Robert Wilkie, the acting secretary of the U.S. Department of Veterans Affairs, will make a decision on whether to move forward with an acquisition contract with Cerner for a new electronic health record (EHR) system by May 28, Memorial Day, according to VA leaders.
During a Senate appropriations subcommittee hearing on Wednesday, Jon Rychalski, assistant secretary for management and chief financial officer at the VA, provided lawmakers with an update on the timeline for the EHR procurement. The hearing was focused on the VA’s Fiscal Year 2019 budget request. During the same subcommittee hearing, several lawmakers raised concerns about what they called a “leadership vacuum” at the VA and the ongoing delays with the EHR acquisition contract.
“[Wilkie] has said he is going to make a decision by Memorial Day,” Rychalski told lawmakers Wednesday, adding that Wilkie “came in cold” with regard to the VA’s EHR modernization. “He knew what was going on with DoD but not enough about the VA, and he wanted to do due diligence to make sure he was comfortable in making a decision of this magnitude. So that’s the reason for the second delay. Before that they were looking at the contract and interoperability and that was probably worthwhile because they came up with about 50 recommendations to improve it.”
In an emailed response, VA Press Secretary Curt Cashour said, “Finalizing a decision on the Department’s electronic health record modernization (EHRM) effort is one of Acting Secretary Wilkie’s top three short-term priorities for VA, given the importance, magnitude and financial investment that this decision represents for Veterans and the department.”
Further, Cashour said, “While VA doesn’t typically comment on ongoing contract negotiations, proper due diligence is required to ensure the best interests of Veterans and taxpayers are served before the department enters into any agreement of this size and importance. We are doing that now, and expect to make a final decision and corresponding announcement on EHRM in the coming weeks.”
It’s been almost a year since the VA announced that it will replace its aging EHR system, called VistA, by adopting the same platform as the U.S. Department of Defense (DoD), a Cerner EHR system. Since then, senators have pushed the agency for a timeline for the EHR project and for plans to ensure that the technology systems of the VA and DoD will be integrated. During an October House Committee on Veterans’ Affairs hearing, Shulkin told lawmakers that it will be seven or eight years before Cerner's EHR system is fully implemented throughout all VA locations.
In March, President Donald Trump dismissed VA Secretary David Shulkin, M.D., and, at that time, negotiations between VA and Cerner were delayed. In December, Shulkin announced “a strategic pause” in the EHR acquisition process, with the purpose being to conduct an assessment of national interoperability language contained in the Request for Proposal that would ultimately support an EHR contract award. MITRE Corporation would be conducting the external assessment and Shulkin said earlier this month that MITRE provided the VA with 51 recommendations, and that the agency was building these into the contract with Cerner.
Trump nominated Ronny Jackson, M.D., White House physician and rear admiral in the Navy, to serve as VA Secretary, while naming Wilkie the agency’s acting secretary. However, Jackson withdrew due to allegations around his professional conduct. A number of top VA leaders have left since Shulkin’s ouster. Scott Blackburn, the department’s acting CIO, announced his resignation in April. As CIO, Blackburn was in charge of VA’s Office of Information and Technology and one of his top projects was replacing VA’s VistA EHR with the same platform as the DoD, a Cerner EHR system.
Senator Brian Schatz (D-Hawaii), ranking member of the appropriations subcommittee, said during Wednesday’s hearing, “I’m concerned that no amount of money from Congress can fix the leadership issues at VA. The department is losing qualified professionals, seemingly by the day, and that includes Scott Blackburn, the person overseeing the EHR transformation, who quit in mid-April,” he said. “If news reports are to be believed, political appointees have no interest in listening to career VA professionals, who are there to help them do their jobs. This is turning into a crisis for our veterans and the 360,000 employees who serve them every day.”
Schatz further said, “There needs to be leadership, trust, collaboration, accountability and stability, all of which are currently lacking. I hope with Congressional oversight, the VA can find its footing again.”
Late last year, the VA submitted a formal request to congressional appropriators to reprogram $782 million of Fiscal Year 2018 funding to kick start its planned procurement of the Cerner EHR. The VA’s FY2019 budget request includes $1.2 billion for EHR modernization. According to the latest data provided to Congress, it will cost the agency a total of $15.8 billion over 10 years to implement the system, Reports have surfaced that the contract will be in the $10 billion range, making it one of the largest health IT implementations in history. However, other reports have put the total figure in the $15 to $16-billion-dollar range.
During the hearing, Schatz also questioned the need to appropriate another $1.2 billion when the contract was currently not moving forward. “The VA has taken steps to overhaul EHRs and Congress has supported those steps. We see the wisdom in buying the same system as DoD, and we provided funding to the VA to get the system online, but the process has stalled, in part because of the leadership vacuum at VA, contracting delays and, finally, the need to align the VA and DoD roll out, if it’s going to be the same system,” he said, continuing, “ I don’t understand that if VA hasn’t spent the hundreds of millions of dolllars that have already been appropriated for this new system, then why would VA then request $1.2 billion on top of it. We have a fixed amount of money in our allocation and it makes little sense to give the VA more money for the EHR system, so it can sit in an account while this all gets sorted out.”
In response to questions about the requested funding, Rychalski’s comments during the hearing implied that the VA would be moving forward on an EHR acquisition in the near future. He explained that a “substantial amount,” about $1.1 billion, would go to the prime vendor, although Cerner was not specifically named, and the balance would be for infrastructure and equipment. According to Rychalski, there is a three-year period of availability for the reprogrammed funding of $782 million. “We’re not going to use all of the $782 million this year, but $160 million will carry over to next year. There is a plan for it and we are projecting the need,” he said.
Rychalski also said, “We don’t anticipate a substantial delay with the first increment of this," and then added, "We owe you a deep dive into the funding for 2018 and 2019 and explaining our trajectory.”