VA Officials Order Strategic Review of Their EHR Modernization Program

March 19, 2021
With the modernization of its core EHR system tangled up in delays, senior Veterans Affairs officials on March 19 announced that they were ordering a “strategic review” of the modernization process

With the modernization of its core electronic health record (EHR) system tangled up in delays, senior officials at the Department of Veterans Affairs (VA) on March 19 announced that they were ordering a 12-week review of the process.

In a report published by RADIO.COM, Abbie Bennett wrote on March 19 that “The Department of Veterans Affairs has ordered a 12-week review of its massive $16 billion electronic health record overhaul, plagued by delays. The review will include a full assessment of the modernization effort to ensure success for future rollouts at more VA medical centers, officials said in the announcement. In a call with reporters Wednesday, VA Press Secretary Terrence Hayes and Deputy Assistant Secretary for Public Affairs Melissa Bryant said that the review did not mean further delay for the overhaul or that work would stop as the department continues to roll out the new system at more facilities.”

Bennett noted that “Problems implementing the new system were outlined in reports released in April by the VA Inspector General, including that VA expected the system to cost another $6.1 billion more than the initial $10 billion 10-year contract with Kansas-based Cerner Corp. That contract was awarded without competitive bidding. Of that additional $6.1 billion, about $4.3 billion is for infrastructure, including IT equipment. VA has been plagued by outdated IT systems -- some dating back nearly 50 years.” And, she added, “Last month, the Government Accountability Office recommended delaying the project until continued issues were addressed.”

At 12 noon eastern time on Friday, March 19, the VA made the public announcement of the strategic review, under the headline “VA announces strategic review of Electronic Health Record Modernization program.” The announcement began thus: “The Department of Veterans Affairs (VA) announced the strategic review of the electronic health record modernization program today after Secretary Denis McDonough’s initial assessment of the program within his first month in office. The strategic review consists of a full assessment of the ongoing electronic health record modernization program to ensure continued success for all future EHR deployments. This assessment period will not exceed 12 weeks.”

“A successful EHR deployment is essential in the delivery of lifetime, world-class health care for our Veterans,” McDonough said in a statement contained in the press release. “After a rigorous review of our most-recent deployment at Mann-Grandstaff VA Medical Center, it is apparent that a strategic review is necessary. VA remains committed to the Cerner Millennium solution, and we must get this right for Veterans.”

And the press release went on to note that “McDonough further explained that VA employees’ diligence while executing the EHR deployment in the face of a challenging and unanticipated global pandemic cannot be overlooked” ‘Our dedicated VA professionals continue to work feverishly on this effort even as we maneuver through the complexities and surges of the COVID-19 pandemic,’ said McDonough. VA’s ongoing analysis of the Mann-Grandstaff Initial Operating Capability (IOC) post-deployment activities have precipitated the need for a schedule shift. While Columbus is currently scheduled to remain the next “go-live” site, the order of subsequent deployments may be revised as a result of this strategic review.” Further, the press release noted, “The strategic review will focus on identifying areas for additional productivity and clinical workflow optimization at Mann-Grandstaff and upcoming “go-live” sites, conducting further research into Veteran-centered improvements for the patient portal experience, data syndication and revenue cycle improvements.”

In her RADIO.COM report, Bennett wrote that “By April of last year, VA had already twice delayed the launch of the anticipated system, set to overhaul the department's legacy health records system, VistA, along with linked partner systems at the Defense Department. Concerns about the project have included ensuring that data-sharing capabilities for the new system would match up between the federal departments and particularly community care providers. So far, more than 24 million veteran records have been moved to the new system.”

