One thing the VA can do to dramatically improve veterans' health care
The Department of Veterans Affairs is now a different system compared to what it was before Congress implemented the Veterans Choice program (the initiative permitting veterans to receive care from non-VA facilities) over a decade ago. With the Mission Act further expanding veterans' choice in 2018, the VA permanently transformed into a system that integrates VA-based facilities and community care.
Today, approximately 44% of veterans' health care expenditures come from the private sector. During this period, overall demand for veterans' health care has grown significantly. The VA enrolled 401,006 veterans in VA health care over the past year, marking the highest number of enrollees in recent times.
Perhaps most significantly, trust levels among veterans have increased. In other words, the new system appears to be moving in the right direction.
Having led the VA, as well as being a seasoned health care executive, I know all too well that health systems cannot be sustained without investments that keep pace with a rapidly changing environment. A world-class system of care for veterans requires the VA to invest in modernizing its facilities, technology and workforce. Additionally, Congress must provide the agency with the flexibility to respond to these requirements.
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The VA receives every new veteran enrollee from the Department of Defense, and increasingly, veterans are receiving their care both within the VA and in the community. For this system to work, there must be clinical coordination of care, which relies on the effective transfer of clinical data between the DOD, community care providers and the VA.
Congress has continued to prioritize addressing veterans’ health care 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, Sens. Angus King, I-Maine, and Jerry Moran, R-Kan., introduced the Coordinating Care for Senior Veterans and Wounded Warriors Act. This legislation aims to provide individualized care plans and care coordination to reduce gaps in care, duplication of services, and other delays and inefficiencies across the board.
However, perhaps most critical for veterans is having good access to data that flows between the VA, the DOD, and the community care network.
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The VA’s current electronic health record (EHR), now over 30 years old, is not cloud-based, which has become the standard in the industry. This makes clinical data exchanges for ensuring care coordination with providers outside of the VA even more challenging.
Given the configuration of the VA’s legacy EHR, the agency risks falling further behind the private sector in advancing technological innovation and interoperability. This is why the successful implementation of a commercial electronic health record is fundamental to the future sustainability of the VA.
As VA secretary, I thoroughly explored how to enable the VA health system to become more interoperable with outside organizations. We consulted with many leading health care systems across the country, including that of the Department of Defense, to see how they did so. I ultimately decided that it was time for the VA to move away from its self-run system and toward commercially available technology.
Almost every private health care system has opted 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 was not their core competency, it is wiser to leverage the expertise and experience of companies that focus on this market.
The VA has faced several challenges in implementing its new commercial EHR, which has proven to be costlier and more time-consuming than anticipated. However, in response to these challenges, the VA appropriately prioritized veteran safety and paused to regroup their approach. Given what it has learned, it is now in a better position to restart the process.
To undertake a large, complex implementation, the VA must have total commitment from their administrative and clinical leadership. A successful EHR implementation is not just a technology issue but a large-scale change management initiative.
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The Department of Defense successfully converted to using the same system that the VA seeks to leverage. It took a full agency commitment by the DOD to accomplish this, and there is no reason the VA cannot do the same.
This week, the VA extended the commercial EHR contract for another year to prepare for further deployments of the electronic health record. This is a step in the right direction, and now it is time for the VA to recommit, focus and get the job done.