The new CIO of the US Department of Veterans Affairs (VA) said the agency plans to focus heavily on digital transformation efforts, rely on more cloud-based applications, continue its push into telehealth, and build out its internal IT staff.

During a media roundtable Thursday, VA CIO Kurt DelBene said his goal is to transform agency's technology landscape to help drive a seamless, unified experience for veterans through digital transformation.

In 2018, the VA began the process of migrating away from its homegrown, 40-year-old Veterans Health Information Systems and Technology Architecture (VistA) system to a new electronic healthcare record (EHR) system from Cerner. (In December, Oracle announced plans to buy Cerner for$28.3 billion.)

The VA's VistA EHR provides clinical, administrative, and financial functions for more than 1,700 hospitals and clinics of the Veterans Health Administration. VistA consists of 180 clinical, financial, and administrative applications integrated in a single transactional database.

The VA's new Cerner Millennium EHR system is a standardized platform that stores health information and tracks all aspects of patient care. It is expected to be fully in place by 2028.

The new EHR system will connect VA medical facilities with the US Department of Defense, the Coast Guard and participating community care providers, allowing clinicians to more easily access a veteran's full medical history in one location. The VA Electronic Health Record Modernization (EHRM) program Integration Office is managing the deployment of the new system.

In 2020, the rollout to a new EHR began on the West Coast with a pilot in the Mann-Grandstaff VA Medical Center in Spokane, WA. It immediately ran into problems; patient safety issues and outages led the agency to halt deployments for a time.

The problems with the new EHR also seeded doubt as to whether the original decade-long schedule remains viable.

"Electronic health records systems are difficult to deploy. I don't think anybody in the industry wouldn't say that," said 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 said. "I also think the clear criteria of what we should meet before we go live could have been crisper."

Based on lessons learned from the Spokane pilot, the VA is better prepared for its next rollout - in the agency's Medical Center in Walla Walla, WA, he said. "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 said.

DelBene said his agency will continue supporting VistA during the transition to a new EHR. For example, the VA is migrating VistA data to cloud providers, such as AWS, to ensure continued performance.

Last week, DelBene told lawmakers he wants to lead an agency-wide digital transformation effort to modernize IT systems and improve internal software development offerings, including low-code and no-code solutions. DelBene said the VA needs to focus on how to do software and services development amid heavy outsourcing to external contractors.

The VA in the past may have relied too much on outside contractors without a solid set of standards to vet those vendors and track their, said DelBene, a former Microsoft executive and Healthcare.gov senior advisor. As Microsoft learned to do, the VA will create standards to deal with contractors work to build out its internal IT staff.

"We should know when we should be using an outside contractor versus what can be done internally," he said. 

DelBene said there will always be a dependency on contractors because can be less expensive than full-time staff. But he also wants to build out the VA's own IT staff by bringing in more developers and technical workers.

DelBene now leads a workforce of approximately 16,000 government and contract staffers who enable healthcare and benefits delivery to more than nine million veterans.

The VA has been working to connect to two major Health Information Exchanges (HIEs), where doctors, nurses, pharmacists, other healthcare providers and patients can access and securely share medical information. The Veterans Health Information Exchange (VHIE) launched in 2020; it connects to two private-sector HIE's - eHealth Exchange and CommonWell. Through that HIE network, 60% to 65% of private healthcare systems can exchange data with the VA, according to Neil C. Evans, MD, a special advisor to VA's CIO.

The VA also wants to continue 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 said. "The ability to have telehealth transform the experience for veterans, especially in rural areas, is huge."

During the pandemic, more than 230,000 veterans were able to schedule COVID vaccinations via text message, according to VA CTO Charles Worthington. This year, the VA rolled out a soft launch of a new flagship mobile app, "that's getting good traction and reviews from veterans," he said.

The VA has also quadrupled its network bandwidth to support the telehealth initiative during the pandemic, according to Todd Simpson, the VA's deputy assistant secretary of DevSecOps.

Since 2019, the agency has also been moving toward the cloud. It hopes to have about 50% of all applications cloud-based by 2024.

While EHR software is becoming the standard across the industry, not all healthcare offices have moved fully to digital record-keeping. In fact, within the VA, the fax machine remains a big part of healthcare information exchange, according to Neil C. Evans, MD, a special advisor to the office of the VA CIO.

The new EHR system is "a way to put the fax machine into legacy of technology," Evans said.