The Department of Veterans Affairs (VA) doesn't have a firm grasp on how much it is going to cost to maintain its current homegrown electronic health record (EHR) system over the next 10 years while it's also rolling out a $10 billion Cerner EHR system, a Government Accountability Office (GAO) representative told members of Congress.
The VA pegs the price for keeping its current EHR VistA system running over the next 10 years at $5 billion.
But the cost likely will be higher, because the VA's cost data are unreliable and not comprehensive, according to Carol Harris, director of IT acquisition management Information at the GAO, testifying during a House VA Subcommittee on Technology Modernization hearing Thursday.
As the rollout to the new Cerner Millennium EHR across all VA hospitals will take 10 years, the agency plans to continue operating its 40-year-old legacy EHR system. At times, VA clinicians will have to use both systems, VA officials testified Thursday.
The VA decided to transition to a commercial EHR because its current medical records system does not possess the modern capabilities, analytics and functionalities medical providers need and is not interoperable with the Department of Defense's (DOD's) EHR.
The VA signed a $10 billion deal with Cerner last May to move from the VA’s customized VistA platform to an off-the-shelf EHR to align with DOD, which has already started integrating Cerner’s MHS Genesis system.
Three pilot sites in the Pacific Northwest will go live with the new system in March, VA officials have said.
There are 130 versions or instances of the legacy EHR system across 1,500 sites. To ensure clinicians have access to current patient records and to prevent interruption in the delivery of care, VA hospitals and clinics will continue using the older system, according to VA officials.
The VA's Office of Information and Technology also is working to move all 130 versions of VistA to the cloud.
Lawmakers have been pressing the VA for a total cost of ownership of VistA compared to a total cost of implementing and operating the Cerner system, and the agency has struggled to report accurate cost information.
"It's an important question and one we haven’t received an answer to. The complexity of this mixed environment is the biggest difficulty confronting VA," Rep. Jim Banks, R-Indiana, ranking member on the subcommittee, said.
According to a GAO report released Thursday, the VA doesn't have a comprehensive definition of the IT capabilities that constitute VistA, which makes it almost impossible for the agency to have accurate data on the cost to maintain it.
"Because of the decentralized nature of how VistA was developed, the VA is not in a position to be able to effectively draw that parameter around what is and isn’t Vista. As a result, they can’t accurately report the annual development sustainment costs. So they don’t have an accurate basis for ROI for moving to the Cerner system," Harris told lawmakers.
Paul Tibbits, M.D., executive director of the Office of Technical Integration at the VA, testified that it currently costs $426 million to sustain VistA through fiscal year 2019 and estimates it would cost $4.9 billion to keep it running over the next 10 years.
Harris said the VA is basing that number on unreliable data and has omitted costs associated with the EHR system. The VA said it cost about $2.3 billion to operate the EHR between 2015 and 2017. But of that $2.3 billion, VA demonstrated that only approximately $1 billion of these costs were reliable, Harris said.
The total price tag for operating the legacy EHR system over the next decade will likely be higher, Harris said, as the VA has omitted key costs from that $2.3 billion initial estimate such as costs for hosting health data by an outside vendor as well as hosting backup VistA instances at each of the medical center sites.
"The VA can’t accurately report annual costs. As such, VA lacks reliable information needed to make critical management decisions for sustaining VistA over the next 10 years," Harris said.
Tibbits said VA leaders agree with GAO's recommendation that it needs a better accounting of VistA's costs. "The VA is currently developing a methodology to update the cost data and define VistA," he said.
When pressed by lawmakers on the high cost of running and upgrading the legacy EHR, Tibbits said the system's age and technical complexity made it costly to operate.
VA officials also said they have transferred 23.5 million health records from the VA EHR to a shared data center with the DOD.
But until the switch from its current record to a Cerner system is complete, it's expected that VA clinicians will have to use multiple EHRs, Thomas O'Toole, M.D., senior medical adviser at the Office of the Assistant Deputy Undersecretary for Health for Clinical Operations for the Veterans Health Administration, told lawmakers Thursday.