Veteran’s Affairs Switch from VistA based Electronic Health Record to Cerner Millennium

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On June 5th, 2017 the VA Secretary at the time, Dr. David Shulkin, announced that the Veterans Affairs (VA) Health Care System would transition from Vista based electronic health record CPRS to Cerner Millennium by MHS GENESIS. This will be the largest implementation of an electronic health record system ever at 10 billion dollars over the next 10 years.

The two primary reasons for the switch are that VistA is over 20 years old and there is a need for modernization and the Department of Defense (DOD) has already moved to the Cerner System. Having the VA and DOD on the same EHR would allow a Veteran’s complete and accurate health record in a single common EHR. From Dr. Shulkin “While we have established interoperability between VA and DOD for key aspects of the health record, seamless care is fundamentally constrained by ever-changing information sharing standards, separate chains of command, complex governance, separate implementation schedules that must be coordinated to accommodate those changes from separate program offices that have separate funding appropriations, and a host of related complexities requiring constant lifecycle maintenance.” (Office of Public and Intergovernmental Affairs, 2017) Due to the urgency expressed by Dr. Shulkin he decided that there is the need for a public interest exception to the requirement for full and open competition in this technology acquisition. This allows the VA to issue a solicitation directly to Cerner Corporation for the acquisition of the HER system currently being deployed by DOD.

VistA The Veterans Health Information Systems and Technology Architecture (VistA) has been around since the 70’s when it was created by a group of VA clinicians. Although this means VistA isn’t on pace with todays health information technology and cybersecurity it does mean that VA clinicians have had a lot of time to learn how to use VistA to its highest potential.

Cerner Cerner is the largest independent health IT company in the world. 532 hospitals have used Cerner EHR’s and 32 have reached HIMSS Analytics stage 7.

Implementation There is no definitive date for rollout yet but an end date of 2022 for complete rollout has been stated. Although Cerner has already been rolled out at the DOD the VA has different services and a far broader age range to serve with many chronic and specialized needs.

Current Updates March 21, 2018: • The budget grows to by an additional 6 billion dollars a 60 percent increase. The additional cost for that 6 billion could not be identified by Secretary Shulkin. • The VA Cerner contract is still not finalized • Primary reason for this delay is finalize language that wouldn’t allow proprietary protection and information blocking to occur • VA is working with Cerner to build a contract that encourages the use of open application programming interface (APIs) and Fast Healthcare Interoperability Resources (FHIR) standards to enable interoperability with the private sector.

Sources [1] [2]

Submitted by (Matthew Howard)

Update October 17, 2019: The VA Cerner EHR implementation began in 2018 and will roll out in 48 deployment waves as well as an initial operating capability (IOC) deployment in Spokane, Seattle, and American Lake in Washington. Cerner implementation for the VA will geographically follow the DOD rollout. This alignment will allow shared costs and improve interoperability. Open application programming interface (APIs) and Fast Healthcare Interoperability Resources (FHIR) standards will be used, and hopes are high that this will help promote interoperability in the private sector. Go live with the VA began in 2019 and is projected to finalize in 2027. The estimated cost is 16 billion.

Sources [3] [4]

Submitted by (Andrea Koegel)