VA Health Records System Yet To Deliver Quality Care for Veterans After Continuing Long Term Development Spanning Years And Over $16 Billion

 

"DEFENSE OPINION" By Frank Larkin

"At issue is the as-yet-incomplete adoption by the Department of Veterans Affairs of a new electronic health records (EHR) system for the 170 VA medical centers and 1,193 outpatient sites across the nation that serve approximately nine million veterans"

__________________________________________________________________________________

"Roll out of the new EHR system has lagged, both due to the ripple effects of developmental problems that have since been corrected, and inadequate training of VA staff and related issues, the Government Accountability Office found in 2023. As a result, only five of VA’s 170 medical centers currently are using the software since Trump launched the effort back in 2017.

The VA system is designed to connect with the new records system in the U.S. military services. The idea is that a servicemember can transition from active duty to civilian life, along with all of his or her medical records – and not get lost in, or forgotten by, what can be an unforgiving bureaucracy. A seamless hand off is the goal, one that is well within reach.

“For veterans, this will result in improved standardization of health care delivery, patient care quality and safety,” the VA said in a statement.

New records keeping system a big step forward

The advent of a new medical records-keeping system for veterans might sound like a minor, logistical turn of the screw. Far from it.

According to Dr. Neil Evans, who leads the VA’s health record modernization office, electronic records “profoundly impact operations.” They help steer “how instructions for care… are transmitted and received within the hospital, how highly complex care is organized in our intensive care units, how surgeries are successfully planned and completed, how  prescriptions are ordered and delivered,” he told a House panel.

At the level of the individual veteran, the new EHR system, under development by Oracle Health, will change lives. Veterans no longer will need to repeat tests or repeat basic info, such as drug allergies, to each provider. Their health risks will be better tracked by clinicians and identified earlier –before spiraling out of control. They will benefit from improved strategies to address suicide risk, post-traumatic stress disorder and traumatic brain injuries. If they move from one state or region to another, their records will follow.

A tool to combat isolation and suicide

From the perspective of my organization, dedicated to preventing isolation and curtailing suicide among veterans, modern record keeping will provide continuity of care, which is essential for keeping veterans connected to the VA. One of the main issues I hear from veterans is that the legacy records system is clunky and clumsy, that veterans regularly and repeatedly are having to provide their health histories to different clinicians, particularly if they use multiple VA medical centers and that they get disenfranchised by bureaucracy.

This matters especially for those standing on the edge of the abyss. By some estimates, two-thirds of vets who die by suicide have had no contact with the VA. Modernized records keeping sends a strong signal to the individual patient that “they are listening to me because I don’t have to cover the same old ground.” It keeps them connected to the VA and support networks. And if they are connected, they are far less likely to harm themselves.

The next major deployment of the new EHR system unfortunately isn’t scheduled until 2026, when four VA facilities in Michigan will get the overhaul.

But in the meantime, veterans are stuck with the VA’s antiquated health records system, which the GAO described as “technically complex, costly to maintain, and does not fully support the need to exchange health data with other organizations.” And also in the meantime, veteran suicide trends remain a national crisis and veteran health outcomes far worse than for civilians."

With New Health Records System, Administration has Opportunity to Deliver Quality Care for Veterans

ABOUT THE AUTHOR

Frank Larkin is a former Navy SEAL, 40th U.S. Senate Sergeant at Arms and father of a Navy SEAL son who died by suicide. Larkin is chief operating officer of Troops First Foundation and chairman of Warrior Call.

