The Veterans Affairs Department's since delayed March go-live for its electronic health record was "likely unrealistic" given deficiencies in the infrastructure of the medical center slated for the first deployment, according to new findings released by the VA Office of Inspector General.
The VA had planned to bring its first site—Mann-Grandstaff VA Medical Center in Spokane, Wash.—live on a new Cerner Corp. EHR in March, but pushed back the deployment just a few weeks before of the scheduled go-live date, saying it needed more time to build the system. Since then, the VA has paused the EHR rollout on account of the COVID-19 outbreak.
The OIG in a report released this week audited the VA to determine whether Mann-Grandstaff VA Medical Center's infrastructure was on track for the initial March go-live date.
Infrastructure needed for an EHR go-live includes upgraded computers and medical devices, but also components like electrical, cabling and ventilation systems.
After a review of the aging physical and information-technology infrastructure at Mann-Grandstaff VA Medical Center, the OIG determined that the "VA committed to an aggressive, but likely unrealistic, deployment date of March 2020 without having the necessary information on the state of the medical center's infrastructure," according to the report.
That's on top of challenges posed by anticipated EHR capabilities—such as online prescription refill— not being ready by the March go-live date, according to a separate report the OIG released this week.
The OIG found that almost one-third of end-user devices, including desktop and laptop computers, needed for the March go-live had yet to be upgraded as of October 2019, and several other physical and IT infrastructure upgrades were not completed as recently as January.
That's concerning, since VA officials had testified before Congress in June that one of the agency's program goals was to have infrastructure in place six months before deployment at all sites, according to the OIG. That goal was informed by the Defense Department, which—after its own set of EHR delays—concluded that upgrades should be completed at sites six months in advance.
With that in mind, to prepare for a March 28, 2020, go-live, infrastructure upgrades should have been completed by September 28, 2019.
"This audit found many deficiencies that increase the risk that VA could repeat DOD's setbacks and potentially hinder performance when the system goes live," the OIG's report reads. "It could also delay the new electronic health record system implementation in VA sites nationwide."
The OIG also noted that infrastructure upgrades are costly.
The VA in May 2018 inked a $10 billion contract with Cerner for a 10-year rollout of an EHR system it's co-developing with the DOD. But on top of that contract, the VA has estimated another $4.3 billion will be needed for costs related to infrastructure, as well as additional funding yet to be determined to cover other physical upgrades needed to individual healthcare facilities.
Dr. Richard Stone, executive in charge at the Veterans Health Administration, agreed with recommendations suggested by the OIG in its report. The OIG's recommendations included steps like establishing an infrastructure readiness schedule for future go-live sites and reassessing the deployment schedule to ensure milestones are realistic.