As the Department of Veterans Affairs looks to secure congressional funding for its $10 billion Cerner electronic health record system, members of Congress are starting to balk at the costs involved of not just implementing the new EHR but keeping its legacy system up and running for years to come.

“While the EHR modernization effort is necessary, it is very expensive,” said Phil Roe, MD (R-Tenn.), chairman of the House Veterans’ Affairs Committee, during a hearing on Thursday. “The contract with Cerner alone has a price tag of about $10 billion, and that doesn’t even include the cost of updating infrastructure to accommodate the new EHR.”

This week, President Trump released his Fiscal Year 2019 budget request for the VA, which includes $1.2 billion to start implementing Cerner’s Millennium EHR platform, which will replace the agency’s decades-old Veterans Health Information Systems and Technology Architecture (VistA).

However, in Thursday’s hearing on the VA’s FY 2019 budget, Roe lamented the fact that VistA will need to be maintained for years, even after the Cerner system has been implemented. “I’m not sure you can ever turn VistA completely off,” he added.

VA Secretary David Shulkin said in his testimony before the committee that the agency is migrating from more than 130 instances (or versions) of the agency’s legacy EHR system, and he acknowledged that the VA’s transition to Cerner will require maintaining VistA over a 10-year implementation period.

“No one’s ever implemented an electronic health record change this big, so we’re taking it very seriously,” testified Shulkin, who said that given the magnitude of the EHR acquisition, the significant long-term costs and complex contracting needs, the VA was requesting a single separate account from Congress for this effort. At the same time, he noted that, in light of the agency’s “track record” of implementing big IT projects, the VA has to “really make sure that we got this one right.”

David Shulkin

Nonetheless, Roe expressed concerns about the VA and Department of Defense plan to implement a single shared Cerner EHR with the goal of achieving full VA-DoD interoperability.

“It is unthinkable that VA could potentially spend billions of dollars on a project that doesn’t substantially increase the department’s ability to share information with DoD or community providers,” Roe said. “Yet that’s exactly what could happen if VA fails to proceed in a careful deliberate manner.”

At the same time, Roe said he was relieved when Shulkin recently ordered a “strategic pause” in the agency’s negotiations with Cerner—as part of the EHR acquisition process—to have the MITRE Corporation conduct an external assessment of the VA’s interoperability requirements.

Also See: VA delays EHR award to Cerner pending interoperability assessment

In addition to creating a single seamless EHR system with DoD, Shulkin told lawmakers that he has also insisted on high levels of interoperability and data accessibility with the agency’s commercial health partners.

“The reason I paused (contract negotiations with Cerner) was because I want to make sure that for those 36 percent (of veterans) who are getting care in the community, we can actually understand what care they got,” testified Shulkin. “We have to make sure that we can be interoperable with dozens of different health systems out there. And, that’s a challenge that—frankly—the American healthcare system hasn’t figured out yet. We think VA can help lead this for the whole country by making this interoperable.”

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