New VA CIO focuses on digital transformation, EHR changeout

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The brand new CIO of the US Division of Veterans Affairs (VA) stated the company plans to focus closely on digital transformation efforts, depend on extra cloud-based purposes, proceed its push into telehealth, and construct out its inside IT workers.

Throughout a media roundtable Thursday, VA CIO Kurt DelBene stated his aim is to rework company's expertise panorama to assist drive a seamless, unified expertise for veterans via digital transformation.

In 2018, the VA started the method of migrating away from its homegrown, 40-year-old Veterans Well being Info Techniques and Expertise Structure (VistA) system to a brand new digital healthcare document (EHR) system from Cerner. (In December, Oracle introduced plans to purchase Cerner for $28.3 billion.)

The VA’s VistA EHR gives scientific, administrative, and monetary capabilities for greater than 1,700 hospitals and clinics of the Veterans Well being Administration. VistA consists of 180 scientific, monetary, and administrative purposes built-in in a single transactional database.

The VA’s new Cerner Millennium EHR system is a standardized platform that shops well being info and tracks all points of affected person care. It's anticipated to be absolutely in place by 2028.

The brand new EHR system will join VA medical services with the US Division of Protection, the Coast Guard and taking part group care suppliers, permitting clinicians to extra simply entry a veteran’s full medical historical past in a single location. The VA Digital Well being Document Modernization (EHRM) program Integration Workplace is managing the deployment of the brand new system.

In 2020, the rollout to a brand new EHR started on the West Coast with a pilot within the Mann-Grandstaff VA Medical Heart in Spokane, WA. It instantly bumped into issues; affected person questions of safety and outages led the company to halt deployments for a time.

The issues with the brand new EHR additionally seeded doubt as as to if the unique decade-long schedule stays viable.

“Digital well being data methods are troublesome to deploy. I don’t assume anyone within the trade wouldn’t say that,” stated DelBene, who took over as CIO in December. “I feel we might do a greater by way of ensuring everybody’s skilled and so they’re on-board and know fully how the system works.

“I feel we had some infrastructure issues early on. So, I feel our degree of preparedness total might have been stronger,” DelBene stated. “I additionally assume the clear standards of what we should always meet earlier than we go reside might have been crisper.”

Based mostly on classes realized from the Spokane pilot, the VA is best ready for its subsequent rollout — within the company’s Medical Heart in Walla Walla, WA, he stated. “We’ve finished rather a lot higher job by way of getting that standards established."

Even so, Rep. Cathy McMorris Rodgers (R-WA) referred to as on the VA this month to delay the rollout of the Cerner EHR in Walla Walla. “Greater than a 12 months after Mann-Grandstaff went reside on the system, many of the productiveness, affected person security, and morale impacts nonetheless haven't been resolved," Rogers stated in a press release. "Whereas the system outages have considerably improved, basic issues, particularly in pharmacy, haven't been addressed. Veterans in my district proceed to battle with delayed and inaccurate prescriptions, in addition to bottlenecks in referrals to specialists or group care.

“Backside line, the Digital Well being Document Modernization (EHRM) transition continues to be making life more durable on veterans and VA suppliers, not simpler, and till these issues are fastened, its continued roll-out ought to be delayed,” she stated.

DelBene stated his company will proceed supporting VistA through the transition to a brand new EHR. For instance, the VA is migrating VistA information to cloud suppliers, reminiscent of AWS, to make sure continued efficiency.

Final week, DelBene advised lawmakers he needs to steer an agency-wide digital transformation effort to modernize IT methods and enhance inside software program improvement choices, together with low-code and no-code options. DelBene stated the VA must concentrate on find out how to do software program and companies improvement amid heavy outsourcing to exterior contractors.

The VA previously might have relied an excessive amount of on outdoors contractors and not using a strong set of requirements to vet these distributors and monitor their, stated DelBene, a former Microsoft govt and Healthcare.gov senior advisor. As Microsoft realized to do, the VA will create requirements to take care of contractors work to construct out its inside IT workers.

“We must always know once we ought to be utilizing an out of doors contractor versus what may be finished internally,” he stated. 

DelBene stated there'll at all times be a dependency on contractors as a result of may be cheaper than full-time workers. However he additionally needs to construct out the VA's personal IT workers by bringing in additional builders and technical staff.

DelBene now leads a workforce of roughly 16,000 authorities and contract staffers who allow healthcare and advantages supply to greater than 9 million veterans.

The VA has beenj working to connect with two main Well being Info Exchanges (HIEs), the place docs, nurses, pharmacists, different healthcare suppliers and sufferers can entry and securely share medical info. The Veterans Well being Info Change (VHIE) launched in 2020; it connects to 2 private-sector HIE’s — eHealth Change and CommonWell. By way of that HIE community, 60% to 65% of personal healthcare methods can change information with the VA, in accordance with Neil C. Evans, MD, a particular advisor to VA’s CIO.

The VA additionally needs to proceed a push into telemedicine. “Now we have seen an incredible surge. Earlier than the pandemic, we had 40,000 visits per thirty days, and now we have now 40,000 telehealth visits per day,” DelBene stated. “The flexibility to have telehealth remodel the expertise for veterans, particularly in rural areas, is big.”

Throughout the pandemic, greater than 230,000 veterans had been in a position to schedule COVID vaccinations through textual content message, in accordance with VA CTO Charles Worthington. This 12 months, the VA rolled out a mushy launch of a brand new flagship cell app, “that’s getting good traction and critiques from veterans,” he stated.

The VA has additionally quadrupled its community bandwidth to help the telehealth initiative through the pandemic, in accordance with Todd Simpson, the VA’s deputy assistant secretary of DevSecOps.

Since 2019, the company has additionally been transferring towards the cloud. It hopes to have about 50% of all purposes cloud-based by 2024.

Whereas EHR software program is changing into the usual throughout the trade, not all healthcare workplaces have moved absolutely to digital record-keeping. In truth, throughout the VA, the fax machine stays an enormous a part of healthcare info change, in accordance with Neil C. Evans, MD, a particular advisor to the workplace of the VA CIO.

The brand new EHR system is “a solution to put the fax machine into legacy of expertise,” Evans stated.