House lawmakers approved a spending bill Thursday that provides $1.6 billion for the Department of Veterans Affairs' electronic health record implementation, a significant increase from the current $1.1 billion funding level.
The Fiscal Year 2020 Military Construction, Veterans Affairs and Related Agencies bill, passed by the House Appropriations Committee, proposed a budget of $108.1 billion in discretionary funding—$10 billion above the fiscal year 2019 enacted level—to fund the Department of Defense, the VA and other related agencies in fiscal year 2020.
The legislation proposes discretionary funding for the VA that is increased by $7.8 billion, or 9%, over the fiscal year 2019 enacted level.
The bill provides $1.1 billion toward the $10 billion Cerner contract, $162 million for program management and $335 million for software infrastructure.
The VA plans to pilot initial operating capabilities of its new EHR platform in March 2020 across three sites in the Pacific Northwest.
VA officials 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.
"After at least a decade of Congressional encouragement to DOD and VA to develop a single electronic health record (EHR), VA has completed a contract to acquire the same EHR that DOD is adopting," according to the report (PDF) accompanying the spending bill.
The bill continues strict quarterly reporting of timelines, performance milestones, costs, implementation and change management. The bill also continues the requirement for the Government Accountability Office (GAO) to review the EHR implementation "so that Congress can be informed of any problems at a point where they can be promptly and economically addressed."
Oversight of the massive $16 billion Cerner EHR update at the VA has been a sticking point with federal lawmakers who have voiced concerns about what they see as a lack of governance for the VA's EHR and interoperability projects
In March, U.S. senators Jon Tester, D-Montana, and Marsha Blackburn, R-Tennessee, introduced bipartisan legislation (PDF) to establish a third-party oversight committee to help monitor the implementation of the new EHR system.
During a recent House subcommittee hearing, GAO's Director for Information Technology Acquisition Management Carol Harris said the VA's EHR project already is facing serious challenges and the ability of VA and DOD to hash out differences between their EHRs would be crucial to the success of the projects.
The House Appropriations Committee also recommends that the VA continue to develop and implement, within the Veterans Health Administration, a comprehensive enterprise interoperability and intelligence strategy in order to benefit from advances in the health IT marketplace. Such a strategy could include modernized enterprise data and analytics capabilities, a clinical interoperability platform and open application program interfaces leveraging community healthcare interoperability standards.
Given the cybersecurity challenges of sharing data between the VA's EHR and the DOD's Genesis system, lawmakers on the committee would also like to see the VA explore and invest in modern, software-defined networking hybrid cloud technologies to ensure its EHR network and IT infrastructure will effectively support the Cerner implementation, according to the report.
In addition, House appropriators encouraged the VA to “ensure the new EHR initiative provides an open architecture that allows a governance and oversight process for administering access and support to deploy third-party applications, components and application programming interfaces to ensure longevity of the EHR platform and requests information on the EHR modernization architecture be included in quarterly reports."
The committee urges the VA to develop, as part of its EHR update, the ability for veterans to have "secure, portable access to their own medical records."
At the same time, the committee said it is concerned about the significant time clinicians spend on current EHR documentation. This administrative burden also means clinicians have less time to spend providing care to each patient and fewer patients are seen in a given day, resulting in long wait times for veterans. "VA's ongoing efforts with EHRM and interoperability with DOD provide an opportunity to assess innovative technologies' ability to solve this challenge," the committee said in the report.