Lawmakers cite VA leadership holes in EHR implementation with first go-live scheduled for 2020

Representatives on the House Committee on Veterans Affairs grilled senior officials at the Department of Veterans Affairs about a lack of leadership that could derail the agency’s ability to execute on a massive medical records modernization project with several positions still unfilled.

Currently, the VA is operating without permanent appointments to three positions critical to the implementation of Cerner’s EHR platform, a 10-year, $16 billion project: The deputy secretary, the undersecretary for health and the chief information officer have yet to be confirmed.

Robert Wilkie, tapped to replace former Secretary David Shulkin, will undergo confirmation hearings on Wednesday. 

VA Acting Secretary Peter O’Rourke agreed that senior leadership involvement in the transition is “absolutely critical for success.” He deferred questions about the deputy secretary to the White House and said the VA is establishing a search commission to fill the undersecretary position, recently vacated by the retirement of Thomas Bowman.  

RELATED: VA Acting CIO Scott Blackburn resigns abruptly weeks after Shulkin’s departure

VA Acting CIO Scott Blackburn resigned abruptly in April. He was replaced by Camilo Sandoval, the former director of data operations during Donald Trump’s presidential campaign. Committee Chairman Rep. Phil Roe, R-Tenn., said Sandoval was not invited to Tuesday’s hearing.

“I don’t see how this is going to end well unless we get the top leadership positions in place, especially [ensuring] the chief information officer is a highly qualified individual to oversee this project,” said Rep. Mark Takano, D-Calif. “It’s not on you, it’s on the White House for leaving these positions unfilled, especially when we have a massive, massive contract we have to oversee.”

Rep. Ann McLane Kuster, D-N.H., asked O’Rourke directly if he felt Sandoval, who is currently facing allegations he “slandered, harassed and sexually discriminated against” a Trump campaign employee, can effectively fill the role.

O’Rourke said he has “a lot of confidence in Sandoval,” who is helping the VA restructure its office of information technology. But he added, “if the president decides to remove a political appointee then we’ll have someone else to step into that role.”

RELATED: VA signs $10B deal with Cerner, but implementation challenges still loom large

There also appears to be some confusion about who is leading the VA’s Office of Electronic Health Record Modernization. On Tuesday, Politico reported that Genevieve Morris, the principal deputy national coordinator at the Office of the National Coordinator for Health IT, would lead the program moving forward.

When pressed, O’Rourke called the report “premature reporting” but stopped short of calling it inaccurate. He said Morris is “perfectly qualified” and “definitely a candidate for the job.”

Go-live scheduled for 2020

Agency officials also a detailed an implementation timeline for three initial VA Medical Centers in Washington: Mann-Grandstaff, American Lake and Seattle. The VA will begin deployment in October with a go-live date of March 2020, O’Rourke said Tuesday.

But those sites don’t appear to be set in stone. When pressed by Rep. Jim Banks, R-Ind., Ashwini Zenooz, M.D., chief medical officer of the VA EHR Modernization Program, said they would “continue evaluating" VA sites.

“I think we’re always evaluating what’s best,” she said. “We’ve had several discussions to see if we should be looking at other sites, but we’ve always been talking about it from day one to make sure we’re going to the right place.”

In addition to the $10 billion contract with Cerner, the VA has set aside $5.8 billion for project management support and infrastructure over the 10 years.

But David Powner, director of IT issues at the Government Accountability Office, said the price tag is even higher because VA did not include internal government employee costs. Powner added that he believes the move to Cerner was the right call, but given the VA’s placement on the GAO’s high risk list, “this project needs to be effectively managed.”

Cerner CEO Zane Burke assured lawmakers that when all is said and done, the cost of running the Cerner system will be less than the annual cost of maintaining the old Vista platform, which is approximately $1 billion a year. Rep. Phil Roe, R-Tenn., countered that the pace of changing technology will likely add new costs, and the EHR rollout in October will “look totally different in 2028.”

“I think there will be added costs; I don’t see how there couldn’t be more costs,” Roe said.