The much-anticipated electronic health record (EHR) modernization contract between the Department of Veterans Affairs (VA) and Cerner was finally signed on May 17.
It’s been almost a year since the VA announced that it would replace its aging EHR system, called VistA, by adopting the same platform as the U.S. Department of Defense (DoD), an EHR system from the Kansas City-based Cerner. "This is one of the largest IT contracts in the federal government, with a ceiling of $10 billion over 10 years," VA Acting Secretary Robert Wilkie said in a statement today. "And with a contract of that size, you can understand why former Secretary [David] Shulkin and I took some extra time to do our due diligence and make sure the contract does what the President wanted."
Although VA announced last June that it would be going with Cerner, negotiations have stalled for a variety of reasons. Last December, for one, then-Secretary Shulkin announced “a strategic pause” in the EHR acquisition process, with the purpose being to conduct an assessment of national interoperability language contained in a request for proposal that would ultimately support an EHR contract award. MITRE Corporation conducted the external assessment and Shulkin said earlier this year that MITRE provided the VA with 51 recommendations, and that the agency was building these into the contract with Cerner.
But then in late March, Shulkin was ousted as VA Secretary by President Trump, leading to more uncertainty about when, or even if, the contract would get signed. Some other health IT vendors, such as CliniComp International, a San Diego-based EHR company, saw the Shulkin dismissal as a possible path to get back in the contract bidding game.
Nonetheless, VA senior officials decided to pull the trigger on the Cerner deal, with pressure mounting on Wilkie to get the contract signed. Just this week, a group of lawmakers called out the VA for what they said has been “malign neglect” in the agency’s efforts to achieve EHR modernization.
The Democratic lawmakers also cited concerns about members of President Trump’s inner circle “inappropriately influencing EHR modernization.” The letter cited reports that President Trump is taking advice from a member of his Mar-a-Lago circle, an internist with no government experience. Politico has reported that a West Palm Beach doctor, Bruce Moskowitz, who has ties to Trump’s Mar-a-Lago social circle, has potentially influenced the delay with the VA-Cerner contract. According to Politico, Moskowitz is a friend of Ike Perlmutter, the chairman of Marvel Entertainment, who advises the President informally on vet issues.
Wilkie noted today that there is already "$782 million in funding for FY 2018 to get the effort underway, thanks to support from Congress." 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.
Cerner Chairman and CEO Brent Shafer said today in a statement that "At its core, this effort will use Cerner’s EHR to achieve interoperability among VA, other federal entities and the commercial sector. Linking the veteran and military populations through a single health record is critical to provide veterans the high-quality care they deserve and will help advance interoperability across the industry."
It should be noted that already, the DoD is having issues with its Cerner implementations. Last week, 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.
Wilkie stated today, "VA and DoD are collaborating closely to ensure lessons learned at DoD sites will be implemented in future deployments at DoD as well as VA. We appreciate the DoD’s willingness to share its experiences implementing its electronic health record."