The problems involved in the VA’s EHR modernization project have long been known; indeed, a report published on April 27, 2020 by the Inspector General of the VA’s Office of Audits and Evaluations, entitled “Deficiencies in Infrastructure Readiness for Deploying VA’s New Electronic Health Record System,” noted that “VA has long recognized the need to modernize its electronic health record information system to ensure greater interoperability with the Department of Defense (DoD) to improve and inform the delivery of quality care to veterans. In May 2018, VA awarded Cerner Government Services Inc. a contract without competition to replace the VA’s electronic health record system. Under the contract, the VA’s legacy information system, Veterans Information Systems and Technology Architecture (VistA), will be replaced. VA will use Cerner’s commercial-off-the-shelf solution titled Millennium. The contract was awarded at a cost of almost $10 billion over a 10-year period of performance. If successfully implemented, it will create a common electronic health record system across the DoD and VA.”

The April 27, 2020 report continued, “DoD’s electronic health record system, Military Health System (MHS) GENESIS, at its core consists of Cerner’s Millennium. The connection of VA and DoD’s electronic health record systems will result in a comprehensive, lifetime health record for service members. From the veteran perspective, the new electronic health record system will drive better clinical outcomes by giving healthcare providers a more comprehensive picture of veterans’ medical history and ultimately improve their access to higher-quality care. There are tremendous costs and challenges associated with this effort. In addition to the almost $10 billion contract, VA estimates another $6.1 billion will be needed for program management and infrastructure-related costs. Of this amount, approximately $4.3 billion is for program infrastructure and the remaining $1.8 billion is estimated for program management. The infrastructure cost estimates do not cover, however, some of the physical upgrades to the individual healthcare facilities, which are to be funded by the Veterans Health Administration (VHA). VHA and Office of Electronic Health Record Modernization (OEHRM) officials indicated to the audit team that these costs are generally anticipated to be funded from VHA’s nonrecurring maintenance budget.”

The VA IG noted that, “Although transitioning from VistA to a new electronic health record system has transformational importance, it is a massive and complex undertaking. Challenges to implementing a new electronic health record system VA-wide are intensified by VA’s need to coordinate and collaborate with DoD, as well as to modernize VA’s aging infrastructure to accommodate the new system. The OIG recognizes the significant level of effort and commitment required by VA to manage and facilitate this large-scale implementation, including the tremendous work from staff thus far.”

Among the specific problems that the VA IG documented were “significant setbacks such as an overwhelming number of help desk tickets, loss of initial system connectivity, and a low user adoption rate,” all of which slowed the implementation of the new system.

The delays involved in the VA’s EHR modernization program have been so severe that the first VA medical center to go live on the new system, Mann-Grandstaff VA Medical Center in Spokane, Washington, didn’t go live until mid-October of last year.

Members of Congress have long been aware of the problems. In an August 6, 2020 report in POLITICO, Darius Tahir wrote that “This year… the program was beset by delays even before the VA became consumed with responding to the coronavirus pandemic. First, the VA backed off a planned March rollout of the EHR at a facility in Spokane, Wash., citing clinicians’ discomfort using the new system. The next phase in July was delayed after department resources were stretched by the coronavirus response. Congressional and technical experts believe the delays will ripple into the future. While the VA previously envisioned deploying the Cerner system in some of the biggest metropolitan areas starting next year, the revised schedule focuses on smaller cities in the Pacific Northwest and Midwest, multiple congressional sources say. That's because a more comprehensive EHR needed for larger VA centers is incomplete.”

Tahir wrote in that report that “The VA blames the pandemic for the change in focus, noting that the health providers who help develop and customize EHRs haven't had the time. ‘Cerner has not had access to the clinicians required,’ the department said. ‘VA has a path forward to complete the development of the extended capabilities, which remains dependent on clinician availability in response to COVID-19,’” a VA spokesperson told Tahir. “But some in Congress remain concerned that critical parts of the infrastructure underpinning the project are suspect,” he wrote. Indeed, he noted, “Concerns over the physical state of VA buildings are longstanding. Rep. Phil Roe of Tennessee, the top Republican on the House Veterans' Affairs Committee, told POLITICO in 2018 that the price of the EHR contract did not account for upgrading infrastructure.”

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