A pair of reports from government watchdogs sheds more light on why the Department of Veterans Affairs delayed the initial March go-live of its new EHR system.
The VA failed to incorporate lessons learned from the Defense Department's implementation of a Cerner electronic health record system, the VA Office of Inspector General (OIG) concluded in a new report.
In its EHR project, DOD concluded that infrastructure upgrades should be completed at sites six months before deploying the system to help ensure an efficient and successful system rollout, the OIG said.
The VA was scheduled to initially deploy its Cerner EHR system on March 28 at the Mann-Grandstaff VA Medical Center (VAMC) in Spokane, Washington.
VA medical centers require significant upgrades to physical and information technology (IT) infrastructure in preparation for the EHR implementation. This means infrastructure readiness should have been completed by September 28, 2019 to make that go-live date, OIG said.
The OIG found that critical physical and information technology infrastructure upgrades had not been completed at Mann-Grandstaff and associated facilities six months before the specified system deployment date, as guidance suggested.
Even as recently as Jan. 8, some infrastructure updates had yet to be completed, jeopardizing the then-planned March 28 deployment.
"The lack of important upgrades jeopardizes VA’s ability to properly deploy the new system and increases risks of delays to the overall schedule. Some needed infrastructure upgrades were not projected to be completed until months after going live," OIG said in its report.
Infrastructure upgrades were not completed at Mann-Grandstaff on time primarily because VA had not completed initial comprehensive site assessments, developed specifications for infrastructure with appropriate monitoring mechanisms, and lacked adequate staffing, OIG concluded.
"VA committed to an aggressive, but likely unrealistic, deployment date of March 2020 without having the necessary information on the state of the medical center’s infrastructure," the OIG said.
The VA announced in February that it would push off its go-live date to commence end-user training. The go-live date was moved back to July, at the earliest.
On April 9, the VA said it was hitting pause on its EHR project due to the COVID-19 pandemic and did not specify a new go-live date.
A second OIG report examined the EHR system's initial capabilities and the potential impact on patients’ access to care at Mann-Grandstaff, the first project site.
In July, the VA's Office of Electronic Health Record Modernization (OEHRM) and its EHR vendor, Cerner, determined that not all anticipated capabilities of the new EHR would be available for the March go-live date. For example, online prescription refills, the most popular form for refilling prescriptions at the facility, was identified as a capability that would be absent when going live
Mann-Grandstaff leaders worked on mitigation strategies but these workarounds, which were needed to address the removal of an online prescription refill capability, presented patient safety risks, the OIG reported.
"Going live at a later date with decreased capabilities and the need to employ necessary mitigation strategies still presents a significant risk to patient safety beyond the inherent risk of deployment of an EHR system," the OIG said in its report.
In May 2018, VA awarded Cerner a contract to replace VA’s legacy information system, Veterans Information Systems and Technology Architecture (VistA), with a commercial-off-the-shelf solution. The contract was awarded at a cost of almost $10 billion over a 10-year period.
There are tremendous costs and challenges associated with this effort and it is a massive and complex undertaking, the OIG said.
In addition to the almost $10 billion contract, VA estimates another $6.1 billion will be needed for program management and infrastructure-related costs. Of this amount, approximately $4.3 billion is for program infrastructure, and the remaining $1.8 billion is estimated for program management.
The new system will be implemented to VA’s 174 medical centers and 1,577 standalone sites.
If successfully implemented, it will create a common EHR system across the DOD and VA.
Between the two reports, the OIG made 16 recommendations for VA project leaders, including establishing an infrastructure-readiness schedule for future deployment sites that incorporates lessons learned from DoD’s experience and ensures projected milestones are realistic and achievable.
The department needs to give clear guidance to medical centers on what electronic health record capabilities will be available at the go-live date.
The OIG also recommends that the VA identify the impact of mitigation strategies on user and patient experience when going live and reevaluate the EHR modernization deployment timeline to minimize the number of required mitigation strategies when going live.