The elephant in the room during the first meeting held by incoming House Veterans Affairs Committee Chairman Phil Roe (R-Tenn) was the home-grown VIstA electronic health record system running at the Veterans Health Administration.

Congress has been pressuring VA brass for more than a decade to use a commercial-off-the-shelf EHR, just as the 56-hospital, 600-clinic Military Health Systems is doing under a $4.3 billion contract with Cerner Corp.

The VHA is much larger, with 152-hospitals and 990-clinics nationwide.

In a three-page letter written after the hearing, Roe, a physician, sought clarification about the VA’s VistA intentions.

Rob Thomas, acting assistant secretary for IT said at the Feb. 7 hearing, that he was “confident” the VA would “go commercial” with a VistA replacement.

But congressional testimony only last month by LaVerne Council, who effectively had Thomas’s position during the Obama administration, suggested the VA could keep VistA and overlay it with a cloud-based Digital Health Platform. The overlay would enable VistA to better connect and interoperate with other internal and external health IT systems, Council said.

“This (Council) statement seems to mean that if the Digital Health Platform could be implemented, the department could retain VistA as its electronic health record system, but purchase commercial-off-the-shelf software, such as customer relationship management software, to perform nonmedical administrative functions that have been incorporated into Vista over the years,” Roe said. “Please clarify . . .”

Neither Roe’s letter nor his opening remarks tipped his hand on whether the chairman favored either the VistA upgrade or the replacement plan.