Lawmakers voice concerns about VA’s plans for Cerner EHR

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Members of Congress are growing increasingly concerned about Department of Veterans Affairs plans to implement the same Cerner electronic health record system as the Department of Defense.

Senior VA officials incurred the wrath of a House appropriations subcommittee on Wednesday, taking heat from both Democrats and Republicans regarding the projected $16.1 billion cost of implementing the EHR over 10 years, as well as their concerns that the new system will not be able to seamlessly exchange data with community care providers.

“I am genuinely pleased the VA is moving in the direction of creating an integrated health record system with DoD, but I am concerned about how this new system will work with the private sector providers,” said Rep. Debbie Wasserman Schultz (D-Fla.), chairwoman of the House Military Construction, Veterans Affairs, and Related Agencies Appropriations Subcommittee.

“I am also concerned about the cost and the projected timeline—as I said just last week to Secretary Wilkie, this is a complex project that is projected to cost $16 billion, which is more than the nuclear-powered aircraft carrier USS Gerald R. Ford, the lead vessel of the U.S. Navy’s latest class of carriers,” added Wasserman Schultz. “I am also concerned about the projected 10-year deployment plan—that seems like an insane amount of time.”

Also See: Rep. Phil Roe has concerns about 10-year VA EHR implementation

Rep. Will Hurd (R-Texas) expressed his frustration that despite technological advances in healthcare and other industries, “our men and women in uniform still don’t have an interoperable health care record” which he said is outrageous.

“Our soldiers, sailors, airmen and Marines are stuck in an outdated system, caught between two agencies that have a management problem,” added Hurd, who noted that there are currently 131 instances of the VA’s decades-old legacy Veterans Health Information Systems and Technology Architecture (VistA). “We have now identified the problem, because it’s not a transition from one system to another. It’s the transfer of 131 programs to one.”

At the same time, while Hurd acknowledged the “monumental undertaking” of mapping 131 separate instances of VistA to Cerner’s Millennium platform, he told VA officials that the EHR modernization effort should not take a decade to complete or cost $10 billion for the Cerner portion of the project.

James Byrne, the VA’s general counsel who is performing duties as the agency’s deputy secretary, testified that implementation of the new Cerner system will not be simple, easy or without hurdles.

“It is in fact a complex, difficult, time-consuming job,” Byrne told lawmakers. “We need to constantly remind ourselves that when we complete this difficult, complex transformation there will be tangible, measurable benefits for veterans, including—but not limited to—patient data residing in a single site with records updated instantly at the time of care, seamless transition as service members become veterans, and equally seamless access to quality care when veterans move between DoD, VA and community care providers.”

Byrne said the Cerner system implementation is “currently scheduled as a 10-year rollout, and I appreciate that that is a long time.” However, he added that accelerating the EHR installation is a possibility, as is “maybe even doing it cheaper than the projected $16.1 billion.”

John Windom, executive director of the VA’s Office of EHR Modernization, told the congressional panel that Cerner “wants to go faster” with the implementation, but the agency is “holding them back.” Windom testified that the VA is taking a cautious approach because the agency “doesn’t want to disrupt the care being delivered to our veterans by being overly aggressive, until we get through (initial operating capability) and are able to ascertain what efficiencies can be gained.”

According to Byrne, the VA’s current VistA system is “simply insufficient” to serve the needs of veterans. Nonetheless, in his testimony, he noted that the agency will continue to use VistA “until all legacy VA EHR modules are replaced by the Cerner solution.” Byrne added that “for the purposes of ensuring uninterrupted healthcare delivery, existing systems will run concurrently with the deployment of Cerner’s platform while we transition each facility.”

Windom emphasized to the subcommittee that the agency “will not be turning off the VistA platforms until we have—if you will—migrated across the country and implemented the Cerner Millennium solution to all of our medical centers.”

The VA’s planned acquisition calls for aligning, as much as possible, the deployment and implementation of its EHR system with ongoing DoD rollout activities to achieve efficiencies. DoD’s Cerner system—called MHS GENESIS—was initially deployed at four military sites in the Pacific Northwest. Likewise, Windom told lawmakers that the VA’s Cerner system will be first implemented at three agency sites in the Pacific Northwest.

“We believe those three (initial operating capability) sites are a representative sample of the enterprise that will allow us to understand the challenges associated with an implementation of this magnitude,” added Windom, who said the “go-live” for the IOC sites is slated for March 2020.

When it comes to achieving EHR interoperability with community care providers, Byrne said that the Cerner Millennium system is a “commercially proven tool in the private sector” and that “many of the providers—that we will be sending our veterans out to—have that tool or tools that are compatible with the Cerner platform.”

“We recognize the issues with community providers,” added Windom. “They’re at the top of our list to ensure that we promote the appropriate information exchange.”

Still, Windom acknowledged that with a system implementation “this complex, this massive, you’re going to have issues—the mitigation strategies that are employed and the resolution of those are what’s important.” Overall, he insisted that the VA is “on the proper track to both mitigate and resolve quickly any issues that we encounter.”

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