How Fragmented Oversight Harms Veterans

Key Takeaways

The Veterans Health Administration (VHA) struggles to provide quality care to veterans, due to various issues ranging from inadequate staffing, safety concerns, to lack of efficiency. The GAO has attested that the VA faces an ongoing struggle in the oversight of their healthcare system, negatively impacting the ability to provide quality care to veterans. The GAO determined that VA leadership must address the “VA’s fragmented oversight and accountability infrastructure.”

With Oracle’s recent acquisition of Cerner, there is an opportunity to resolve the VHA health system’s fragmented oversight by acquiring PHI from a heterogeneous EHR environment to create a complete longitudinal record to facilitate care management and coordination. Although there is skepticism regarding Oracle’s acquisition of Cerner, this presents an opportunity to provide better continuity of care as military service personnel transition to civilian life.

Introduction

With over 9 million members, 1,298 health care facilities, 1,113 outpatient sites, and 171 medical centers, the VHA is America’s most extensive integrated health system. The VHA was established by Congress following World War I to equip veterans with disability compensation, life insurance, rehabilitation, and hospitalization services. The goal was to provide extraordinary care that prioritizes veterans’ health and wellbeing; however, the VHA has failed to satisfy this goal in recent years.

The VA has struggled to ensure that providers maintain safe and effective care. In 2019 the GAO determined that the VA’s oversight of regional networks was minimal. The GAO recommended that the VA implement a process to assess the overall performance of its network to determine if the network is performing by VA standards.

In February of 2021, the GAO identified 227 providers that were no longer employed with the VA but continued to provide care within the VHA network. The VA followed up by reviewing and excluding 155 providers from the community care network. Interestingly, a handful of these providers had been previously removed because they failed to provide and prioritize safe care. 

Roots of the Problems and What the VA is Doing to Address Them

Insufficient staffing, failure to allocate funds, and an overall lack of efficiency when logging patient interactions are just a few issues the VHA faces on the long list of grievances. The depth of these issues is daunting. Our veterans have lost faith in the system designed to serve them, as a majority report dissatisfaction and frustration with the long wait times and subpar quality of care. As a result, many veterans are seeking care outside of the VHA provider network. This is a significant fault within the healthcare system, and considerable action must be taken to restore the system’s integrity.

To combat these barriers to care, the VA has implemented initiatives to equip veterans with internet access and technology to enhance the quality of care by promoting and utilizing telehealth modalities. Through Lifeline, a program that offers free cellphones and discounted cell phone service from major phone providers, the VA subsidizes data charges for veterans who are involved in the following programs: Medicaid, Supplemental Security Income, Federal Public Housing Assistance, Supplemental Nutrition Assistance Program, VA Survivors Pension, and VA pension.

Unfortunately, approximately 15% of Veteran households lack internet access (Bridging the Digital Divide). The Affordable Connectivity Program has expanded eligibility for home internet service discounts including eligibility to receive a one-time deal to purchase a computer or tablet. Additionally, through ATLAS (Accessing Telehealth through Local Area Stations), the VHA has established telehealth sites in communities with limited access to the internet by providing comfortable, secure spaces in select areas such as Walmart, the American Legion, and Philips North America for veterans to have telehealth appointments.

With the expansion of these telehealth modalities comes the responsibility of ensuring that PHI is shared amongst providers, both in and out of the network, to ensure that veterans receive quality care that reflects accurate patient records.

Conclusion: The Future

Oracle closed on its $28.3 billion acquisition of EHR vendor Cerner a couple of weeks ago.  Part of Oracle’s vision is to build a nationwide health record database that would receive data from the thousands of EHRs currently used by clinicians. The VHA is currently transitioning from its home-grown EHR, Vista, to Cerner. Likewise, the military service branches are also transitioning to Cerner. This will facilitate care continuity for military personnel as they transition to civilian life. 

Cerner’s deep domain expertise in healthcare and interoperability, combined with Oracle’s vision for a nationwide health record database, has the potential to greatly benefit the VHA as they struggle to work with countless EHRs distributed across its TriCare provider network.

This initiative has the potential to greatly improve continuity of care across the VHA’s distributed network of service providers to significantly improve the care delivered to our veterans.