The Cerner electronic health record system that the Department of Veterans Affairs plans to implement over 10 years will cost a total of $15.8 billion, according to the latest VA data provided to Congress.

The VA’s 10-year cost estimate for the entire EHR modernization program includes $10 billion for the Cerner contract (which has yet to be signed), $4.6 billion for infrastructure improvements and $1.2 billion for contractor program management support services; the VA has already awarded the main contract in this category to Booz Allen Hamilton.

Of the $15.8 billion, the agency says it plans to ask for $10 billion of new appropriations from Congress and to internally reprogram $5.8 billion over the 10-year system implementation period.

However, members of Congress are starting to balk at the costs involved in replacing the agency’s decades-old Veterans Health Information Systems and Technology Architecture (VistA) with Cerner’s Millennium EHR platform.

Also See: Lawmaker expresses sticker shock over $10B VA EHR

“Given the magnitude of this transformation and the significant long-term costs and complex contracting needs, we are requesting a single separate account for this effort,” said VA Secretary David Shulkin in his written testimony last week during a House hearing on the agency’s Fiscal Year 2019 budget request.

Rep. Debbie Wasserman Schultz (D-Fla.), ranking member of the House Military Construction and Veterans Affairs Appropriations Subcommittee, noted at the hearing that the VA is requesting $1.2 billion in its FY19 budget request “to continue the massive implementation, preparation, development, interface management, rollout and maintenance” of the new EHR.

"We’re talking about a $16 billion project that will take a very long time—probably longer than many of us will be here to see it completed,” said Wasserman Schultz. “I can understand this degree of complexity will have its growing pains, but it’s crucial that we understand how its procurement will work.”

She added that proper oversight must be put in place “to guard against abuses and mismanagement, which can and do occur in projects of this magnitude.” In particular, Wasserman Schultz voiced her concerns that the implementation of the Cerner system may result in increased, costly customization.

“I think what you are bringing up appropriately is this is a very, very risky, complex implementation, and you’re absolutely correct that a lot of things could go wrong,” responded Shulkin. “But, this is not so much about the technology as about how we manage change management across the system.”

To ensure proper oversight of the massive EHR implementation, Shulkin testified that the VA is standing up a project management office which will be “clinician led and driven.” He added that the use of an open application programming interfaces (API) process, in conjunction with HL7’s Fast Healthcare Interoperability Resources (FHIR) standard, will “allow us—I think—to avoid some of this proprietary customization that’s going on in the market right now.”

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