After more than a month of rumors of agency infighting at the U.S. Department of Veterans Affairs and speculation that not all were happy with the leadership of VA Secretary David Shulkin, MD., President Donald Trump has removed Shulkin from his post.

As a result, the future of the Cerner EHR deal -- estimated at upwards of $16 billion -- is now wholly uncertain.

One Axios report said President Donald Trump finally lost patience with Shulkin, based on a recent meeting at the White House between the secretary, his Deputy Tom Bowman, Shulkin’s Chief of Staff Peter O’Rourke and White House Chief of Staff John Kelly.

[UPDATE: Trump dumps VA chief David Shulkin, will give his personal doctor oversight over agency]

Kelly told Shulkin to just get back to work and stop causing drama, according to the report, and that meeting was followed by an Oval Office discussion between Trump and Shulkin, focused on legislation to reform the VA health system that also did not go well. 

Shulkin’s Strategic Communications Advisor Ashleigh Barry told Healthcare IT News: “Shulkin has made it clear that his singular focus is the work moving forward at the VA. He says the meeting with the President and Chief of Staff was, in fact, productive, supportive and focused solely on moving forward in the best interest of our veterans.”

The curtain lifted on the agency in the wake of revelations found in a VA Office of Inspector General report in February that alleged Shulkin misused federal funds during a European work trip. From improperly accepted tickets to Wimbledon to misusing government funds to cover his wife’s airfare, Shulkin has been under fire for more than a month.

That report tainted his image, and Shulkin repeatedly said that he felt his own staff were conspiring to undermine his leadership. In his own defense of the OIG report, Shulkin said even the watchdog’s report “reeked of agenda.”

The way forward for Veterans Affairs

Shulkin repeatedly said he would not step down and was fully concentrated on his efforts to modernize the VA. In fact, at HIMSS18, Shulkin reiterated his focus on moving the agency’s legacy VistA EHR system to the Cerner platform to match the Department of Defense.

[Also: VA switch to Cerner EHR too big an opportunity not to get right, Secretary Shulkin says]

But the EHR contract has been on hold for three months over interoperability concerns to make sure the transition is done right. Shulkin also highlighted the need to leverage analytics and discussed the agency’s API gateway to accomplish this.

Hailing the work with Cerner as “extraordinary,” it would seem the Cerner contract could be signed at any time. And the secretary has, seemingly up until the OIG report, had bipartisanship support for his efforts. 

But what would happen to the EHR contract if Shulkin is fired or resigns?

[Also: VA, Cerner EHR deal held up after spat over interoperability definition, report says]

Especially given that Shulkin broke with government protocol by going with the non-competition award to Cerner instead of issuing requests for information and proposals, and given that the contract is still paused, the secretary’s potential departure raises questions about the future of VA’s EHR modernization work.

Shulkin made massive strides since his appointment just over a year ago. He helped to pass 11 Congressional bills, all designed to bring change to the scandal-ridden agency.

Not only that, but he launched a 24-hour hotline for veterans’ complaints, created a platform for tracking wait times at VA medical centers, sought to ease the backlog of benefit applications and cleared the path to make it easier to fire employees involved in misconduct -- along with the ambitious Anywhere to Anywhere telehealth program and a focus on reducing veteran suicides.

Even still, the recent reports are beginning to show cracks in Shulkin’s plans and Congress has recently seemed a little less than thrilled.

During a February hearing, House VA Committee Chairman Phil Roe, MD, R-Tennessee balked at the $10 billion planned price tag for the Cerner EHR. “That doesn’t even include the costs of updating infrastructure to accommodate the new EHR, implementation support or sustaining VistA up until the day it can be turned off,” Roe said. 

Roe was glad to hear of Shulkin’s push for interoperability, but expressed doubt about whether the project could be successful -- and given recent reports that the DoD-Cerner EHR project isn’t going as smoothly as planned, the future of VA-Cerner contract may not be as close as hoped.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com