Lawmakers on Thursday told leaders from the Veterans Affairs Department that they intend to add "tighter controls" to ensure the agency's electronic health record project is moving on schedule.
"Our implementation of a project of this magnitude, this significance, this cost, and the kind of arc of the timeline that this includes requires trust," said Chairwoman Rep. Debbie Wasserman Schultz (D-Fla.) during a House Appropriations Committee's Subcommittee on Military Construction, Veterans Affairs and Related Agencies hearing to discuss the VA's fiscal 2021 budget request.
"You have, for lack of a better term, stripped the trust that existed," she said.
Earlier this month the VA delayed plans to begin end-user training for its new EHR, which could signal a delay for the VA's overall implementation timeline. The department was slated to bring its first site—Mann-Grandstaff VA Medical Center in Spokane, Wash.—live on a new Cerner Corp. EHR on March 28.
While lawmakers have said they support the decision to not rush the go-live, Representatives at the hearing took the opportunity to question what they see as the VA's lack of timely communication to Congress about problems with the EHR project. Lawmakers said they hadn't learned of the potential for the delay until two weeks ago.
"I apologize for the anger, but I am furious," said Rep. Nita Lowey (D-N.Y.), who chairs the House Appropriations Committee. "Billions and billions of dollars, my friends, and we don't have a system."
The VA inked a multi-billion contract with Cerner in May 2018 for a 10-year rollout of an EHR system it's co-developing with the Defense Department.
VA officials earlier this month attributed the delay in end-user testing to needing more time to build the EHR system, which they said is 75% to 80% complete.
Dr. Melissa Glynn, the VA's assistant secretary for enterprise integration, explained that the agency's initial schedule had planned to begin end-user training with the incomplete EHR, as suggested by Cerner , since the system was mostly completed. However, she said clinicians raised concerns that the EHR was missing "critical requirements and capabilities" that needed to be available for training.
"A revised go-live date allows us to include additional capabilities," Glynn said.
In response to questions over when the VA realized it might need to delay its go-live at Mann-Grandstaff VA Medical Center, Dr. Richard Stone, executive in charge at the Veterans Health Administration, said he had brought up concerns over the plan to train clinicians on an incomplete EHR system to former VA Deputy Secretary James Byrne as early as last year.
"Training on products that are similar to your product doesn't work very well for the VHA," he said.
Byrne, who was fired from his post earlier this month, had reassured lawmakers that he was "very confident" the Mann-Grandstaff VA Medical Center would have a successful go-live on March 28 as recently as November.
Schultz suggested it was inappropriate to be "pointing the finger at someone who's no longer here to be held accountable."
"What we can't have in a multi-, multi-billion dollar implementation is finger pointing from the agency who is responsible, which is a multi-headed agency," she said. "I look forward to working with the leadership of the VA, including the Secretary, in ensuring that we don't have these kinds of surprises again."
VA leaders said it's still adhering to the EHR project's overall 10-year timeline. The agency plans to share an updated implementation schedule with Congress on March 10.
While Representatives voiced frustration with the VA's EHR project, Schultz stressed that "we're at the point now where we have to replace outrage with accountability, and that accountability's going to need to go in this bill."
That includes plans for the subcommittee to "establish tighter controls" over the VA's EHR implementation, Schultz said.
"We tried 'trust me,' and we're now going to have to try 'show me'," she said.
The VA requested $2.6 billion for its EHR modernization office in fiscal 2021, $1.1 billion more than fiscal 2020's $1.5 billion. That additional funding would support the EHR's implementation, chiefly by upgrading the technology infrastructure at facilities prior to go-live.