Veterans Affairs officials told House lawmakers on Wednesday that the VA plans to pilot initial operating capabilities of its new electronic health records platform in March 2020 across three sites in the Pacific Northwest.
VA officials testified before the House Appropriations subcommittee on Military Construction, Veterans Affairs and Related Agencies about the current status and timeline of the $10 billion, 10-year EHR project.
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 Department of Defense, which has already begun integrating Cerner’s MHS Genesis system.
John Windom, executive director of the VA’s Office of Electronic Health Record Modernization, told lawmakers that one of the heavy lifts of the project was mapping 131 national instances, or versions, of the VA’s current Vista platform and getting the data from that platform into the Cerner medical records platform.
Tough questions on timing
Windom testified that 22 data domains of clinically relevant data have been mapped so far and 5 billion records are “queued up and ready to be transferred.”
The EHR system will generate a single longitudinal record that will transition from active duty service life to veteran service life, Windom said.
“It will not be instantaneous, we have to move the data in the old record to the new system,” he said.
Windom said the data migration process has begun but could not say how long it took to map a single instance of Vista to Cerner’s platform.
“It’s a bit shocking that no one knows how long that process took because the two complaints you’re going to hear are that it’s taking too long and it’s costing too much,” Rep. Will Hurd, R-Texas, said.
House lawmakers made it clear that they continue to have concerns about the cost and timeline of the multibillion-dollar EHR project, as well as ensuring seamless interoperability between the VA and DOD systems and with private sector healthcare providers.
Rep. Debbie Wasserman Schultz, D-Fla., noted that a government review back in 1998 cited the lack of interoperability between DOD and VA.
“My oldest children, who are 19, weren’t born when this process started,” she said. "This should have been resolved years ago; there has been a lot of time and resources wasted on this endeavor."
Windom also confirmed that the $10 billion cost is inclusive only of the Cerner contract, and the total project cost includes an additional $6 billion for IT modernization and program staff and resources, bringing the total cost to $16.8 billion.
Wasserman Schultz also questioned VA officials about reports that EHR project leaders were dismissing feedback from VA physicians and nurses participating on the project's clinical councils.
“We would hope that doctors and nurses taking time out of their jobs to provide feedback and advocating for workflows they want to see out of the Cerner system are not then overruled by the DOD. If you have a lack of physician buy-in, which is a major lesson learned from DOD, then this is not going to go well,” she said.
James M. Byrne, general counsel, who is performing the duties of the deputy secretary, said he had not heard those concerns and noted that 60% of clinical council members were “from the field” while the remaining 40% were from the VA central office. “I will dig into that concern. That is disturbing,” he said.
Lawmakers also highlighted a Politico article last year that detailed major failures in the Pentagon's $4.3 billion Cerner EHR implementation. Military and VA health IT specialists and doctors reported that technical glitches and poor training caused dangerous errors and reduced the number of patients who could be treated, according to that article.
Windom said the errors had been corrected: “With something this complex and massive, you’re going to have issues. We’re on the proper track to mitigate and resolve any issues that we encounter.”
More influence from Mar-a-Lago members: report
Unrelated to the subcommittee hearing, ProPublica reports that a member of the Mar-a-Lago Club, President Donald Trump's private club in Palm Beach, Florida, pitched a dental policy for the VA to the president, which was handwritten on Mar-a-Lago stationery, and that proposal was then sent to then-VA secretary David Shulkin's desk.
It's another example of Mar-a-Lago members enjoying influence over the VA and acting as shadow leadership with sway over contracting and budgeting, ProPublica's Isaac Arnsdorf reports.