Could Cerner Upend Epic for VA’s Scheduling System Contract?

Jan. 2, 2019
The Department of Veterans Affairs’ (VA) preference is to use software from Cerner for its patient scheduling system, according to a recent letter from Rep. Jim Banks (R-IN).

The Department of Veterans Affairs’ (VA) preference is to use software from Cerner for its patient scheduling system, according to a recent letter from Rep. Jim Banks (R-IN).

According to Banks’ letter to VA Acting Deputy Secretary James Byrne, “While all available information indicates VA’s pilot of the Epic Cadence scheduling system in Columbus, Ohio has been successful, my understanding based on testimony from and conversations with Department leaders is that VA’s preference is to implement the Cerner Millennium scheduling package, because it has either already been purchased or a commitment has been made to purchase it.”

Banks, chairman of the House VA Subcommittee on Technology Modernization, noted in the letter that scheduling is one of the most archaic modules of VistA—the VA’s current EHR (electronic health record) platform. “These scheduling inefficiencies and a serious lack of internal controls created the environment resulting in the veteran wait list crisis, revealed in 2014,” he wrote, referring to a patient scheduling scandal at a VA Phoenix hospital in 2014 that may have led to the deaths of some veterans while they were awaiting care.

“Four years later, a significant infusion of staffing and community care resources has reduced wait times in many states, but VA has only implemented the modest VistA Scheduling Enhancement (VSE), intended to be a temporary improvement,” according to the letter.

The VA awarded its Medical Appointment Scheduling System (MASS) $624 million contract in 2015 to Systems Made Simple, a subsidiary of giant defense and national security contractor Lockheed Martin, and Epic. Already, an initial software implementation has begun in Columbus, Ohio.

But according to Banks’ letter, the testing of that system, “stopped and started it repeatedly, at one point announcing that a resource-based scheduling system was unnecessary and VSE was sufficient. When MASS was allowed to proceed, it was structured in an excessively slow and expensive manner, which had the effect of making it appear unfavorable when compared to VSE. Even the companies performing the MASS contract have expressed their opinion that it could be carried out more quickly and at lower cost. It seems if Epic Cadence’s implementation had been unimpeded it could have been nearly complete by now,” the letter read.

The VA, of course, also signed its $10 billion contract with Cerner last May to replace the department’s 40-year-old legacy health information system—VistA—over the next 10 years with the new Cerner system, which is in the pilot phase at the Department of Defense.

Banks stated in the letter than regardless of the decision made by VA on its scheduling system, the Epic Cadence system should be retained in Columbus, Ohio over the medium term. He wrote, “Time and money have already been invested to implement it, and by all accounts it is functioning well. Perhaps more significantly, the MyChart patient portal which was implemented along with Cadence could serve as a valuable interoperability test bed at little or no additional cost.”