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  Outdated, clunky and inefficient legacy systems at banks and insurance companies have proved to be rather ineffective at keeping pace with technology.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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SFTT News: Highlight for Week Ending Jun 7, 2017

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Found below are a few military 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.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Syrian Military Threatens Coalition Forces on Border
Forces loyal to the Syrian government have threatened to retaliate with force after the U.S. military struck their positions on multiple occasions. A military alliance fighting the Islamic State militant group (ISIS) and other insurgents on behalf of Syrian President Bashar al-Assad and his allies in Iran and Russia issued a statement Wednesday containing five points of criticism after U.S. warplanes carried out strikes against their fighters on Tuesday. The U.S. argued that Iran-backed militants had approached too closely a Special Forces base in the Syrian region of al-Tanf near the Iraqi and Jordanian borders, prompting the U.S. to launch its second such attack in three weeks against pro-Assad forces.  Read more . . .

Veterans with PTSD

Treating PTSD at the Department of Veterans Affairs
The Department of Veterans Affairs has greatly expanded its treatment programs for mental health problems overall, and for post-traumatic stress disorder in particular, said Dr. Harold Kudler, acting assistant deputy under secretary for Patient Care Services at the VA. In fiscal 2016, the VA provided mental health treatment to 1.6 million veterans, up from 900,000 in 2006, Kudler said. Of the overall figure, 583,000 “received state-of-the-art treatment for PTSD,” including 178,000 who served in Iraq and Afghanistan, he added.   Read more . . .

European Military Command Center Moves Forward
The European Union approved a new military command center for foreign training missions on Thursday after Britain dropped its opposition, the latest step in EU efforts to integrate its militaries and defense industries. A day after the European Commission offered 1.5 billion euros ($1.68 billion) a year in support of Franco-German plans for greater EU defense cooperation, all 28 EU governments agreed for the command center in Brussels to run training missions in Somalia, the Central African Republic and Mali. EU foreign policy chief Federica Mogherini said in a statement the decision was “a very important operational decision to strengthen European defense”.   Read more . . .

Senate Passes VA Reform Bill
The Senate approved bipartisan legislation by voice vote Tuesday to reform civil service protections at the Department of Veterans Affairs. The legislation, dubbed the “Department of Veterans Affairs Accountability and Whistleblower Protection Act” would make it easier to fire federal employees, including executives. The legislation follows numerous scandals at the VA in recent years, most notably the manipulation of waiting lists for veterans, with patients dying while waiting for treatment.  Read more . . .

Secretary Shulkin Announces Shift in Electronic Records
In a move that’s been long-discussed and much anticipated, Veterans Affairs Secretary David Shulkin announced his intention to move VA to a commercial, off-the-shelf electronic health record and turn the page on a new chapter toward achieving interoperability with the Defense Department. VA will abandon its own, existing Veterans Information Systems and Technology Architecture (VistA) and adopt MHS Genesis, the same EHR system that DoD is deploying. All patient data will reside in one common Cerner Millennium system.  Read more . . .

Crisis in PTSD Drug Development Leads to Other Treatment Alternatives
Only two medications – sertraline (Zoloft, Pfizer) and paroxetine (multiple brands) – are currently approved by the US Food and Drug Administration (FDA) for the treatment of PTSD. Although these drugs and a few others have modest effect sizes, they are not as effective as trauma-focused psychotherapies, as reported in a recent review, which, Dr Davis said, factored largely into the pivotal clinical guidelines shift. Although the results reflect the potentially robust efficacy of psychotherapy, they also underscore the need for better medications, a sentiment that Dr Davis and her colleagues on the working group noted in a consensus statement.  Read more . . .

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

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