An executive from Cerner—the health IT company in charge of the Department of Veterans Affairs' (VA's) $16 billion medical records project—tried to assure members of Congress this week that the project is "on the right track" with the VA and is set to go live with pilot sites in less than a year.
But during a House Veterans’ Affairs Subcommittee on Technology Modernization hearing Tuesday, federal lawmakers indicated they are increasingly concerned about the lack of governance between the VA and the Department of Defense (DOD) as it also rolls out Cerner's electronic health record (EHR).
The VA signed a deal with Cerner last May 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 DOD, which has already begun integrating Cerner’s MHS Genesis system. The DOD signed its $4.3 billion contract with Leidos in 2015 for a Cerner EHR system.
The VA said in March it plans to pilot initial operating capabilities of its new Cerner EHR platform in March 2020 across three sites in the Pacific Northwest.
"The VA doesn’t have a great track record of implementing health IT," said Susie Lee, D-Nevada, chairwoman of the subcommittee. Lee cited failed IT projects and failed attempts to modernize the VA's EHR.
Lee said she visited a VA hospital in Seattle and learned about "serious infrastructure issues" that she fears could threaten to derail implementation of the Cerner EHR.
The VA and DOD opted for a single common system, but "after nine months of haggling and jockeying for power a suitable single, common management structure has still not yet emerged,” said Rep. Jim Banks, R-Indiana, ranking member of the technology modernization subcommittee. “The departments have refused to share virtually any information with Congress," he said.
Travis Dalton, president of Cerner Government Services, told lawmakers he had confidence in VA leadership over the EHR modernization project.
"With the size and complexity of the VA, it is not easy but it is achievable," Dalton said. He noted that the challenges of the project include moving from 130 disparate systems of VistA to one open, modern, integrated system. "We must deploy at 1,700 sites, train 300,000 VA employees, interoperate with the community, aggregate decades of clinical data and update technology."
He added, "It won’t happen overnight, but we can and we will achieve these goals."
Progress is being made, Dalton said, as project leaders have migrated 23 million veterans' health records into the Cerner data center and established 18 clinical councils working to set standards and bring best practices to the table, Dalton said.
However, he testified that there have been delays in decision-making and that a joint decision-making authority between the VA and the DOD would help facilitate the progress of the project. "We're getting into difficult decisions around referral management and workflow. We’re behind in a few areas, and we know what those areas are. We have escalation plans to resolve those."
An interagency program office was created by law to act as a single point of accountability for VA-DOD interoperability efforts. However, the Government Accountability Office has reported that the agencies have shown little progress in creating a working governance structure.
"The realities of working in a joint environment is you have to have a common cyber posture between the two environments. There are decisions that DOD needs to make in authorizing assessment strategies for some technologies and connections from VA to DOD. Although some decisions are in process, we have not seen those at the speed that we would like to maintain the expected schedule," David Waltman, vice president for strategy and technology at Cerner, testified during the hearing.
When Banks asked whether the lack of coordination between the VA and the DOD would impact the project going forward, Dalton said, "When you’re in a single instance environment, it gets to a point in time when if you can’t make decisions then it's hard to proceed forward. You also miss out on an opportunity to work together and get efficiencies and synergies."
Waltman said there would be a "drop dead" date to ensure project leaders have enough time to complete testing in the field and meet the training requirements for going live. "At that point, we'll have a good idea if that looks realistic or not. That time frame not too far from now."
A subcommittee hearing is scheduled for next Wednesday to hear from VA and DOD leaders about the progress on the EHR modernization projects.