VA's Cerner EHR implementation requires close oversight, lawmakers say

For the VA to successfully install its new Cerner electronic health record, both the agency and outside groups must monitor the agency's progress and management, according members of House Veterans' Affairs Committee, who worried that the agency's leadership instability could hinder the project.

Committee members at a hearing about the VA's EHR modernization project Tuesday voiced concerns about instability and lack of transparency at the agency as it embarks on a 10-year project to replace its homegrown EHR with one made by Cerner. They were also concerned that the VA will face the same struggles the Defense Department is facing in its own Cerner installation.

"Leadership will make or break this project," Rep. Tim Walz (D-Minn.) said. "So will oversight."

Although the VA has tried to address lawmakers' oversight concerns as recently as Monday by creating the Office of Electronic Health Record Modernization, those moves have only raised new worries about how the agency will manage the $16 billion project. Walz pointed out the email notice he got about the office was missing an attachment. "You can't make this stuff up," he said, holding a printout of the notice.

Acting VA Secretary Peter O'Rourke assured Walz and other members of the committee that the agency will manage the Cerner project properly and address three key challenges: cost, performance and schedule.

"EHR modernization is deep change," O'Rourke said. "It's a technical and a cultural challenge, and the human component is central so success."

In an attempt to learn from the Defense Department's issues with its Cerner EHR implementation, the VA has created its own "proactive and pre-emptive contract management strategy" so they can adjust course as technology changes, according to O'Rourke.

The VA will also take suggestions from the Defense Department itself.

"One of the big lessons learned is that frontline providers have to be involved in the designing process and the testing process," said Dr. Ashwini Zenooz, chief medical officer of the VA EHR Modernization Program.

The House, for its part, is creating an oversight panel of three to five lawmakers to monitor implementation of the new EHR system.

Since signing the contract in May, the VA has been setting timelines and planning the first installations, which will take 18 months after they begin in October in the Pacific Northwest.

Though the contract is valued at $10 billion, that doesn't include the costs for project management, support and infrastructure, which will bring the actual cost to $16 billion, according to David Powner, director of IT management issues for the Government Accountability Office.

The cost to run the VA's current EHR, the homegrown VistA system, is about $1 million per year. But a Cerner EHR will ultimately cost less to run, Cerner President Zane Burke said. There are more than 100 different versions of VistA, he said, which makes training and upgrading expensive.

The new EHR will also boost interoperability, Burke said. Though the technical challenge isn't as great as it once was, there are still business challenges in getting provider organizations to actually share patient data.

Cerner is "committed" to pursuing interoperability, Burke said. "It's an opportunity for the VA and DoD to lead in this space."

Achieving interoperability won't be a one-time-only project, though, Zenooz said. "Interoperability is not an end state," she said. "It requires constant care and maintenance, and as technology advances, we need to ensure that VA keeps up."