Lawmakers concerned about VA plans for Cerner scheduling solution

The Department of Veterans Affairs intends to accelerate the deployment of a Cerner patient appointment scheduling solution so the VA can implement the system earlier than its new EHR.

The Department of Veterans Affairs intends to accelerate the deployment of a Cerner patient appointment scheduling solution so the VA can implement the system earlier than its new EHR.

The agency is putting Cerner’s medical appointment scheduling solution on a faster track because of concerns about the 10-year implementation period required to deploy the $10 billion Cerner EHR across the VA.

However, the House Veterans’ Affairs Subcommittee on Technology Modernization—which has oversight and investigative jurisdiction over the VA’s major IT projects—is not convinced that the agency’s plan is the right course of action.

“For almost 20 years, the VA has attempted to update its patient appointment scheduling system,” said Rep. Susie Lee (D-Nev.), chair of the House subcommittee, during a hearing on Thursday. “Now, the VA plans to implement Cerner’s scheduling solution but on a separate and faster deployment schedule than the rest of the electronic health record.”

Lee complained that while the VA contends that their plan is efficient and cost-effective, “it’s been difficult to get information to support those assertions.”

In addition, Lee noted that officials from the VA’s Office of Electronic Health Record Modernization briefed her staff last week that the current target date for completing the full deployment of the Cerner scheduling system is 2025—two years longer than what the agency reported to Congress in December 2018.

Lee added that she has “serious reservations” about the VA’s approach including the fact that agency decided to adopt the Cerner scheduling solution across the VA instead of the Medical Appointment Scheduling System (MASS), which was successfully deployed ahead of schedule last year at the Chalmers P. Wylie Ambulatory Care Center in Columbus, Ohio, as part of a pilot program.

In August 2015, the VA awarded Systems Made Simple a MASS contract valued at $624 million for a “best-of-breed, proven and mature” commercial off-the-shelf medical scheduling solution. Systems Made Simple partnered with EHR vendor Epic to leverage their scheduling software for the MASS contract.

Lee questioned the VA’s decision to forgo the MASS contract in favor of the Cerner scheduling solution “especially given the investment, resources and apparent success of the MASS pilot program.”

She pointed out that VA plans to begin the Cerner implementation in Columbus. “So, just months after the successful completion of one scheduling solution, VA’s going to scrap it and implement another,” Lee added. “I’m also concerned that the VA made assertions to Congress before it had any actual analysis of user needs, costs or benefits. Despite being six months out from beginning system implementation, the plan seems to be in rough shape.”

Rep. Jim Banks (R-Ind.), ranking member of the subcommittee, commented that “the appointment scheduling system is the VA IT system most badly in need of an overhaul—more so than the financial system, the claims paying system or even the EHR.”

Banks said he was not surprised by the VA’s decision to select the Cerner solution over MASS, given that the agency is replacing its legacy EHR with Cerner’s Millennium platform.

“The idea to put the (Cerner) scheduling implementation on a separate, faster track (than the new Millennium system) seems justified,” Banks added. “However, my colleagues and I have spent all year asking for the details and analysis. That information is only now starting to emerge. I need to see a lot more before I can put my confidence in this plan.”

John Windom, executive director of the VA’s Office of Electronic Health Record Modernization, told the House subcommittee that—like MASS—Cerner’s software is a “resource-based scheduling solution and will be implemented in a number of VA facilities in advance” of the full EHR implementation.

“The Chalmers P. Wylie Ambulatory Care Center in Columbus will serve as the pilot site for the Cerner scheduling solution and will go live in April of 2020,” said Windom. “VA will leverage the architecture and lessons learned from the MASS solution.”

However, Banks criticized the VA for “pulling the plug on Epic” and its MASS pilot at the Columbus site, which he contends will lead the agency to “forfeit the opportunity—which may become valuable in the future—to encourage greater interoperability between Cerner and Epic.”

Windom emphasized that “accelerating” the implementation of the Cerner scheduling solution will enable the VA to more quickly replace its antiquated VistA scheduling system and VistA Scheduling Enhancement (VSE), which he called the “temporary bridge” for the agency’s current scheduling needs.

But, Banks challenged the assertion that the VA’s plan is a significant acceleration of the timeline. “I was disappointed to see the three-year scheduling implementation stretch out to five years before it even begins,” he added. “And, I’m not so sure that this still qualifies as ‘accelerated.’ ”

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