Lawmakers grill VA officials on higher costs of EHR overhaul

Veterans affairs sign
VA leaders said higher EHR costs are associated with hiring necessary, and expensive, subject matter experts. (JeffOnWire CC BY 2.0)

Members of a House committee overseeing the Department of Veterans Affairs’ massive EHR overhaul questioned agency leaders on Wednesday about new program costs that have added $350 million to the budget. 

During a 180-day review hearing before the House Veterans Affairs Committee's Subcommittee on Technology Modernization, Rep. Jim Banks, R-Ind., wondered why despite $650 million in lower infrastructure costs over the next three years, the overall EHR modernization budget has increased $350 million to $16.1 billion. 

"The total estimate has already gone up before any real work begins," he said. "How can that be?"

John Windom, executive director of the Office of Electronic Health Record Modernization at the VA, said the agency's original cost estimates did not include VA government employee costs, which total approximately $35 million per year over the course of the 10-year contract with Cerner. 

When Banks pushed back, arguing that level of spending buys the agency roughly 2,000 full-time employees, far more than the 269 currently working in the EHR Modernization Office, Windom said he had provided lawmakers with "a realistic estimate." He said the high costs were tied to the level of expertise required from subject matter experts hired by the industry. 

"Those experts in the industry cost money,"  he said. 

Banks also questioned the need for a $583 million contract with Booze Allen Hamilton over the life of the contract. Windom said that money would go toward an executive council, oversight of workflow and process development and a satellite command center in the Pacific Northwest where the VA is beginning the Cerner rollout. Windom committed to meeting separately with Banks to give him a more detailed breakdown of the budget. 

Meanwhile, other lawmakers were focused on how the VA plans to work in concert with the Department of Defense, a task that has faced cultural roadblocks in the past. Windom pointed to a joint statement signed by VA Secretary Robert Wilkie and Defense Secretary James Mattis last month, adding that integration with the DOD is a top priority. 

"I don’t know if it's just the stars aligning, but the stars have aligned," he said, adding "some tension is good" because it "keeps us on our toes."

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Windom also denied a recent report from ProPublica that the DOD sought to take over the Cerner implementation for both agencies, but lawyers determined it wasn't authorized to do so. 

"I know of no such attempt," he said. "The VA has been on a course we have not wavered from since June 2017." 

But Banks and others continued to warn of the "daunting" task ahead, with a nod to reports that President Trump's allies in Florida have been pulling the strings behind the deployment. 

"Some in the media see the 'Mar-a-Lago crowd' behind every unexaplained or unfavorable development," Banks said. "I can't speak to that. What I do know is community interoperability is a very real problem and for $16 billion, the VA had better solve it."