Dr. Toby Cosgrove, Nancy Schlichting, others urge VA to adopt commercial EHR, strengthen IT leadership

A report from an independent commission tasked with determining how The Department of Veterans Affairs can best organize and deliver quality care to veterans has deemed the agency's long-term viability is threatened by inconsistencies, poor infrastructure and undefined leadership.

The Commission on Care was established in 2014 as part of the Veterans Access, Choice and Accountability Act which Congress passed in response to concerns about the VA's ability to manage the Veterans Health Administration. The Commission was charged with evaluating and assessing how the VA provides care to veterans and developing recommendations to improve. The 12-person commission includes prominent healthcare leaders including Delos "Toby" Cosgrove, MD, president and CEO of Cleveland Clinic, and Nancy Schlichting, CEO of Detroit-based Henry Ford Health System.

"Although care delivered by VA is in many ways comparable or better in clinical quality to that generally available in the private sector, it is inconsistent from facility to facility, and can be substantially compromised by problems with access, service and poorly functioning operational systems and processes," according to the commissions' final report released last week. "The long-term viability of VHA care is threatened by problems with staffing, facilities, capital needs, information systems, healthcare disparities and procurement."

In the report, the commission outlined 18 recommendations across all sectors of operations. Regarding health IT, the commission recommends the VHA select a commercial, off-the-shelf EHR to replace the VA's "antiquated, disjointed clinical and administrative systems" that it says is not interoperable or capable of connecting with other healthcare providers.

VistA, the EHR currently used in the VA, can no longer keep up with commercial products, and its lack of upgrades puts it at risk of becoming obsolete, according to the commission. The commission notes many major health systems — and, notably, the Department of Defense — were in a similar situation with their homegrown EHRs, and they have since selected commercial products.

The commission also recommends the VA has a CIO with healthcare experience to manage and advocate for the clinical IT needs of the agency. "VA does not have staff with the necessary expertise to execute large-scale IT projects," according to the report. "Previous system implementations have failed because VA did not have individuals with adequate experience to effectively plan and manage system development and deployment."

The commission recommends a VHA CIO report to the chief of the VHA Care System and closely work with clinical and operational leaders.

"To avoid repeating…previous IT implementation failures, VA needs to develop effective oversight systems and develop in-house staff with the expertise to oversee, fully support, manage and execute complex integrated IT programs," reads the report.

Robert McDonald, secretary of veterans affairs, responded to the commission's report with a statement thanking the commission for their work and recommendations. "The Commission has produced a wide-ranging set of recommendations on reforming the Veterans Health Administration, and VA looks forward to reviewing and considering these recommendations as we ensure that we remain true to our mission to serve and honor the men and women who are America's Veterans," he said.

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