_______________________________________________________________________________________________________

EDITOR'S NOTE: For further recent details of the VA EHR System Development effort, please see: ‘Connecting The Dots’ In the Military And Veterans Health Care Systems Maze

Sole Source Contractor With Non-Competitive $16 Billion VA Records Integration Contract Calls It “Immense Challenge”

Image: FCW.com

Editors Note:  Cerner was determined to be the sole source for this requirement because they are running the current system for the Military and after billions in historical failures to connect the VA records system to the military, the military and the VA jointly decided to move the entire VA records system over from its current hosting to the military software.  This company thus became the sole source and competition was waived.  For further details please see:   https://rosecoveredglasses.blogspot.com/2018/06/the-next-10-billion-tax-payer-chapter.html

________________________________________________________________________

MILITARY.COM“

“This won’t be easy,” the prime contractor said of the $16 billion effort to overcome decades of failure and finally make veteran and military health records compatible with a few computer clicks.

We must deploy to 117 sites, train over 300,000 VA employees, collaborate with DoD, interoperate with the community, aggregate decades of clinical data and update technology,” he told a hearing of the House Veterans Subcommittee on Technology. “

“It carries risk, and we don’t take the challenges lightly” in implementing Electronic Health Record Modernization (EHRM) programs across the Departments of Veterans Affairs and Defense”, said Travis Dalton, president of government services for Cerner Corp. of Kansas City.

In addition, the new system will have to link with additional community health care providers expected to come onboard with the June 6 rollout of the VA Mission Act, which will expand private health care options for veterans, said Rep. Jim Banks, R-Indiana, the ranking member of the subcommittee.

“Interoperability with the community providers is still the elephant in the room,” he said.

About 30% of veterans currently get health care at taxpayer expense in the private sector, and they “rightfully expect their records to follow them,” Banks said. He said his main concern is that a “half-baked system” will be rushed into use.

Rep. Susie Lee, D-Nevada, chairwoman of the subcommittee, said that Cerner and partners Leidos and Booz Allen Hamilton are attempting to create “one seamless lifetime record for our service members as they transition from military to veteran status,” but “this effort also has the potential to fail.”

“The VA unfortunately does not have a great track record when it comes to implementing information technology,” she said, “and it threatens EHRM.”

Previous attempts to mesh VA and DoD records have either failed or been abandoned, most recently in 2013 when then-Defense Secretary Leon Panetta and then-VA Secretary Eric Shinseki dropped an integration plan after a four-year effort and the expenditure of about $1 billion.

“This won’t be easy, but it is achievable and we are making progress” in the overall effort to let “providers have access to records wherever they deliver care,” Dalton said.

Jon Scholl, president of the Leidos Health Group and a Navy veteran, said the example to follow is the MHS Genesis system, the new electronic health record for the Military Health System. “MHS Genesis is the solution,” he said at the hearing.

However, Lee said that “a suitable single management structure has yet to emerge” for EHRM since then-Acting VA Secretary Robert Wilkie awarded a $10 billion, 10-year contract to Cerner in May 2018. The cost estimate for the contract has since risen to $16 billion.

At a hearing last month of the House Defense Appropriations Subcommittee, Acting Defense Secretary Patrick Shanahan was challenged on the DoD’s efforts to work with the VA on EHRM.

“I don’t ever recall being as outraged about an issue than I am about the electronic health record program,” Rep. Kay Granger, R-Texas, told him.

“Personally, I spend quite a bit of time on how do we merge together” with the VA on the records, Shanahan assured her.

He said pilot programs on making the records compatible are underway in Washington state at Joint Base Lewis-McChord, Naval Base Kitsap, Naval Air Station Whidbey Island and Fairchild Air Force Base.

The “rollout and implementation” of the fix to the electronic health records has shown promise at those installations, Shanahan said, adding that the next step is to put the programs in place at California installations in the fall.”

Making VA, DoD Records Compatible Is an Immense Challenge: Contractor

A Veteran Connects the Dots In the Military and Veterans Health Care Systems Maze

PLEASE CLICK ON IMAGE TO ENLAGE

The Massive backlog recently highlighted in the press and in Congress  reveals a dire necessity for simplification, communication and  efficiency in processes, systems and government service contracting in DOD and the Veterans Administration as well as better management of federal government contractors. 

