Looking to avoid the problems that plagued the Department of Defense's initial electronic health record system rollout last year, the Department of Veterans Affairs is launching a training program for its $16 billion Cerner EHR effort.
The training will address real-world VA healthcare challenges, the department said.
The VA said it is leveraging the experiences of the DOD's ongoing medical records system rollout to develop a training program called VA Innovative Technology Advancement Lab (VITAL). The aim is to provide advanced training to selected end-users who will support continuous performance improvement, the VA said in a press release.
“VA established VITAL to specially train staff who can identify possible challenges and work across the entire VA organization to make improvements,” VA Secretary Robert Wilkie said in a statement. “VITAL is an important component in our larger training strategy, which will help ensure efficient and timely user adoption of the modernized EHR system.”
In February 2017, DoD rolled out the first MHS Genesis EHR at Fairchild Air Force Base in Washington. It was followed closely by implementations at Naval Hospital Oak Harbor, Naval Hospital Bremerton, and Madigan Army Medical Center.
But a scathing DOD report in April 2018 said the MHS Genesis EHR is “neither operationally effective nor operationally suitable,” highlighting concerns that the system’s failures jeopardize patient safety and impact clinical usability.
Robert Behler, the DOD’s director of operational test and evaluation, reviewed the Cerner implementations at three facilities in Washington state and found that 156 incident reports were of “critical deficiencies” that included potential patient safety concerns. Users gave the Cerner system a usability score of just 37 out of 100, “well below the threshold of 70 that indicated acceptable usability,” according to last year's report (PDF).
MHS leaders recently said the system's initial challenges had been addressed, citing changes in training as a key factor. Project leaders also conducted rigorous testing, training and change management efforts during the initial rollout in the Pacific Northwest, DOD officials said.
The Cerner EHR system is now live at four new military sites, three in California and one site in Idaho.
Based on observations of the MHS GENESIS program, VA officials identified key clinical and frontline staff who require advanced training to ensure smooth EHR modernization implementation, enhance functionality and support continuous performance improvement, the VA said. Examples of other lessons learned from the DOD project include the importance of excusing training participants from clinical responsibilities during training sessions.
As of Sept. 12, 76 trainees were participating in the advanced training. The VITAL program, a 12-18-month training series, develops both the technical and supporting change management skills necessary to drive greater efficiency and effectiveness in all aspects of veteran health care, the VA said.
"VITAL graduates directly influence a successful EHRM introduction at their facilities by performing as 'change agents' who can capitalize on and advance the capabilities and value of EHRM’s transformational innovation. This will naturally help to promote the smoothest possible transition for all users and, in turn, patients," VA officials said.
In May 2018, VA awarded Cerner Corp. a contract to replace the department’s legacy patient record systems with the commercial-off-the-shelf solution currently being deployed by DOD. The Cerner EHR will replace the approximately 130 operational instances of VistA, currently in use across VA, and will be interoperable with the DOD system, according to VA.
The VA plans to roll out its new health records at hospitals in March 2020, but Politico reported that the EHR modernization project faces significant delays and unanticipated challenges. The March 2020 rollout for the new Cerner system is almost certainly to be partially or completely delayed until October, sources told Politico.