The Subcommittee on Technology Modernization under the House Committee on Veterans' Affairs on Wednesday convened its first hearing on the Veterans Affairs Department's electronic health record implementation since the department completed its go-live at Mann-Grandstaff VA Medical Center.
Mann-Grandstaff in Spokane, Wash., went live on the EHR in fall 2020, becoming the first VA site to do so. It's a milestone for the multibillion-dollar contract the VA inked with Cerner Corp. in 2018 for a 10-year rollout of an EHR system, which will replace the agency's homegrown EHR, called VistA.
But in March, the VA said the agency would undertake a "strategic review" of the EHR project, following an assessment conducted during VA Secretary Denis McDonough's first month in office.
McDonough at the time said the VA was committed to the Cerner EHR, but that the review could involve adjusting the timeline for future EHR deployments.
It's the third time the VA has delayed its timeline for EHR implementations.
"I whole-heartedly support the Secretary's strategic review," said Frank Mrvan (D-Ind.), the subcommittee's chair, at the hearing Wednesday. However, "while we understand that this delay is part of 'getting it right,' at some point, we can't accept continued delay without a complete explanation from the VA on what the problems and solutions are."
Here are five takeaways from the hearing:
1. Lawmakers questioned whether the VA is on track to complete the project in the expected 10-year timeframe. Lawmakers asked VA officials to explain how the department expects the systemwide project to be completed by 2028, with 169 sites remaining.
John Windom, executive director of the office of EHR modernization at the VA, said there are "efficiencies" gained through improvements made during the first go-live, which will inform future deployments.
"We see the timeline over 10 years, and we think it's feasible," Windom said.
The Defense Department already has gone live on the Cerner EHR at 20 sites and the Coast Guard has gone live at four sites, according to Brian Sandager, general manager of Cerner Government Services. He said he thinks the VA is "well-positioned" to continue deploying the EHR, although he acknowledges there are challenges that need to be resolved.
2. Lawmakers raised concerns about growing program costs. Mike Bost (R-Ill.), ranking member of the House Committee on Veterans' Affairs, asked the VA to rethink its initial estimates. Congress has allocated $6 billion to the VA's EHR modernization effort since 2018, and the VA has requested an addition $2.7 billion for fiscal 2022.
That's $8.7 billion for a project that's estimated to cost $16.1 billion in total—although the VA has only gone live on one site to date.
"We need to pump the breaks on spending until that happens," Bost said. "This spend rate simply cannot hold."
The VA so far has spent $2.6 billion on the EHR effort, while another $3.8 billion has been "obligated," Windom said. The VA doesn't pay the bill for services until the work has been completed, which explains how some money has been committed but not spent.
3. VA shared details on how many issues it's resolved at the first site. Since going live at Mann-Grandstaff, the VA has implemented more than 350 change requests, said Dr. Laura Kroupa, chief medical officer at the VA's office of EHR modernization.
Change requests are sizeable configuration adjustments that require review from the VA and the DOD; that's different than an incident ticket, which relates to small technical issues that can be fixed more quickly. Many of the change requests to date have involved customizing the EHR for the VA beyond what's set up in the commercial system.
Any tickets related to patient safety are expedited and resolved in 24 to 48 hours, she said.
The VA has received 247 patient safety reports "of various urgencies," according to Dr. Robert Fischer, director of Mann-Grandstaff.
4. The new EHR isn't just about sharing data with DOD. Matt Rosendale (R-Mont.), ranking member of the subcommittee, questioned why, if physicians are able to exchange patient data using a new health information exchange, it's still necessary to implement the expensive EHR—since interoperability has been one of the primary goals of the EHR effort.
The VA and the DOD launched a joint HIE in April 2020, designed to make it easier for the agencies to exchange patient data with one another, as well as with community providers.
Dr. Carolyn Clancy, acting deputy secretary at the VA, said the EHR isn't only to support clinical care, but also to create a way to track things like supplies across facilities. That's been particularly challenging amid COVID-19; early in the pandemic, VA staffers had to manually count personal protective equipment at many sites.
5. VA won't move forward with deployments until after the strategic review. Lawmakers urged the VA to delay additional EHR go-lives until all issues have been resolved at Mann-Grandstaff, including setting benchmarks so it's clear when the work is complete.
"I'm concerned about starting something until we have all the kinks worked out," Rosendale said. "If the countdown to go live starts during the strategic review, it will not make positive impact on the results."
Clancy said the VA would not start additional go-lives until after the strategic review is shared with the subcommittee.