The news media, the auditors and the average American are pointing the finger at the President and the Head of the VA.  One cannot ignore the accountability aspects of these individuals.  

However, the real root causes lie in the massive volume of war veterans returning from our pointless incursions in the Middle East over the last decade, coupled with the historically poor process and systems work conducted between the Department of Defense and the VA and poorly managed contractors taking home millions on systems specifications that change like the wind blows.  

It is not unlike the Obama Care fiasco.

After returning from two combat tours in Vietnam, I worked in the government contracting environment for 36 years then went through the VA system as a Veteran getting treatment at retirement in 2006

In 2006 I found the VA had a magnificent system capable of handling medical records and treatment anywhere in the world once a veteran was in the system; a key point.  Please contrast the below Time Magazine Story with current events and ask yourself : Why have we had such deterioration?  

http://content.time.com/time/magazine/article/0,9171,1376238,00.html

ANSWER:   We have not experienced deterioration - within the VA itself, except  from pressures due to millions returning from war and from human beings who look for excuses when systems fail.

We have had over 17 years of Middle East incursions, a sudden discharge of veterans and poor management from the DOD to the VA, from the systems contractors to the state veterans homes.  

Veterans fall through the cracks as a result.

 This is an F-35 aircraft, cost plus scenario, revisited in the form of veterans care systems mismanagement and it will cost billions to fix.  THAT IS THE COST OF WAR.

Unlike the F-35 we must have veterans health care or our volunteer army will disappear.

THE TOTAL SPECTRUM MUST BE VIEWED TO MANAGE THE ISSUES. 


BACKGROUND

A recent 3 part special in Time Magazine addresses the serious gaps between treatment,  benefits and services processes and systems between the military  services and the Veterans Administration:

http://nation.time.com/2013/04/22/what-the-hell-is-going-on-with-va/#ixzz2RnspoSM4

"While awaiting  processing, "the veteran’s claim sits stagnant for up to 175 days as VA  awaits transfer of complete (service treatment records) from DoD,":

After years of work to move toward integrated electronic records that would eliminate this sort of delay, Defense Secretary Chuck Hagel recently  conceded that the Defense Department is not holding up its end of the bargain to improve the disability process.

"I didn’t think, we knew what the hell we were doing.":
 
http://www.federalnewsradio.com/394/3288748/Hagel-orders-DoD-to-restructure-path-toward-integrated-health-record 
 

HISTORICAL SIMILARITIES

The above scenario is not unlike the Walter Reed Army Hospital care  fiasco a few years ago, before the facility was shut down and consolidated with the Bethesda Naval facility.

OTHER SYMPTOMS

The VA decided to have those who would  actually use the system (claims processors) work with software  developers. This process took longer but will create a system more  likely to meet the needs of those who actually use it. VA also worked  closely with major Congressional-chartered veterans’ service  organizations.

2013 was the year in which regional offices were to be being transitioned to the new electronic system.  It obviously has not occurred as planned.

ROOT CAUSE

Both DOD and the Veterans  Administration use service contractors to perform this type of systems development.  Government Computer News (GCN)  carried a story on the  difficulties experienced with, "Performance-Based Contracting", which  has been made part of the Federal Acquisition Regulation (FAR) in an  attempt to pre-establish at contract award those discrete outcomes that determine if and when a contractor will be paid.

http://gcn.com/articles/2006/12/01/performancebased-contracting-still-baffles-agencies.aspx 

Interestingly enough, the article splits the blame for the difficulties  right down the middle, stating the government typically has problems  defining what it wants as an end product or outcome and looks to  contractors to define it for them. More than willing to do so, the contractors detail specific end products or outcomes, set schedule  milestones and submit competitive proposals.

The winner is selected based on what the government thinks it needs at  the time to fulfill its requirement and a contract is negotiated. Once underway, the government decides it wants something else (usually a  management-by-government committee phenomena with a contractor growing  his product or service by offering lots of options). The resulting  change of contract scope invalidates the original price and schedule, so  a whole new round of proposals and negotiations must occur with the  winner while the losers watch something totally different evolve than  that for which they competed. The clock keeps ticking and the winner  keeps getting his monthly bill paid based on incurred cost or progress  payments.

