VA now required to report performance, costs of troubled EHR system to Congress

The Department of Veterans Affairs (VA) will now have to submit regular reports to Congress about the performance of its new $16 billion medical records system, including incidents that risk patient safety, under new legislation headed to President Joe Biden's desk.

The Senate approved a bill (PDF) last week that aims to increase transparency surrounding the VA's electronic health record modernization (EHRM) program, a project that has been plagued with problems as it has been rolled out to three VA locations.

This legislation already passed the House of Representatives and will now go to the president to be signed into law.

“The VA, and consequently our nation, has invested a great deal of time and money into the VA electronic health record modernization program,” Senator Jerry Moran, R-Kansas, one of the sponsors of the bill, said in a statement.“The potential benefits of this program are tremendous, and we have to get it right. This legislation and soon to be law will ensure the VA is providing the proper transparency throughout the EHRM implementation to better allow this committee to conduct oversight during the deployment process to ensure veterans receive the care they deserve and hold the VA accountable for taxpayer dollars.”

Under the legislation, the VA secretary must submit periodic reports to Congress regarding the costs, performance metrics and outcomes for EHRM.

The reports ordered by Congress would have to include "a list of patient safety reports, incidents, alerts or disclosures" at each facility where the new electronic system is in use.

The new EHR system, developed by Cerner, was first rolled out to Mann-Grandstaff VA Medical Center in Spokane, Washington, in November 2020, following two monthslong delays to address the department's information technology infrastructure and training and respond to the COVID-19 pandemic. The EHR system then was brought online at a VA hospital in Walla Walla, Washington, and Columbus, Ohio, earlier this year.

A year ago, in July, the VA scrapped the rollout schedule for its new medical records system for at least six months to overhaul training and fix governance and management problems, recognizing fundamental flaws in the work so far. The planned six-month pause followed a 12-week strategic review ordered by VA Secretary Denis McDonough that looked at problems with the initial go-live of the Cerner electronic health record system at Mann-Grandstaff VA hospital.

In March, the EHR system at Mann-Grandstaff crashed, and the hospital was forced to suspend patient admissions and most outpatient appointments, according to media reports.

The Cerner EHR system at Mann-Grandstaff VA Medical Center has gone down more than 50 times since the VA implemented it in 2020, according to recent reporting from The Spokesman-Review.

Also in March, the VA inspector general flagged a number of patient safety issues in a series of scathing reports about the VA's EHR system. The medical records system failed to flag patients who had been identified as suicide risks, gave doctors inaccurate information about patients' medications and caused delays in scheduling appointments, the department's watchdog said in one report.

"We found serious deficiencies and failures in the implementation of the new electronic health record at the Mann-Grandstaff VA Medical Center, which increased the risks to patient safety and made it more difficult for clinicians to provide quality health care," VA Inspector General Michael Missal said in a video statement.

There have also been media reports of glitches and shortcomings, including dozens of crashes. The issues have prompted some lawmakers to call on the VA to halt the rollout of the program.

The VA signed a $10 billion deal with Cerner in May 2018 to move from the VA’s customized VistA platform to an off-the-shelf EHR to align the country’s largest health system with the Department of Defense (DOD), which has already started integrating Cerner’s MHS Genesis system.

For the VA, the Cerner EHR will replace the approximately 130 operational instances of VistA currently in use across the department. While the initial EHR contract signed with Cerner was for $10 billion, the VA has pushed the estimated 10-year cost for implementing the system past $16 billion.

However, in a pair of 2021 reports, the Office of Inspector General said the VA's $16 billion cost estimate could be an underestimate by as much as $5 billion.

The VA's troubled multibillion-dollar technology project has been plagued by delays, leadership turnover, and infrastructure problems since it kicked off in 2018.

"The EHR has been very frustrating, very disruptive and even dangerous for some of our patients," Sen. Patty Murray, D-Washington, told McDonough at a congressional hearing earlier this month, as reported by "I do not want EHR to move an inch further in my state until all of this is fixed and ready to go."