VA efforts to implement Cerner EHR face close scrutiny from Congress

Agency says it will install the system at initial sites to identify problems and correct them before continuing wider deployment.

As the Department of Veterans Affairs looks to implement a new Cerner electronic health record system replacing the agency’s legacy EHR, members of Congress are letting the VA know they are committed to seeing the project through.

“$15.8 billion over 10 years, including $10 billion to Cerner, is a staggering number for an enormous government agency,” said Phil Roe, MD (R-Tenn.), chairman of the House Veterans’ Affairs Committee, during a hearing on Tuesday. “The EHR modernization is a big bet on the future of VA, and we simply must make sure it succeeds.”

Last week, the House Committee on Veterans’ Affairs announced plans to create a new subcommittee focused on providing oversight of the VA’s major information technology projects, including the $10 billion EHR modernization contract awarded last month to Cerner.

Also See: New House subcommittee to hold VA EHR program accountable

“To get this done right is going to take transparency and oversight—the creation of this subcommittee is a great first step,” said Tim Walz (D-Minn.), the ranking member of the House Committee on Veterans’ Affairs. “I’ve seen too many VA projects fail because of lack of leadership…we still don’t have a confirmed secretary, deputy secretary, under secretary for health, or chief information officer—it’s pretty important that those positions be filled.”

Walz pointed out that the VA intends to create a single common EHR system with the Department of Defense using a shared Cerner Millennium platform, and that the agency’s planned acquisition calls for aligning the deployment and implementation of the system with DoD’s ongoing rollout of its own system—called MHS GENESIS—in order to achieve efficiencies.

However, he noted that DoD’s director of operational test and evaluation released a report last month that found that the military’s Cerner EHR system—installed at four initial sites in the Pacific Northwest—is neither operationally effective nor operationally suitable.

“The root cause must be identified and remedied—VA cannot fail veterans again,” Walz said. “VA and the White House must act now to remedy the deficiencies so that we have qualified leaders in place before the project implementation begins this fall.”

Acting VA Secretary Peter O’Rourke testified that the agency recognizes and fully appreciates the challenges that DoD has faced in its initial implementation of its own Cerner EHR. As a result, he told members of the House Committee on Veterans’ Affairs that the VA has adopted a “proactive and preemptive” contract management approach to deploying the system at targeted initial operating capability (IOC) sites to identify problems and correct them before installation at additional sites.

“The contractor will begin conducting site assessments for the IOC sites beginning in July 2018 and concluding in September 2018,” O’Rourke said in his written testimony. “VA anticipates the system implementation for the IOC sites to begin Oct. 1, 2018, with an estimated completion date set in March 2020. With this IOC site approach, we will be able to hone governance, identify efficient strategies and reduce risk to the portfolio by solidifying workflows and detecting course correction opportunities prior to deployment.”

He added that DoD and VA are working closely to ensure lessons learned at the military’s initial sites will benefit future deployments for both agencies.

Vice Admiral Raquel Bono, MD, director of the Defense Health Agency, testified that DoD is in the midst of making “important improvements” to software, training and workflows based on lessons learned from deploying the Cerner EHR at four initial military sites in the Pacific Northwest.

“The VA and DoD understand that the mutual success of this venture is dependent on our continued close coordination and communication,” said Bono, noting that by adopting the same EHR platform the two agencies will “fundamentally solve the problem of transitioning patient health record data between the departments by eliminating the need for moving data altogether.”

“These projects are very complex, and this will be a significant undertaking,” adds Cerner President Zane Burke. “All these kinds of projects have what I call ‘white knuckle’ moments—and, I would anticipate that this will have a handful of those. What I do feel good about is that we have a governance model to address those. And, that’s one of the key reasons for success or failure.”

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