CONCLUSION

The present state of the economy and the needs of our servicemen will not allow the aforementioned to  continue. Government agencies are now hard pressed to insure the most  "Bang for the Buck". It is in the long term interests of the politician, the DOD, the VA and astute contractors to assist in that endeavor. 

(1)The only way to achieve such an objective is through sound technical, cost and schedule contract definition via an iterative process of baseline management and control.

http://www.smalltofeds.com/2009/08/contract-baseline-management-in-small.html

(2)  Government civil servants must be trained to report systemic poor service up the line in lieu of hiding bad news from superiors or developing workarounds.  This must be an expectation built into their job description and they must be rewarded and promoted for meeting that requirement just as they are for the other requirements of their jobs. 

The first whistle to be blown must be to the boss when the service issue occurs, not to the press a year from the occurrence. 

Our returning soldiers and those who have served before deserve better"

U.S. Veterans Hospitals Quality Ratings FY 2018

"U.S. DEPARTMENT OF VETERANS AFFAIRS"

"The Veterans Health Administration uses a comprehensive performance improvement tool called Strategic Analytics for Improvement and Learning (SAIL). SAIL is developed for the VA to drive internal system-wide improvement.

Many of the metrics on SAIL are not publicly reported by non-VA hospitals and health systems.  Therefore, it is not appropriate to directly compare evaluation findings derived from SAIL with results from public and private sector hospitals. "

---

The metrics are organized into 9 Quality domains and one Efficiency and Capacity domain.  The Quality domains are combined to represent overall Quality.  Each VA medical center is assessed for overall Quality from two perspectives: (1) Relative Performance compared to other VA medical centers using a Star rating system from 1 to 5 and (2) Improvement compared to its own performance from the past year.  Both relative performance and size of improvement are used to guide improve efforts.

In 2018 66% (96 out of 146) of VA Medical Centers Reported on SAIL Showed Improvement Compared to Their Baseline One Year Earlier.

The table below displays relative performance in star rating in the third column and size of improvement in arrows in the fourth column that indicate whether medical center performance has improved, stayed the same or declined over the past year.

