Key lawmakers are fed up with what they see as poor Department of Veterans Affairs (VA) leadership over the rollout of a Cerner EHR system and vowed to take tighter control of the project.
"Leaders at the VA are either less than forthright or not on top of this, both of which are disturbing and unacceptable," said Rep. Debbie Wasserman Schultz, D-Florida, chairwoman of a key House subcommittee that oversees the VA, during a hearing Thursday.
The VA announced earlier this month that it would push off its go-live date for a new $16 billion medical records system.
The VA had planned to flip the switch on the new electronic health record (EHR) at its first site—Mann-Grandstaff VA Medical Center in Spokane, Washington—on March 28. But the VA recently announced it was delaying those plans to commence end-user training.
VA Secretary Robert Wilkie said during a House Veterans Affairs Committee hearing earlier in the day that the go-live date for Mann-Grandstaff VA Medical Center had been pushed to July. The second site, VA Puget Sound Healthcare System - American Lake, will go live in November.
During the hearing of the House Appropriations subcommittee on military construction and veterans' Affairs, lawmakers voiced frustrations—not at the missed deadline, but at what they saw as a lack of transparency and communication about potential delays.
"[The delay] was a surprise to Congress. It was a woefully inadequate, almost absent, line of communication to make us aware of the problems that have been encountered," Schultz said.
Lawmakers also noted that a key leadership position overseeing the EHR modernization project is now vacant after former VA Deputy Secretary James Byrne was fired Feb. 3.
Earlier this month, VA clinicians raised concerns about the readiness of the EHR for end-user training, noting that critical capabilities were not available, Melissa Glynn, Ph.D., the VA's assistant secretary for enterprise integration, testified during the hearing.
The agency bases its clinician training process on an iterative model using Cerner's best practices which calls for training doctors and nurses on a system that is "mostly completed" with VA specific workflows.
That process doesn't work for Veterans Health Administration (VHA) clinicians who want to train on a system that is 100% complete, said Richard Stone, M.D., the executive in charge of the VHA.
Questioned about why VHA officials didn't communicate their concerns about EHR readiness to Congress sooner, Stone said he expressed his concerns to Byrne a year ago.
"He knew about this, and I’m sure he got lots of input," Stone said.
Cerner will have the system completely built by early March, and the interfaces will be completed by April, Glynn said.
'"No other healthcare organization in the world is attempting something of this scale and complexity," she said
While lawmakers acknowledged the complexities of the project, Schultz said she wants more accountability. She indicated that the committee would ramp up oversight measures into the VA's 2021 budget appropriations bill.
"We cannot just take your word for it anymore, and we are going to establish tighter controls over this process," Schultz told VA leadership.
Agency watchdogs also plan to do a joint audit on the Cerner EHR system to access the system's interoperability. The Department of Defense (DOD) is implementing a Cerner EHR system, and a key goal of both projects is to achieve a seamless health record for service members and veterans, according to DOD and VA officials.
In a letter (PDF), Pentagon and VA inspectors general said the objective was to determine whether the VA and DOD will meet that interoperability goal by rolling out a common, commercial EHR system.
The two agencies have been under a mandate for decades to bring their separate medical records systems in line with one another.
"We have been promising this for the past two decades. We have been having these hearings for the last 10 to 15 years without any success," said Rep. Nita Lowey, D-New York, chairwoman of the House Appropriations Committee.
Added infrastructure costs
VA is seeking $2.6 billion in its fiscal year 2021 budget—$1.2 billion more than in FY 2020—to continue the implementation of its Cerner EHR system. Of that, nearly $1.2 billion is for infrastructure upgrades at future deployment sites, $1.2 billion for the Cerner EHR contract and $255 million to add staff to the program management office.
"We've identified infrastructure deficiencies that must be rectified before deploying a commercial state-of-the-art solution," John Windom, executive director for the VA's Office of EHR Modernization, said during the hearing.
"A new solution doesn’t run well on an old network," he added.
Stone said when he came on board as the head of VHA in the summer of 2018 it was "clear that infrastructure was not prepared for the Cerner product."
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.
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.