Can Trump Make Veterans' Health Care Great Again?

Past scandals, complaint backlogs and looming decisions about how to best provide health care to more than 9 million veterans provide President Donald Trump “a chance to lead” at the Veterans Affairs Department early in his new administration, according to former U.S. Chief Technology Officer Aneesh Chopra.

Chopra, now the president of the open data intelligence service NavHealth, spoke Tuesday on a Politico-hosted panel of health care experts, and suggested Trump is in a great position to catapult VA back to the forefront of health care providers.

First, Trump must acknowledge “VA has a history of getting it right,” regarding the link between quality health care and IT, Chopra said. He cited a 2010 study from the Center for Information Technology Leadership that found VA’s investment of $4 billion on health IT from 1997 to 2007 turned into $3 billion in savings by eliminating duplicative testing and lowering operating costs.

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Much of that spending was on the Veterans Health Information Systems and Technology Architecture, the health records system developed by VA.

The department would later spend $1 billion with the Defense Department in a futile effort to attempt to make their individual health records systems interoperable, yet Chopra said VA “understands the linkage between quality health care and IT.”

DOD has since moved onto a commercial health records system for its troops, but VA has the potential to do even more. If ever there was an opportunity for Trump to make good on his campaign promises to improve and expand health care for veterans, this is it.

Trump has "a chance to lead, not just in the VA but in the country, in bringing the internet to health care,” Chopra said.

Chopra called for an “open, internet-based architecture” that would allow doctors and patients to communicate on a secure platform. With the right application development and security, electronic health records could be shared freely between patients and doctors and—perhaps more importantly—between health care providers, regardless of the network they reside in.

This represents a stark change from patient health care today, where proprietary systems and cultural resistance represent huge roadblocks to interoperable health records—often to the detriment of patients themselves.

Trump could tackle the complex issue of interoperable health records by advocating for VA to take a proactive approach to patient care. Can VA, which developed its once-revolutionary system only two decades ago, be a pioneer in health care again?

“We need technology that supports proactive ways of managing health,” said Josh Seldman, senior vice president of payment and delivery innovation for health care consulting firm Avalere. “How do we get from VA being a digital health pioneer for an era that has passed us by? How can it be a pioneer moving forward?”

The reactive way VA has used technology in the past decade needs to move to a “proactive approach,” which might include technologies like cloud computing, artificial intelligence, big data and complex analytics, he said. Already, both DOD and VA are exploring ways natural language processing technologies can sift through and process doctor’s notes, which make up significant portions of patient records.

Trump’s bargaining skills may also improve VA’s position.  

Trump’s VA Secretary David Shulkin has already committed to making a call on whether to pursue a commercial electronic health records solution or improve upon VA’s existing system—something his predecessors didn’t do. Experts say either way it will be expensive, with estimates ranging from $7 billion to $16 billion, and Trump could come into play here, too. The famed deal-maker has already used his platform on Twitter to pressure large contractors like Boeing and Lockheed Martin, with some degree of success.

He could be called upon again.

“We have a president who is a negotiator, so I’m going to call on him,” Shulkin said Tuesday.