VISN	Medical Center	Relative Performance Star Rating (1 to 5)	Improvement From Baseline Scores 2017
2	Albany	3	↑↑
22	Albuquerque	2	↑
16	Alexandria	2	→
4	Altoona	4	→
17	Amarillo	4	↑↑
20	Anchorage	3	→
10	Ann Arbor	3	↑
6	Asheville	5	↑↑
7	Atlanta	1	→
7	Augusta	2	→
5	Baltimore	3	↑
2	Bath	5	↑
10	Battle Creek	2	↑↑
8	Bay Pines	3	→
5	Beckley	2	→
1	Bedford	5	→
17	Big Spring	1	↑↑
7	Birmingham	4	↑
20	Boise	3	→
1	Boston	4	→
2	Bronx	4	↑
2	Brooklyn	3	↑
2	Buffalo	4	↑↑
4	Butler	5	↓
2	Canandaigua	4	↑↑
23	Central Iowa	4	↑
7	Charleston	4	→
19	Cheyenne	2	→
12	Chicago	3	↑
10	Chillicothe	4	→
10	Cincinnati	5	↑
5	Clarksburg	4	↑↑
10	Cleveland	5	↑
4	Coatesville	5	→
15	Columbia MO	3	↑
7	Columbia SC	2	↑
10	Columbus	4	↑
1	Connecticut	5	↑
17	Dallas	2	↑
12	Danville	3	↑
10	Dayton	3	→
19	Denver	2	↑
10	Detroit	3	↑
7	Dublin	3	↑↑
6	Durham	3	↑
2	East Orange	2	↑
17	El Paso	1	↑↑
4	Erie	5	↑
23	Fargo	4	↑
16	Fayetteville AR	3	→
6	Fayetteville NC	2	→
23	Fort Meade	3	→
10	Fort Wayne	2	↑
21	Fresno	2	↑
8	Gainesville	3	↑
19	Grand Junction	4	↑
16	Gulf Coast HCS	2	→
6	Hampton	2	→
17	Harlingen	2	↑↑
12	Hines	3	↑
21	Honolulu	2	↑
23	Hot Springs	5	↑↑
16	Houston	3	→
2	Hudson Valley	3	→
5	Huntington	4	↑↑
10	Indianapolis	3	↑
23	Iowa City	3	↑
12	Iron Mountain	5	↑
16	Jackson	2	↑↑
15	Kansas City	2	↑
8	Lake City	2	→
21	Las Vegas	2	↑↑
15	Leavenworth	4	↑
4	Lebanon	5	↑
9	Lexington	4	↑
16	Little Rock	3	↑↑
22	Loma Linda	1	↑
22	Long Beach	2	→
22	Los Angeles	3	↑
9	Louisville	3	→
12	Madison	5	↑
1	Manchester	3	↑
15	Marion IL	2	↑
5	Martinsburg	2	↑
9	Memphis	1	↑
8	Miami	3	→
12	Milwaukee	3	→
23	Minneapolis	4	→
19	Montana	2	↑
7	Montgomery	1	→
9	Mountain Home	4	↑
9	Murfreesboro	2	↑
19	Muskogee	2	→
9	Nashville	2	↑
16	New Orleans	3	↑
2	New York	4	↑
12	North Chicago	4	→
1	Northampton	5	↑↑
2	Northport	3	→
19	Oklahoma City	2	↑
23	Omaha	4	→
8	Orlando	3	→
21	Palo Alto	2	→
5	Perry Point	3	↑↑
4	Philadelphia	3	↑
22	Phoenix	1	→
4	Pittsburgh	4	↑
15	Poplar Bluff	3	→
20	Portland	3	↑↑
22	Prescott	2	↑
1	Providence	3	→
20	Puget Sound	2	↑
21	Reno	3	→
6	Richmond	4	→
20	Roseburg	2	↑
21	Sacramento	3	↑↑
10	Saginaw	5	↑↑
6	Salem	5	↑
6	Salisbury	3	↑
19	Salt Lake City	3	→
17	San Antonio	3	↑↑
22	San Diego	3	→
21	San Francisco	3	↑
8	San Juan	2	→
19	Sheridan	4	↑↑
16	Shreveport	3	↑
23	Sioux Falls	4	→
20	Spokane	3	↑↑
23	St Cloud	5	↑
15	St Louis	3	↑
2	Syracuse	3	→
8	Tampa	4	→
17	Temple	3	↑
1	Togus	5	↑↑
12	Tomah	3	→
15	Topeka	3	↑
22	Tucson	1	→
7	Tuscaloosa	3	↑
20	Walla Walla	2	↑↑
5	Washington	1	→
8	West Palm	3	↑↑
20	White City	3	↑↑
1	White River	3	↑
15	Wichita	4	↑
4	Wilkes Barre	3	→
4	Wilmington	3	↑↑

*Note: Improvement From Baseline: ↑↑ - Large Improvement; ↑ - Small Improvement; →: Trivial Change; ↓: Large Decline

VA Hospital End of Year Ratings

"MILITARY TIMES"

 Veterans Affairs officials claimed improvements at 66 percent of their medical centers across the country last fiscal year, with 18 earning the highest level of excellence in the department’s internal ratings system.

But nine others remain on the VA’s list of underperforming facilities after getting the lowest possible rating. They include the embattled Washington VA Medical Center, which sits just a few miles from the White House and has seen a series of leadership shake-ups in recent years.

