The U.S. Department of Veterans Affairs (VA) plans to begin deployment of a new $16 billion electronic health record (EHR) system at three sites in the Pacific Northwest—Spokane, Seattle and American Lakes, all in Washington—in October 2018 with a goal of full capability by March 2020, according to VA officials.
During a House Committee on Veterans Affairs hearing Tuesday, Acting VA Secretary Peter O’Rourke updated lawmakers on the initial stages and planning for the VA EHR modernization project as the agency transitions from its aging legacy VistA system, which it’s been using for several decades, to a new Cerner EHR system.
The much-anticipated EHR modernization contract between the VA and Cerner was finally signed on May 17, after a delay of several months. A year ago, the VA announced that it would replace its aging EHR system by adopting the same platform as the U.S. Department of Defense (DoD), an EHR system from the Kansas City-based Cerner. The Cerner-VA project is a $10 billion contract, but the VA estimates that $5.8 billion will be needed for project support and infrastructure over 10 years.
“VA’s EHR modernization will be a flexible, incremental process, welcoming course corrections as we progress. Effective program management and oversight will be critical, it will be critical to cost adherence as well as to timelines, to performance quality objectives, and to effectively implement risk mitigation strategies,” O’Rourke said.
“We’ve designed a proactive and preemptive contract management strategy. We’re working closely with DoD, listening to advice from respected leaders in healthcare, and we’re fully engaged with Cerner, establishing governance boards and optimizing deployment strategy. We intend take advantage of lessons learned to mitigate risk, and strategy will adapt as we learn and technology evolves.
In the midst of this project, President Donald Trump’s nomination to lead the VA, Robert Wilkie, has still not been confirmed; he faces a Senate confirmation hearing today. There has been tumultuous turnover among VA leadership in the past six months. Former VA Secretary David Shulkin was fired back in March and President Trump’s initial nominee, Navy Rear Adm. Ronny Jackson, withdrew his nomination amid damaging professional allegations.
O’Rourke reported to lawmakers that the VA was moving forward to establish appropriate governance and to tackle change management issues. “This is deep change, and this is a technical and cultural challenge; the human component is central to success. We’ll engage end users early to train facility staff and promote successful adoption. It’s a user-centric approach to veteran-centric change,” he said.
During the hearing, Congressional leaders voiced concerns on a number of issues and potential hurdles for the VA EHR modernization project.
Governance, Accountability and Leadership Vacancies
Committee chairman Rep. Phil Roe, M.D. (R-Tenn.) and ranking member Tim Walz (D-Minn.) announced last week the creation of a new subcommittee to focus on conducting oversight of the EHR modernization program and other technology projects at VA.
“Leadership will make or break this project, as will the oversight,” Rep. Walz said. “This panel will be a small group of three to five committee members who will focus intensively on these issues. EHR modernization is a big bet on the future of VA and we simply must make sure it succeeds.”
On the subject of governance and leadership, many committee members voiced concerns that there are still critical leadership roles that have yet to be filled, including a confirmed VA Secretary, a deputy secretary, an undersecretary for health and the CIO.
“I don’t see how this is going to end well unless we get top leadership positions in place,” Rep. Mark Takano (D-Calif.) said.
Committee members also questioned O’Rourke about media reports stating that Genevieve Morris, principal deputy national coordinator health information technology (ONC), will be leading the Electronic Health Record Modernization Program (EHRM) team. Morris was detailed to the VA earlier this year.
O’Rourke called those media reports “premature,” while acknowledging that Morris was a candidate for the position. “She has been instrumental in helping us in the past few months. She was loaned to us from HHS, and she has been critical to this team and helped us with broader perspectives of the industry and successful ways of implementing this project.”
DoD Cerner Implementation Issues
The DoD already is having issues with its Cerner implementations, according to a Pentagon report, and committee members pressed VA officials on these issues. Back in May, Politico detailed a Pentagon report which found that experts who have seen the DoD-Cerner deployments have cited highly damaging issues with that rollout, inclusive of problems so severe that they could have resulted in patient deaths. The DoD-Cerner EHR deal from 2015 is worth about $4.3 billion.
One Congressional leader on the committee questioned O’Rourke about this report and whether it had any impact on the decision to adopt the Cerner platform. “We’re putting all eggs in one basket—every DoD and VA health record—did it give you pause?”
“We knew about implementation issues and how they have been resolved and we have integrated what we learned from them into our deployment strategy,” O’Rourke said. “We never had rose-colored glasses on; we knew that this would be an extreme challenge.”