Secretary Shulkin Announces Electronic Health Records for VA

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In a rather unusual setting:  the White House press room – Department of Veterans Affairs’ Secretary, Dr. David Shulkin, announced that the VA “will be overhauling its electronic health records, adopting a commercial product used by the Pentagon that he hopes will improve care for veterans and reduce wait times for medical appointments.”

Dr. David Shulkin, VA Secretary

While many have been pressing for a complete overhaul of the VA’s inefficient medical record system, Dr. Shulkin has taken on the challenging task of dispensing with the VA’s current VistA system in exchange for the Department of Defense MHS Genesis system.

Without going into too many details, Secretary Shulkin showed courage by selecting the MHS Genesis system without competitive bidding, “citing a ‘public interest’ exception. He noted that when the Pentagon did competitive bidding on its system, it took 26 months.”

While I fully agree with his rationale for accelerating the implementation process, I am quite certain that others will question the bidding process.  After-all, Secretary Shulkin claims that it would be “unrealistic” to assume that the VA’s new electronic health record would cost less than $4 billion.

Congressional approval is required for this supplemental appropriation, but this overhaul of the VA electronic health records was a key recommendation of the June 30, 2016 Commission on Care Report.    I have no doubt that Congress will pass the required appropriation.

Electronic Health Records for Veterans and the VA

On the plus side, a “cloud-based” commercial solution is far preferable to internally-developed and internally-maintained VA legacy systems.  Outdated, clunky and inefficient legacy systems at banks and insurance companies have proved to be rather ineffective at keeping pace with technology.  Systems at the VA are probably not different.

There is no question, that the VA will be able to operate far more efficiently with state-of-the-art electronic health records.  Whether Veterans will benefit from this improved information technology remains a matter of conjecture.

Dr. Shulkin claims that the transition to the MHS Genesis system will take “about 3 to 6 months at the latest.”  Recalling the delays in the rollout of the Affordable Care Act online marketplace, I suspect that this is a very ambitious target.  I hope to be proven wrong.

Furthermore, I recall that it took members of the medical profession about two years to fully implement the transition to electronic health records to receive reimbursement from Medicare and Medicaid.

While the technology may be fully deployed and implemented within six months, I suspect that it is highly unlikely that 300,000 plus employees at the VA will easily transition to the new electronic health records.

Realistically, I suspect that it will be about 24 months before the first major efficiencies make themselves manifest at the VA.

Privacy and Electronic Health Records

While it makes sense to use the common elements of the Department of Defense (“DoD”) database to populate and communicate with a similar system at the VA, access to individual records creates privacy issues.

Veterans tell SFTT that they are reluctant to share health information with the VA because of privacy concerns.  Linking the DoD and VA databases seems – on the surface – to raise additional “privacy” issues.

While the VA can use any number of filters and access restriction to protect the confidentiality of electronic health records, it is evident that a human interface will at some point be required to get actionable medical information to “the right” caregiver.

Getting a person on the phone – let alone “the right person” – has always been a problem at the VA.  In fact, SFTT reported late last year that 1/3 of the calls to the VA Crisis Center go unattended.

Is it enough to assume that things will be different this time around?

Conclusion

While the move to electronic health records is yet another great decision by Dr. Shulkin, it remains to be seen whether he has sufficient tools at his disposal to mobilize the staff of VA to reach out to Veterans and help close the divide.

On behalf of our brave Veterans, SFTT certainly hopes so.

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VA Secretary David Shulkin: Glass Half Full?

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Department of Veterans Affairs (“the VA”) Secretary, Dr. David Shulkin means well, but it is not surprising that his leadership is being undermined by the same chronic conditions that have plagued other VA Secretaries.

Dr. David Shulkin, VA Secretary

THE VA IS SIMPLY TOO LARGE TO SUCCEED IN ITS MISSION

This week brings yet three more examples of the chronic problems facing the VA:

The VA still can’t FIX the Suicide Hotline

Secretary Shulkin Needs Senate Approval to Fire VA Employees

VA Dropping Veteran Caregivers from Their Rolls

Indeed, this litany of weekly crises is not dissimilar from scandals that have surfaced under the leadership of other VA secretaries.

What follows is a well-choreographed skit designed to reassure the public and Veterans that all is well in the Music Man’s River City.

“New Crisis” at the VA attracts national media;

VA Secretary assures Congressional subcommittee that problem will be fixed;

Congressmen get public facetime preaching to the converted;

– VA Secretary Shulkin sulks back to his office to prepare for next week’s Congressional hearing;

VA Labor Union blocks any constructive legislation that would allow the Secretary Shulkin to implement much-needed change within the VA.    Why?  Just ask J. David Cox, President of the American Federation of Government Employees, who once threatened a VA Secretary with “physical violence” for suggesting a change to the status quo.

For those who have followed this same tragic charade for many years, it is clearly evident that the VA is too big to succeed.  In the words of Nassim Taleb, the VA is fragile.

In my opinion, NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

Will “change you can believe in” actually take place?  I think not, considering the entrenched political interest in maintaining the status quo and the patronage of a large block of voters represented by J. David Cox.

As presently configured, there is no possible way that the VA can fulfill President Abraham Lincoln’s promise: “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.

As argued on several other occasions, the VA should be reconfigured to concentrate on those Veteran functions which require centralization.  All other activities should be assigned to smaller VA components or outsourced (with supervision) to the private sector.

