments’ network modernization policies will be executed beyond Dec. 31, 2016, the target time established in the NDAA for DoD and VA to deploy modernized EHR software to motivate clinicians while making sure complete standards-based interoperability.