The Department of Veterans Affairs is now a different system than it was more than a decade ago, prior to Congress implementing the Veterans Choice program—the initiative that permits veterans to receive care from non-VA facilities. In 2018, with the Mission Act expanding veterans’ choices further, the VA permanently transformed into a system integrating VA-based community care and facilities.
About 44% of veterans’ healthcare expenditures today come from the private sector. Overall, the demand for veterans’ healthcare has grown significantly during this period. The VA enrolled 401,006 veterans over the past year in VA health care, marking the most significant number of enrollees in recent times.
Perhaps more importantly, trust veteran trust levels have increased. In other words, the new system seems to be moving in the right direction.
Healthcare systems can’t be sustained without investments that keep pace with a rapidly changing environment. A world-class veteran care system requires the VA to invest in modernizing its facilities, workforce, and technology. In addition, Congress must provide the agency with the flexibility to respond to these requirements.
Every new veteran enrollee the VA receives is from the Department of Defense (DoD); increasingly, veterans are receiving care from the community and within the VA. For this system to function, there must be clinical coordination of care, which depends on the effective transfer of clinical data between the VA, the DoD, and community care providers.
Congress has continued to prioritize addressing veterans’ healthcare issues. Recently, a bipartisan group of senators introduced the Veterans Affairs Major Medical Facility Authorization Act, which would authorize 11 VA construction projects.
Last month, Senators Jerry Moran, Republican from Kansas, and Angus King, Independent from Maine, introduced the Coordinating Care for Senior Veterans and Wounded Warriors Act. The legislation aims to provide individualized care coordination and plans to reduce care gaps, delays, duplication of services, and other inefficiencies across the board.
However, perhaps the most crucial thing for veterans is access to data that flows between the DoD, the VA, and the community care network.
The VA’s current electronic health record (EHR)—more than 30 years old—isn’t cloud-based, which has become the industry standard. This makes exchanges of clinical data to ensure care coordination with providers outside the VA even more challenging.
Agency further risks falling behind the private sector in advancing innovation
With the configuration of the VA’s legacy EHR, the agency risks further falling behind the private sector in advancing interoperability and technological innovation. This is why the successful implementation of the commercial electronic health record is fundamental to the future of the VA’s sustainability.
Almost every private healthcare system has chosen to utilize commercial vendors for its 21st-century digital updates, and most that have tried to maintain their homegrown systems have failed.
They learned that if technology weren’t their core competency, it would be wiser to leverage the experience and expertise of companies focusing on this market.
The VA has confronted several challenges in implementing its new commercial EHR, which has proven to be more time-consuming and costlier than anticipated. But, in response to these challenges, the VA prioritized veteran safety appropriately and paused to regroup their approach. Given what has been learned, it’s now in a more favorable position to restart the process.
To undertake a complex, large implementation, the VA must have a complete commitment from their clinical and administrative leadership. A successful implementation of EHR isn’t just a technology issue but a significant change management initiative.
The DoD successfully converted to using the same system the VA looks to leverage. It took a total agency commitment by the Department of Defense to accomplish this, and there is no reason the VA can’t do the same.
This week, the VA extended the commercial EHR contract for another year to prepare for further electronic health record deployments. This is a step in the right direction, and now it’s time for the VA to focus, recommit, and accomplish it.
