VA $16B EHR project moving forward without key governance leadership in place

veteran health care
The Department of Veterans Affairs is undertaking a $16 billion IT modernization effort focused on implementing a new electronic health records system. (Rawf8/Getty Images)

A Department of Veterans Affairs (VA) official told members of Congress that the VA is moving forward with a $16 billion electronic health record (EHR) project slated to go live at pilot sites in 10 months without key governance leadership in place.

But one key lawmaker, Rep. Jim Banks, R-Indiana, said during a House Veterans' Affairs Subcommittee on Technology Modernization hearing Wednesday that he is taking legislative action to address what he sees as a failure of VA and Department of Defense (DOD) leadership.

Banks, ranking member on the subcommittee, said he filed amendments to the fiscal year 2020 National Defense Authorization Act that require the VA and the DOD to put in place qualified leadership at its joint governance office. A second amendment would call for VA and DOD to create a comprehensive interoperability strategy.

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The five-member subcommittee on technology modernization was created last year with the sole purpose of overseeing the VA's technology modernization, namely the development of its new EHR system.

"Since taking on this assignment one year ago, I've seen and heard enough to have some serious concerns. VA and DOD are different animals. VHA and the military health system have cultures, priorities, organizational structures and even missions that are quite different. I think they should be more closely integrated in the future. But if we force them into a one-size-fits-all solution now and ignore those realities, it may very well break them," Banks said.

RELATED: Lawmakers fear lack of governance of DOD-VA EHR project will derail progress

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 the country’s largest health system with the DOD, which has already started integrating Cerner’s MHS Genesis system.

Despite continued pressure from lawmakers to set up a joint governance program with the DOD, there is still no interim leadership much less permanent leadership for that joint governance program, called the federal EHR modernization office.

William Tinston, program executive officer, Defense Healthcare Management Systems at the DOD, told lawmakers that the departments are considering options for an interim deputy director and director for that office and will then pursue permanent hires for those positions.

That office will be responsible for jointly managing the VA and DOD EHR projects, which are rolling out separately but are closely intertwined.

RELATED: VA plans to go live with Cerner EHR pilot by March 2020

At a subcommittee hearing last week, lawmakers heard from a key Cerner executive, Travis Dalton, president of Cerner Government Services, who testified that the project is "on the right track" with the VA and on schedule.

But Dalton noted that it's imperative for there to be a joint decision-making authority between the VA and DOD, and the lack of that authority is slowing things down.

The VA and DOD are the nation’s largest healthcare systems, serving more than 37 million beneficiaries, according to VA and DOD officials. Over 60% of DOD and 30% of VA beneficiaries receive care from the private sector.

RELATED: Spending bill gives VA $1.6B for EHR upgrade

The DOD completed its EHR pilot at four sites in the Pacific Northwest in January 2018 and plans to roll out the EHR at Travis Air Force Base in Northern California in just three months.

Lawmakers on the committee made it clear that they were less concerned about the project being on schedule than having accountability and transparency about the progress of the EHR rollout.

"Joint governance is not the only challenge," Lee said. "The time for VA’s first go-live is March 2020 and that is fast approaching with many key decisions and tasks that have yet to be completed. We are concerned that the VA has left itself little margin for error."

RELATED: Senators move to ramp up oversight of VA's $16B EHR project

Banks said the subcommittee has been given "scant details" about the progress to establish the joint management structure, and the process has been secretive. "I understand the desire to make the agreement private before disclosing it but the problem is that there has been no agreement. Compromise has been elusive because the stakes are so high and both sides have dug in so deeply."

Lee said past federal IT projects have failed not due to technical problems but from lack of effective leadership and management.

The VA is currently focused on training clinicians and physicians on the new EHR system and aligning clinical workflows with DOD, Windom said, with 18 clinical councils helping to facilitate that work.

The technology will work, Windom said. It's user adoption that's the critical piece that determines how the project progresses.

Laura Kroupa, M.D., chief medical officer of the Office of Electronic Health Record Modernization at the VA, testified that the biggest challenge is transitioning VA clinicians from a customized system to a commercial system. "There's education about what does that mean, how does it work, how does it speak the same language. We are now in a phase where they are hitting their stride and are able to really see the places where we can accept commercial best practices and where there are specialized things that VA needs for our patient population and for our mission."

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