In an October 2020 briefing to Congress, the U.S. Government Accountability Office recommended that the Department of Veterans Affairs (VA) postpone deployment of its new EHR system in new locations until all critical issues that might affect the success of the deployment are resolved.
In June 2017, VA announced the decision to acquire a commercial EHR system from Cerner Government Services Inc. to replace the home-grown Vista EHR. This new system was to be a configuration of the same system that the Department of Defense is in the process of implementing. In May 2018, VA signed a contract with Cerner for a maximum amount of $10 billion over 10 years to acquire the system as part of its Electronic Health Record Modernization (EHRM) program.
In the briefing, GAO informed Congressional staff that the VA had made progress toward implementing its new EHR system by making system configuration decisions, developing system capabilities and interfaces, conducting end-user training, and completing system testing events. However, GAO noted that the department had not yet resolved all critical severity test findings (that could result in system failure) and high-severity test findings (that could result in system failure, but have acceptable workarounds), as called for in its testing plan.
Specifically, 17 critical severity test findings and 361 high-severity test findings remained open as of late September 2020. As a result, VA was at risk of deploying a system that did not perform as intended and could negatively impact the likelihood of its successful adoption by users if these test findings were not resolved prior to initial deployment, the report said. GAO recommended that VA delay deployment of the new EHR until the critical severity test findings were closed, and high-severity findings were closed or otherwise addressed with workarounds.
VA deployed its new EHR system in Spokane, Wash., on Oct. 24, 2020, with no open critical severity test findings and with 306 of the 361 high-severity test findings closed. Of the 55 remaining, 47 had workarounds that were accepted by the user community, seven were associated with future deployments, and one had a solution identified at the time of initial deployment. VA’s actions reflect implementation of GAO’s October recommendations, the report said.
Nevertheless, as the department moves forward with deployment of additional capabilities at new locations, VA will likely identify new critical and high-severity test findings, the GAO report said, noting that If VA does not close or appropriately address all critical and high-severity test findings prior to deploying at future locations, the system may not perform as intended.
VA is planning its next system deployment at the Puget Sound Health Care System in the fourth quarter of fiscal year 2021. Testing of additional capabilities prior to that and other future deployments will likely result in the identification of new issues. If VA does not address the 55 open high-severity test findings and any additional critical severity or high-severity test findings identified prior to future deployments, the system may not perform as intended and may negatively impact the likelihood of its successful adoption by users, GAO said.
The GAO recommended that the Secretary of VA should direct the Executive Director of the Office of Electronic Health Record Modernization to postpone deployment of the new EHR in new locations until all existing open critical severity test findings are resolved and closed, and until any additional critical severity findings identified before planned deployment are closed.
In the VA’s written comments on a draft of the GAO report, the department said it concurred in principle with the recommendations to resolve and close critical severity and high-severity test findings prior to future EHR deployments; it also described actions it plans to take to address the recommendations. Specifically, VA stated that it plans to continue to test and appropriately adjudicate all critical severity and high-severity test findings prior to future deployments. The department added that it planned to resolve and close all critical severity and high-severity test findings by January 2022.
