VA’s New Health Chief Outlines Top Priorities

Only two weeks after his Senate confirmation, newly appointed Undersecretary for Health Shereef Elnahal is eyeing a continued effort to combat COVID-19, recruit and retain a health care workforce, modernize electronic health records and promote health equity.

During the Disabled American Veterans (DAV) National Convention in Orlando Saturday, Elnahal detailed how the COVID-19 pandemic put strains on the supply chain and workforce at VA.

“The overall trajectory of the pandemic is still uncertain,” Elnahal said. “We’re in a situation now where the vaccines that initially came out are becoming less and less effective as the virus mutates and changes. There are vaccines on the horizon that will help protect against this virus better, and hopefully, in coming months. We’re excited to see that and we’re going to offer that to our employees and veterans across the country.”

VHA has also seen a massive increase in telehealth appointments and services throughout the pandemic. Prior to the pandemic, the agency was conducting more telehealth services than its private-sector counterparts. VHA expanded its services to the point where almost every clinic appointment was done via telehealth in the peak of the pandemic.

“I think [telehealth] not only benefited our employees, being more facile with it, but I think made veterans more and more comfortable using new technology,” Elnahal said. “Now we’re in the situation where we have to figure out what the role of telehealth is versus in-person appointments. I think the answer is a mix. … It has to be personalized and tailored to what that veteran needs. It’s our job to design our programs and equip our frontline doctors, nurses and care teams with that technology.”

In terms of the supply chain, Elnahal noted that VHA is moving away from a “just in time” methodology, developing new stockpiles of personal protective equipment to combat future shortages. Now, VHA has 90 to 120 days’ worth of medical equipment stockpiled to serve veterans. VHA also created regional readiness centers that hold backup stocks in strategic locations across the country, so if stockpiles begin to run out, VHA can deliver supplies to hospitals and medical centers in need.

COVID-19 also resulted in workforce burnout and shortages, causing VHA to develop new retention and recruitment programs and initiatives.

Elnahal will focus on removing the workforce barrier to enable VA employees to work faster and better. For this, he’s turning to technology and modernization. He explained that, currently, VA’s network level schedulers have to use four to five different scheduling grids on the same computer screen to navigate every veteran question. He will work to simplify those processes to reduce the burden and improve the efficiency of VA’s workforce.

Elnahal noted that the Promise to Address Comprehensive Toxics (PACT) Act includes language that will help VA’s internal processes and workforce strategies, making “the gears at VA work better and better.”

“For VA to be competitive to be able to pay these extremely talented, hardworking people competitive rates compared to our colleagues in the private sector, that got harder and harder,” Elnahal said. “With the passage of the PACT Act, that is giving us even more authorities to be able to bring on staff of all different kinds, … [and] we will have even more tools in our tool belt to be able to do that better.”

The PACT Act is the biggest expansion of veterans’ benefits in a generation. President Biden is expected to sign the act Wednesday. With its passage, Elnahal will collaborate with the Veterans Benefits Administration (VBA) to prepare and execute the new legislation. The law will require VHA to screen veterans within a 90-day period, after it goes into effect, for toxins.

“It’s a requirement by law, so we have to execute it. The way we’re going to execute that is basically through clinical alerts … so that veterans are being asked a question proactively,” Elnahal said. “We should be getting that from you when you come to our clinics and hospitals. … That’s one way to do it. The second is this concept that we’re talking about now called ‘no wrong door.’”

Under this concept, VHA will work to unify its operations and services to improve veteran access to care. Elnahal explained that one way his team will do this is by developing phone trees to better route calls to the proper division. VHA is working with the Veterans Experience Office (VEO) to improve veterans’ experiences and ensure that regardless of where the veteran enters, they end up at their destination.

As VHA continues to build out new services and expand its offerings following the PACT Act, the agency will improve data sharing and exchange to leverage relevant veteran data from the Defense Department, VBA and medical centers to better understand needs and improve care delivery.

VHA will also support VA’s Electronic Health Record Modernization Integration Office as it continues to implement its EHR system. VHA has faced major challenges related to the EHR deployment, one of which being patient safety. This prompted VA to halt its rollout until these concerns are addressed.

“There were a couple of cases where they were trying to see if the electronic health record was a component of something that should not have happened to a veteran,” Elnahal said. “The moves that Dr. Terry Adirim has made, and the deputy secretary and secretary, on delaying the rollout in certain medical centers across the country has everything to do with the safety. We have to make sure that our physicians are not pressured and are not facing a system that ultimately makes their care unsafe.”

To ensure safety of the EHR, Elnahal said VA will focus on four primary components: change management, leveraging user feedback, holding industry partner Cerner accountable for system downtime and preparing for the next deployment.

“We are learning over time with each of these deployments,” Elnahal said. “Veterans should never, ever feel the impact of electronic health record change. That just should not happen. We need to make sure that our systems and our people are supported and trained so that care veterans are getting is not affected. That’s my commitment.”