Commission: VA needs CIO for health

The Department of Veterans Affairs’ health care system could better meet veterans’ medical needs by creating a CIO position dedicated solely to health IT matters, the VA Commission on Care noted in its final report.

The Commission on Care — charged in the Veterans Access, Choice and Accountability Act of 2014 with improving veterans’ access to health care in the next two decades and examining how to best organize the Veterans Health Administration — calls for the creation of a CIO position responsible for the IT of the commission’s proposed VHA Care System, which would stand as a network of VA, Defense Department and other private health care providers that reflects veterans increasingly seeking care outside of traditional VA hospitals.

The commission recommends: “VHA establish a Senior Executive Service (SES)-level position of VHA Care System chief information officer (CIO), selected by and reporting to the chief of VHA Care System (CVCS) with a dotted line to the VA CIO. The VHA CIO is responsible for developing and implementing a comprehensive health IT strategy and developing and managing the health IT budget.” 

Prior to 2006, when the VA’s budget was centralized and its Office of Information and Technology took over IT matters departmentwide, the VHA had a chief health informatics officer responsible for the VHA electronic health record system, the report explains. When IT was centralized to VA’s OI&T, the report says, “VHA’s needs became only one of the priorities that OI&T has had to accommodate and VHA’s priorities have not always prevailed.”

Citing other organizations’ success with a chief medical information officer, like the DOD, Cleveland Clinic, Geisinger and Kaiser Permanente, the commission recommends VHA follow suit creating such an IT leadership position.

“[T]he Commission believes that it is essential for VHA to have a CIO with health care expertise and substantial experience, reporting to the chief of VHA Care System,” the report states. “The VHA CIO will be responsible for managing the complex implementation of a state-of-the-art comprehensive information system platform to support the new integrated VHA Care System, with the functionality, interoperability, and data management capabilities to support the delivery and coordination of high-quality health care for veterans.”

The new position, the commission urges, should work closely with VA’s CIO.

The commission also recommends that VHA move to a commercial off-the-shelf health IT system that can support its proposed VHA Care System through “a comprehensive electronic health care information platform that is interoperable with other systems; enables scheduling, billing, claims, and payment; and provides tools that empower veterans to better manage their health.”

In countless congressional hearings, the VA has been criticized for its decision to continue building its Veterans Health Information Systems and Technology Architecture, its custom-built EHR platform better known as VistA, rather than buying a commercial off-the-shelf solution. VA, however, is looking beyond VistA to develop what it calls its Digital Health Platform.

“We are leveraging open-source standards such as the Fast Healthcare Interoperability Resources (FHIR) framework and Health Level 7 International (HL7) models to integrate the 130+ instances of VistA we have today into a cloud-based, Digital Health Platform,” according to a midyear report from VA OI&T.

The Commission on Care was established in the Veterans Choice Act as a response to the VA waitlist scandal of 2014, when it was reported that dozens of veterans at VA hospitals across the country had allegedly died while on waitlists because they did not receive timely care.  

In its more than 300-page report, submitted to President Barack Obama last week, the commission — comprising 15 leading health care professionals, veterans and others familiar with the VA — concludes “that America’s veterans deserve much better, that many profound deficiencies in VHA operations require urgent reform, and that America’s veterans deserve a better organized, high-performing health care system.”

VA has taken many steps since the commission was chartered in 2014 to address the issues it was established to investigate, VA Secretary Bob McDonald said in a statement.

“However, until all Veterans say they are satisfied, I won’t be satisfied,” McDonald said. “Nobody at VA will be satisfied. But our progress so far proves that VA’s current leadership, direction, and momentum can produce the necessary transformation.”