An opportunity to improve the technology of health care for veterans and the nation
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Opportunities to serve are often unexpected. Serving in the House of Representatives is immensely rewarding for so many reasons, and to one extent or another, you learn about a range of issues.

Like many Americans, I had never spent much time thinking about electronic health records. When the opportunity to serve as the chairman of the Veterans’ Affairs Subcommittee on Technology Modernization was presented, overseeing the Department of Veterans Affairs’ massive EHR modernization program, I embraced it. I also had a lot of homework to do. Here is what I have learned.


First of all, the health care industry – especially the heath information technology industry – and the rest of the country rarely communicate. Health care affects literally everyone’s life at one time or another, is gradually consuming the economy, and is the biggest driver of the federal government’s deteriorating long-term financial condition. Health care is also increasingly automated. Nearly every medical practice, even tiny rural doctors’ offices, now has an electronic health record (EHR). They can organize the information necessary to prevent costly medical mistakes and eliminate wasteful and unnecessary procedures. But sometimes it seems the programmers of these systems have never talked to a physician or a patient. Capabilities are at an all-time-high, but too often, so is frustration.

Government policy played a major role in getting us where we are. The HITECH Act, enacted almost 10 years ago, sought to encourage the adoption and meaningful use of EHRs. It succeeded beyond any expectations at the time. There are hundreds of different EHRs in use with a product available for every imaginable need. But far too often they do not interoperate. As a result, Congress set out to correct the problem it had a hand in creating.

In 2016, the 21st Century Cures Act imposed stiff penalties on companies for “information blocking” and emphasized interoperability. Since most EHRs began as coding and billing systems, they rightfully play a part in a variety of recent legislation encouraging paying for quality medical outcomes rather than the number of procedures performed.

The Veterans Health Administration faces most of these same issues and, as the largest integrated health care system in the country, it does so on a large scale. Many VA health care providers are overwhelmed by systems and information. The technology budget is consumed by maintaining old systems and starved for new capabilities. The homegrown EHR led the way by transmitting records to VA facilities throughout the country, but it struggles to interoperate with the jungle of private sector EHRs that has increased outside the four walls of the VA. As a Navy veteran but an outsider to this industry, I see this challenge somewhat differently.

In transitioning to a commercial EHR along with the Military Health System, the VA aims to achieve a seamless, lifetime health record for service members and veterans. That is widely known. But in undertaking the largest EHR implementation in the country, the federal government is also implicitly trying to tame the jungle, and in a different way than before. The biggest order ever gets to shape the business by driving the adoption of common standards, impacting the direction of product development, and sending a powerful signal about what users and patients need.

VA and the Military Health System have the opportunity to improve the technology of health care not just for veterans and the military, but for the whole country. The stakes could not be higher, and as chairman of the subcommittee, I intend to make sure these agencies are making the right decisions. These decisions impact everyone, including people who have never thought about electronic health records, and especially our nation’s veterans.

Banks represents the 3rd District of Indiana and is chairman of the Veterans Affairs Subcommittee on Technology Modernization.