For instance, the VA centralized suicide crisis line makes little sense.   Aside from the fact that the crisis line is currently non-responsive (and has been for a long period of time), it seems evident that we should allocate responsive resources far closer to a high-risk Veteran.

Let’s face it, few jumpers have been talked down off the ledge by a Call Center.  If you want to deal with high-risk Veterans in urgent need of support, get human resources to them as quickly as possible.  THINK LOCAL and COMMUNITY-BASED SERVICES.

While this more decentralized approach may not resolve the current Crisis Center problems, it would be far easier to manage and control at a local level.  Better yet, high-risk Veterans will benefit from a far more responsive human touch by local communities that truly care.

For Veterans, BIG IS NOT BEAUTIFUL!   Many Veterans see a largely unresponsive institution that seems more preoccupied with statistical adherence to protocol than positive patient outcomes. Wouldn’t it be wonderful if we could turn that perception around?

From the perspective of the VA, it is a lot easier to say that “we need more resources to deal with current shortcomings,” rather than face the reality that the VA has become a dysfunctional bureaucracy.

The Titanic

The ability to turn around the “Titanic” VA was lost many years ago.  Going forward, we must chop down the VA into far smaller component “passenger ships”  with accountability and leadership that can truly effect meaningful change.

Sure, one or more of these smaller components may fail, but not ALL Veterans will be held hostage by the continued failure in leadership of an INSTITUTION THAT IS TOO BIG TO SUCCEED.

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SFTT News: Week Ending Sep 30, 2016

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Found below are a few news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

President Obama Faces Tough Questions from Military and Veterans
Obama was at this Army base near Richmond to take part in a military-focused special that aired Wednesday night on CNN. The cable network selected questioners who were respectful but who reflected a military population that is more conservative than the population as a whole and generally skeptical of the president’s performance as commander in chief over the past eight years.  Read more . . .

U.S. Military Readiness Questioned
Four of America’s top military officers recently testified before the Senate Armed Services Committee on long-term budget challenges facing the military. While the hearing didn’t grab many headlines, some of the statements from these leaders should make all Americans concerned about the status of our military. Ultimately, these four officers (the chiefs of staff of the Army and Air Force, the chief of naval operations, and the commandant of the Marine Corps) stressed the dire and potentially deadly effects of inadequate funding on military readiness.  Read more . . .

VA Suicide Hot Line

A Third of Calls to Veteran Suicide Hotline Don’t Get Answered
More than a third of calls to the Department of Veterans Affairs’ suicide hotline aren’t being answered by front-line staffers because of poor work habits and other problems, according to the hotline’s former director.  Some hotline workers handle fewer than five calls per day and leave before their shifts end, even as crisis calls have increased sharply in recent years, said Greg Hughes, the former director of the VA’s Veterans Crisis Line.  Read more . . .

Privatization of Some VA Programs Becomes Election Issue
A key Democrat wants to bring the presidential campaign fight over veterans health care to the House floor, offering a resolution Wednesday that opposes the privatization of Veterans Affairs programs.  Republicans counter that department health systems are overburdened and unable to meet veterans’ needs, and proposals to expand health care choices for veterans in no way represent privatizing the department.  Read more . . .

Military Funding and Pay Raises Still on Congressional Agenda
After months of debate, Congress was unable to pass an annual budget on time and came within days this week of a government shutdown – and potential troop pay freeze – due to a dispute over emergency funds for the Flint, Michigan water crisis. A deal on money for Flint allowed lawmakers to pass the temporary budget, called a continuing resolution, and it set up another potential last-minute showdown over a final defense budget and other difficult military issues in November and December.  Read more . . .

Studies Suggest that Concussions May Lead to PTSD
Studies of troops who deployed to Iraq and Afghanistan have found that service members who have suffered a concussion or mild traumatic brain injury are far more likely to develop PTSD, a condition that can cause flashbacks, nightmares and severe anxiety for years after a traumatic event.  And research on both people and animals suggests the reason is that a brain injury can disrupt circuits that normally dampen the response to a frightening event. The result is like “driving a car and the brake’s not fully functioning,” says Mingxiong Huang, a biomedical physicist at the University of California, San Diego.  Read more . . .

U.S. on Verge of Ending Talks with Russia over War in Syria
Speaking at the Atlantic Council think-tank on Thursday, John Kerry (Secretary of State) said that the US is “on the verge of suspending the discussion because it’s irrational in the context of the kind of bombing taking place”. He said the US has no indication of Russia’s “seriousness of purpose” and discussions made no sense at a time when Russian and Syrian warplanes were bombing rebel-held areas of Syria’s second largest city.  Read more . . .

special forces

U.S. to Send 600 More Troops in Preparation to Retake Mosul
The United States will send around 600 new troops to Iraq to assist local forces in the battle to retake Mosul from Islamic State that is expected later this year, U.S. and Iraqi officials said on Wednesday.  The new deployment is the third such boost in U.S. troop levels in Iraq since April, underscoring the difficulties President Barack Obama has had in extracting the U.S. military from the country.  Iraqi Prime Minister Haider al-Abadi said in a statement that his government asked for more U.S. military trainers and advisers. Obama called it a “somber decision.”  Read more . . .

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider becoming a member of Stand For The Troops

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