Lawmakers concerned VA’s Cerner EHR will not be ready for go-live

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The chair of the House subcommittee, charged with legislative oversight of the VA’s $10 billion Cerner electronic health record implementation, is concerned that the agency will not be ready for the EHR’s initial go-live slated for March.

“We have reached a critical juncture in the implementation—we are now a little more than four months from the planned go-live in Spokane, Washington, on March 28, 2020,” said Rep. Susie Lee (D-Nev.), chair of the House Veterans’ Affairs Subcommittee on Technology Modernization, during a hearing on Wednesday. “However, many questions remain about VA’s readiness to operate the Cerner Millennium system in a clinical environment.”

Lee pointed out that that the ongoing EHR rollout is a very complex undertaking that includes configuration, interface development, testing and training—all leading to the first go-live on March 28.

“If any of those items are not completed in a timely manner, it will be very difficult for the VA to bring the system online in a manner that does not compromise patient care,” she warned. “I know that Cerner has been engaged in testing individual modules. But we need the entire integrated system to be tested so that it can be used for training.”

Lee advised VA officials not to repeat the “same mistake” that the Department of Defense made in the initial rollout of its Cerner EHR, when it “tested on a mocked-up system.”

The initial rollout of DoD’s Cerner Millennium platform—called MHS GENESIS—to pilot sites was not without some major challenges. The system was deemed “neither operationally effective nor operationally suitable,” according to a 2018 report from DoD’s director of operational test and evaluation (DOT&E) that was based on an assessment of three of four pilot sites in Washington state.

"As I’ve said, since I became chair of the subcommittee, the most important thing is that the VA get this right, not that it hits an arbitrary deadline,” Lee added. “I am concerned that the VA has not given itself enough time to fully test the system, nor have they allowed time for all users to adequately train on it.”

However, Rep. Jim Banks (R-Ind.), ranking member of the subcommittee, commented that he is “cautiously optimistic that a March 28, 2020, go-live is still achievable in Spokane.” Still, Banks acknowledged the complexity of the VA’s short-term EHR activities, which he described as a “tightly linked series of milestones” over the next four months.

“It is easy to imagine some of these targets may slip,” Banks observed. “If that happens, I urge VA and Cerner to take the time necessary to get it right rather than adhering to a symbolic deadline.”

Nonetheless, in his testimony before the subcommittee, VA Deputy Secretary James Byrne told lawmakers that he is “very confident” that the agency is going to be ready for the initial go-live in March and that it will be successful.

“We have a governance construct that is in place that provides oversight and drills down into the various issues and challenges that we have,” testified Byrne. “We very much appreciate that this is a major undertaking for any agency or healthcare system. But we have metrics that we’re tracking very closely.”

At the same time, Byrne said once the go-live occurs, the agency’s rollout of its Cerner system involves deploying the EHR at initial operating capability (IOC) sites with the goal of identifying challenges that emerge and correcting them.

“With this IOC site approach, VA will hone governance, identify efficient strategies, and reduce risk to the portfolio by solidifying workflows and detecting course correction opportunities prior to the deployment at additional sites,” testified Byrne. “Specifically, at the IOC sites, VA will implement new workflows in discrete capability sets, also known as blocks."

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