During a House Appropriations Military Construction and Veterans Affairs subcommittee meeting Wednesday, VA Secretary David Shulkin, M.D., said the department is facing a “time crunch” and wants to jumpstart its work to implement a Cerner electronic health record (EHR) system in order to align its EHR deployment with the U.S. Department of Defense (DoD).
The VA is requesting Congress to reprogram almost $800 million ($782 million) from its current budget to get started on the work to replace its aging homegrown EHR system with the Cerner EHR in order to achieve cost savings, and also avoid a longer implementation. Essentially, Shulkin said VA needed the funding by the end of the calendar year to achieve efficiencies to align closely with the DoD’s current multi-billion-dollar Cerner implementation.
“We prefer to fund the plan as part of the enacted 2018 appropriations bill. However, we have to do this quickly, as we have achieved substantial discounts by aligning our EHR deployment and implementation with DoD. In absence of an appropriations bill by end of the year funding the plan, we ask Congress to consider approving the transfer request, so we can promptly award the contract,” Shulkin said during the subcommittee hearing. “This continency allows us to avoid cost increases and to move forward with IT infrastructure modifications and expand our program management office to provide necessary oversight and manage implementation.”
Recently, the House Appropriations Committee cleared the fiscal year 2018 Military Construction and Veterans Affairs Appropriations bill, which included $65 million for the modernization of the VA EHR system—for year one alone. Some media reports have estimated that the cost of the entire project could be as much as $18 billion.
Shulkin told lawmakers on Wednesday that failure to obtain the funds and to get started on the work would mean missing a window to align its work with the DoD’s current roll out of its Cerner EHR and would drive up the project’s costs by about 5 percent over the 10-year project.
Ranking Member Debbie Wasserman Schultz, (D-Fla.) said during the hearing, “It’s frustrating that the VA’s foot dragging and missteps have become our emergency.”
Wasserman Schultz also voiced frustrations about the long history of failed attempts to modernize the VA’s EHR and build interoperability between the VA and the DoD, including an effort to create a single EHR for both agencies back in 2011. That effort fell apart two years later, despite spending nearly $1 billion. At that time, the VA chose to modernize its aging EHR system, the Veterans Health Information Systems and Technology Architecture, called VistA, while the DoD chose to implement a commercial, off-the-shelf EHR system.
This past June, the VA announced its plan to replace VistA with the Cerner Millennium EHR system, which the DoD is already implementing. In the announcement, VA cited the need to achieve seamless interoperability with DoD and a desire to reallocate resources away from in-house software development and back into core functions of VA.
“I’m pleased VA is moving in the direction of an integrated EHR system with DoD. I was not pleased with getting a $782 million reprogramming request at end of October, which needs to be acted on by November, with no details concerning how the system will work with private sector providers. Veterans are taking advantage of community care and we need to ensure that new EHR system can seamlessly exchange data with the private sector,” Wasserman Schultz said, adding, “Years down the road, I hope not to be in a hearing where we’re discussing our frustration over the less than complete interoperability and ability to seamlessly move electronic health records from DoD and military service to the private sector.”
During the hearing, Shulkin testified, as he has said in previous hearings, that the VA intends to award a 10-year contract to Cerner with plans, once the contract is signed, to have the EHR implemented at the first site in 18 months, followed by a seven- to eight-year roll out to get the EHR fully implemented throughout the VA.
“We have to implement much faster and more aggressively than DoD because, looking at the number of facilities we have, we have two-thirds more than DoD,” Shulkin said.
Shulkin said DoD leaders are sharing lessons learned and implementation plans which helps to create efficiencies in the VA’s roll out. However, the noted, “The DoD is one third the size of VA. Ours is a much more complex and larger implementation.”
The VA’s new EHR has to be rolled out to the VA’s 1,600 facilities and the VA intends to run VistA in parallel with the new Cerner system and will be shutting down the 130 instances of its current EHR, over time, until full implementation in 10 years, Shulkin said.
Lawmakers voiced concerns about the timeline and costs for the project, given the VA’s history of spending time and money on IT modernization projects yet the VA and DoD have yet to achieve interoperability.
Shulkin said the VA was tackling the project in a different way than previous VA IT projects. “The VA does not have a great history of being on time, on cost. But, first of all, we’ve given up on the idea that we’re going to be doing software development ourselves. By buying commercial off the shelf, we’re relying on industry partners with good track records. Secondly, we’re going to do the governance on this project, and the oversight on this project directly out of the Secretary’s office. The root cause of problems with VA has been the silos between IT and the health system,” Shulkin said, noting the creation of a governance committee comprised of both Veterans Health Administration and IT leaders.
What’s more, Scott Blackburn, executive in charge of the VA’s Office of Information and Technology, said he was in the process of speakign with private sector healthcare CIOs in order to gather input and recommendations about the VA’s EHR contract with Cerner and project implementation.
John Windom, program executive for electronic health record modernization at the VA, said, “We intend to align efforts to those of DoD today. We’re leveraging the lessons learned that DoD has in their associated deployment challenges. That critical alignment early in the process allows us to move out more aggressively in our approach to be more efficient in our approach and again to maintain the configuration management over both sides, the VA and DoD, and to support seamless information exchange,” Windom said.
Windom told lawmakers that the VA planned to start its EHR roll out in the Pacific Northwest, to align with DoD’s current work. The DoD rolled out its Military Health System (MHS) Genesis EHR system at Madigan Army Medical Center in Takoma, Washington in October. Madigan is the fourth military site to go live with the Cerner EHR, and that follows installations at Fairchild Air Force Base, Naval Health Clinic Oak Harbor and Naval Hospital Bremerton.
“Our intent is to deploy to the Pacific Northwest and there are economies of scale to be gained by labor efficiencies. By us deploying into the same geographical area, we’ll be able to leverage the resources that are already in that area,” Windom said.
Shulkin and other VA leaders did not disclose more details about total project costs during the public hearing, but a closed-door hearing with lawmakers followed the public hearing.
Shulkin also explained the complexities of the project to replace VistA with Cerner’s Millennium EHR. “VistA, by itself, is not a system; it’s 130 different instances of an EHR,” he said, also telling lawmakers that upgrading VistA to industry standards would cost $19 billion over 10 years.
Rep. Scott Taylor (R-Va.) wanted assurances from VA leaders that, once the project is completed, the VA and DoD will have “100 percent) interoperability.
Windom responded, “We will be on the same Cerner Millennium platform, hosting our data in the same hosting facility, so we will communicate seamlessly across the VA and DOD environments.”
“I’m convinced that being on the same EHR as DoD is the best solution. It will allow VA to keep pace with health information technology and cybersecurity improvements that VistA can’t achieve. Veterans’ health information will reside in a single common system to provide seamless care and we will be able to share veterans’ health information with community partners,” Shulkin said.