Why moving the VA to a new EHR was a pivotal decision

Dr. David Shulkin has been busy since he was unceremoniously fired in 2018 from his post as secretary of the Veterans Affairs Department. He’s the chief innovation officer at Sanford Health and a distinguished health policy fellow at the University of Pennsylvania. He also recently penned the book It Shouldn’t Be This Hard To Serve Your Country. But as one of only 10 people to have led the nation’s largest integrated healthcare system, Shulkin’s boldest move was asking Congress for $728 million to do away with a cornerstone of the agency’s history.

WHAT WAS YOUR RISKIEST DECISION? Moving away from the VA’s electronic health records system to a commercial EHR system.

WHY WAS THAT MOVE RISKY? The VA was one of the early leaders in developing an EHR 30 years ago and I think had a great influence and pride because of that. It was the largest EHR transition in history and because of the size and scale of the VA, it had lots of execution risks. It was essential that a successful EHR work with so many community hospitals and physicians that care for veterans, but the success of doing that was unknown because of the issue of interoperability. There also was no budget allocated. I knew that I’d have to go to Congress, as no one had necessarily planned on the move despite there being calls for 17 years. I did not go through a normal (request for proposals) process and procurement; I made a much more streamlined decision and so, put myself at greater risk, but I felt this was in the direct interest of the safety of veterans.

WHAT WAS THE RESPONSE FROM THOSE INVOLVED? Because of this debate that had been going on for close to 20 years, members of Congress were almost uniformly pleased that we had made any decision. The president was very pleased because it was further support that we are modernizing the system for veterans. The Department of Defense was very supportive because now we would have a single system from the time somebody entered the military all the way through the full continuum of their life, so it’d be a lifetime record. Veterans generally were pleased because they knew that their information about their health would now be available to the people caring for them. The reactions that weren’t necessarily all enthusiastic were from the VA employees.

ANY ADVICE FOR EXECS IN SIMILAR POSITIONS? Remember that the job of leadership is really to listen to those around you and those who you serve. What I did was to really try to spend a lot of time understanding the problem, understanding the data, and then knowing that it wasn’t going to be easy, but it was important to make a decision and not to pass the buck down the line because the organization would have been in worse shape without making a decision.

DESCRIBE YOUR LEADERSHIP STYLE: Principle-based, strategic, analytic, but also impatient and a risk-taker.

HOW WOULD OTHERS DESCRIBE IT? The fact that the VA and the president have continued to implement the exact policies that I put in place (says a lot) and that’s comforting to me because we were beginning to fix some of the problems that have plagued the VA for decades. My reason for serving the VA was to bring a contemporary, modern approach into government using what I learned in the private sector, and I see that continuing.

After I left, the VA signed a contract with Cerner. They’ve continued to work closely with the private sector to make sure that veterans have good access and good quality. They continue to focus on the things that I set as the priority, like veteran suicide reduction. When you’re not there but your ideas continue and your policies continue, that’s a validation that you’re an effective leader.