New VA CIO focuses on digital transformation, EHR changeout
Kurt DelBene, a former Microsoft govt who’s now the CIO of the US Department of Veterans Affairs, needs to concentrate on reworking the company right into a digital pleasant group that makes use of fashionable applied sciences equivalent to telehealth providers.
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The new CIO of the US Department of Veterans Affairs (VA) mentioned the company plans to focus closely on digital transformation efforts, depend on extra cloud-based functions, proceed its push into telehealth, and construct out its inside IT employees.
During a media roundtable Thursday, VA CIO Kurt DelBene mentioned his objective is to remodel company’s expertise panorama to assist drive a seamless, unified expertise for veterans by digital transformation.
In 2018, the VA started the method of migrating away from its homegrown, 40-year-old Veterans Health Information Systems and Technology Architecture (VistA) system to a brand new digital healthcare report (EHR) system from Cerner. (In December, Oracle introduced plans to purchase Cerner for $28.3 billion.)
The VA’s VistA EHR supplies medical, administrative, and monetary capabilities for greater than 1,700 hospitals and clinics of the Veterans Health Administration. VistA consists of 180 medical, monetary, and administrative functions built-in in a single transactional database.
The VA’s new Cerner Millennium EHR system is a standardized platform that shops well being data and tracks all elements of affected person care. It is predicted to be absolutely in place by 2028.
The new EHR system will join VA medical services with the US Department of Defense, the Coast Guard and collaborating neighborhood care suppliers, permitting clinicians to extra simply entry a veteran’s full medical historical past in a single location. The VA Electronic Health Record Modernization (EHRM) program Integration Office is managing the deployment of the brand new system.
In 2020, the rollout to a brand new EHR started on the West Coast with a pilot within the Mann-Grandstaff VA Medical Center in Spokane, WA. It instantly bumped into issues; affected person questions of safety and outages led the company to halt deployments for a time.
The issues with the brand new EHR additionally seeded doubt as as to whether the unique decade-long schedule stays viable.
“Electronic health records systems are difficult to deploy. I don’t think anybody in the industry wouldn’t say that,” mentioned DelBene, who took over as CIO in December. “I think we could do a better in terms of making sure everyone’s trained and they’re on-board and know completely how the system works.
“I think we had some infrastructure problems early on. So, I think our level of preparedness overall could have been stronger,” DelBene mentioned. “I also think the clear criteria of what we should meet before we go live could have been crisper.”
Based on classes realized from the Spokane pilot, the VA is healthier ready for its subsequent rollout — within the company’s Medical Center in Walla Walla, WA, he mentioned. “We’ve done a lot better job in terms of getting that criteria established.”
Even so, Rep. Cathy McMorris Rodgers (R-WA) called on the VA this month to delay the rollout of the Cerner EHR in Walla Walla. “More than a year after Mann-Grandstaff went live on the system, most of the productivity, patient safety, and morale impacts still have not been resolved,” Rogers said in a statement. “While the system outages have somewhat improved, fundamental problems, especially in pharmacy, have not been addressed. Veterans in my district continue to struggle with delayed and erroneous prescriptions, as well as bottlenecks in referrals to specialists or community care.
“Bottom line, the Electronic Health Record Modernization (EHRM) transition is still making life harder on veterans and VA providers, not easier, and until these problems are fixed, its continued roll-out should be delayed,” she mentioned.
DelBene mentioned his company will proceed supporting VistA through the transition to a brand new EHR. For instance, the VA is migrating VistA information to cloud suppliers, equivalent to AWS, to make sure continued efficiency.
Last week, DelBene advised lawmakers he needs to guide an agency-wide digital transformation effort to modernize IT techniques and enhance inside software program improvement choices, together with low-code and no-code options. DelBene mentioned the VA must concentrate on how one can do software program and providers improvement amid heavy outsourcing to exterior contractors.
The VA previously could have relied an excessive amount of on exterior contractors with out a stable set of requirements to vet these distributors and monitor their, mentioned DelBene, a former Microsoft govt and Healthcare.gov senior advisor. As Microsoft realized to do, the VA will create requirements to take care of contractors work to construct out its inside IT employees.
“We should know when we should be using an outside contractor versus what can be done internally,” he mentioned.
DelBene mentioned there’ll at all times be a dependency on contractors as a result of will be inexpensive than full-time employees. But he additionally needs to construct out the VA’s personal IT employees by bringing in additional builders and technical staff.
DelBene now leads a workforce of roughly 16,000 authorities and contract staffers who allow healthcare and advantages supply to greater than 9 million veterans.
The VA has beenj working to hook up with two main Health Information Exchanges (HIEs), the place medical doctors, nurses, pharmacists, different healthcare suppliers and sufferers can entry and securely share medical data. The Veterans Health Information Exchange (VHIE) launched in 2020; it connects to 2 private-sector HIE’s — eHealth Exchange and WidespreadWell. Through that HIE community, 60% to 65% of personal healthcare techniques can change information with the VA, in keeping with Neil C. Evans, MD, a particular advisor to VA’s CIO.
The VA additionally needs to proceed a push into telemedicine. “We have seen an amazing surge. Before the pandemic, we had 40,000 visits per month, and now we have 40,000 telehealth visits per day,” DelBene mentioned. “The ability to have telehealth transform the experience for veterans, especially in rural areas, is huge.”
During the pandemic, greater than 230,000 veterans have been capable of schedule COVID vaccinations through textual content message, in keeping with VA CTO Charles Worthington. This 12 months, the VA rolled out a mushy launch of a brand new flagship cellular app, “that’s getting good traction and reviews from veterans,” he mentioned.
The VA has additionally quadrupled its community bandwidth to help the telehealth initiative through the pandemic, in keeping with Todd Simpson, the VA’s deputy assistant secretary of DevSecOps.
Since 2019, the company has additionally been transferring towards the cloud. It hopes to have about 50% of all functions cloud-based by 2024.
While EHR software program is turning into the usual throughout the business, not all healthcare places of work have moved absolutely to digital record-keeping. In reality, inside the VA, the fax machine stays a giant a part of healthcare data change, in keeping with Neil C. Evans, MD, a particular advisor to the workplace of the VA CIO.
The new EHR system is “a way to put the fax machine into legacy of technology,” Evans mentioned.