Shulkin: A Transparent VA Will Lead the Way for the Rest of Healthcare

VA Secretary David Shulkin, MD, speaks with David Nash, MD, Dean of Jefferson College of Population Health, at the Eighteenth Population Health Colloquium in Philadelphia.

Department of Veterans’ Affairs (VA) Secretary David Shulkin, MD, read off a scathing criticism of his agency from New York Magazine:

“VA is a vast dehumanized bureaucracy, embedded in mountains of red tape, ingrown with entrenched mediocrity, undemocratically operated under autocratic control centered in Washington, DC, and rigidly resistant to proposed reforms.”

At the 18^th Population Health Colloquium in Philadelphia, Pennsylvania, he admitted that it hasn’t been “the best of times” at VA. But he ribbed anyone in the crowd who thought the above quote was recent: That passage was written in 1940. Contrary to the spirit of that text, the Secretary said, the VA has been a leading force in American healthcare for decades, and he believes it will continue to be so.

A VA nurse came up with the idea of barcoding medications, he pointed out. The nicotine patch was invented in the VA. And the first liver transplant was performed by VA doctors.

Today, Shulkin said, he wants the agency to introduce new firsts, mostly related to transparency. He promised that his agency would be “the most transparent organization in government.”

The VA now posts wait times at all of its facilities, and Shulkin said that on average, VA actually has shorter appointment wait times than hospitals in the private sector: 96% of their appointments occur within 30 days of a patient visit, he said.

It also now posts its opioid prescribing rates publically, sorted by facility. In the spirit of transparency, he pointed to the Roseburg, Oregon facility as the organization’s “worst” with a 20% prescription rate (some facilities, like Cleveland, Ohio, are down to about 3%).

“When you look at pop health measures, VA almost always outperforms the private sector,” he said, adding in its unparalleled use of telehealth interventions. Although the population it serves faces obvious and severe problems, like suicide and homelessness, he said the agency is also leveraging analytics tools to track those at highest risk so that it can intervene.

The VA’s biggest first was, however, the elephant that follows Shulkin into every room: electronic medical records (EMRs).

The agency rolled out the first incarnation of VistA in 1977, digitizing patient information for the first time. Over the years, however, each VA center altered and customized their VistA platform, leaving the agency with 130 different platforms that can’t communicate.

Shulkin said that the commitment to use a new system from Cerner was made without a bidding process because the situation was a matter of public safety.

“We’re now in the final touches of that contract,” he said of the still-absent contract. Holdups were a result of his need for a guarantee of total interoperability with the private sector—he said without that, he would sign anything.

And that demand would be another signal from VA that the rest of American healthcare should follow.

“When we sign this, we’ll be introducing a new model for the public sector,” he said, encouraging hospital Chief Information Officers to refuse any new EMR arrangement that doesn’t include such a guarantee.