The VA ratings — made public in 2016 after a USA Today report on the internal scorecards — grade each of the locations on metrics like patient mortality, patient length of stay, reported accidents and patient satisfaction. Officials have said the system is used to collect best practices from high-performing facilities to use in underperforming ones.

In a statement, VA Secretary Robert Wilkie touted improvements across the 146 medical centers.

“With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” he said. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

The number of one-star facilities dropped by six from the start of fiscal 2018 to the end. Of the nine medical centers still at that level, four were cited for significant improvements: El Paso and Big Spring in Texas, Memphis in Tennessee, and Loma Linda in California.

The five others — Washington, Phoenix and Tucson in Arizona, Montgomery in Alabama, and Atlanta in Georgia — saw no overall change.

Earlier this year, VA placed 12 medical centers on a high-risk list for “aggressive” management intervention. Of those, eight were removed from the program after showing sufficient improvement by the end of last month.

Wilkie said while he is pleased with the results thus far “there’s no doubt that there’s still plenty of work to do.”

Here are the Best and Worst VA Medical Centers

VA Will Shift Medical Records To DOD’s “In-Process” Electronic Medical Records System

Image:  Military Times

Total Investment To Date Now Projected at Nearly $10 Billion

“MILITARY TIMES”

“VA has already spent more than $1 billion in recent years in attempts to make its legacy health record systems work better with military systems.

The military’s health record system is still being put in place across that department, more than three years after the acquisition process began. The initial contract topped $4.6 billion, but has risen in cost in recent years.

Shulkin did not announce a potential price tag for the move to a commercial electronic health records system, but said that a price tag of less than $4 billion would likely be “unrealistic.”

---

“Veterans Affairs administrators on Monday announced plans to shift veterans’ electronic medical records to the same system used by the Defense Department, potentially ending a decades-old problematic rift in sharing information between the two bureaucracies.

VA Secretary David Shulkin announced the decision Monday as a game-changing move, one that will pull his department into the commercial medical record sector and — he hopes — create an easier to navigate system for troops leaving the ranks.

“VA and DoD have worked together for many years to advance (electronic health records) interoperability between their many separate applications, at the cost of several hundred millions of dollars, in an attempt to create a consistent and accurate view of individual medical record information,” Shulkin said.

“While we have established interoperability between VA and DOD for key aspects of the health record … the bottom line is we still don’t have the ability to trade information seamlessly for our veteran patients. Without (improvements), VA and DoD will continue to face significant challenges if the departments remain on two different systems.”

White House officials — including President Donald Trump himself — hailed the announcement as a major step forward in making government services easier for troops and veterans.
Developing implementation plans and potential costs is expected to take three to six months.

But he did say VA leaders will skip standard contract competition processes to more quickly move ahead with Millennium software owned by Missouri-based Cerner Corp., the basis of the Pentagon’s MHS GENESIS records system.

“For the reasons of the health and protection of our veterans, I have decided that we can’t wait years, as DOD did in its EHR acquisition process, to get our next generation EHR in place,” Shulkin said.

Shulkin for months has promised to “get VA out of the software business,” indicating that the department would shift to a customized commercial-sector option for updating the health records.

The VA announcement came within minutes of Trump’s controversial proposal to privatize the nation’s air traffic control system. The president has repeatedly pledged to make government systems work more like a business, and in some cases hand over public responsibilities to the private sector.

Shulkin has worked to assure veterans groups that his efforts to rely on the private sector for expertise and some services will not mean a broader dismantling of VA, but instead will produce a more efficient and responsive agency.

He promised a system that will not only be interoperable with DOD records but also easily transferable to private-sector hospitals and physicians, as VA officials work to expand outside partnerships.

Shulkin is expected to testify before Congress on the fiscal 2018 budget request in coming weeks. As they have in past hearings, lawmakers are expected to request more information on the EHR changes then. ”

http://www.militarytimes.com/articles/va-share-dod-electronic-medical-records-decision