It will cost the Veterans Affairs Department at least $4.89 billion to maintain its current electronic health record system during its Cerner transition, a VA official told lawmakers Thursday.
The VA currently uses a homegrown EHR called VistA, which agency programmers and clinicians developed in the 1970s. Now, under a $10 billion contract that the VA inked with Cerner last year, the agency plans to transition to a Cerner EHR, bringing its first sites live on the new system in 2020.
The Cerner EHR rollout is slated to take about 10 years.
That means the VA will spend nearly half of what it's spending on the new Cerner EHR to sustain the VistA system, noted Rep. Conor Lamb (D-Pa.) at the House Veterans' Affairs Committee's Technology Modernization Subcommittee hearing Thursday.
"As the nationwide Cerner rollout progresses, VA will decommission VistA instances as necessary," Dr. Paul Tibbits, executive director of the office of technical integration in the VA's office of information and technology, said at the hearing. "During the transition period VA must maintain VistA to ensure current patient-record accessibility and continued delivery of quality of care."
An Government Accountability Office official at the hearing noted that the VA has had trouble reporting accurate cost information for VistA.
The VA previously said that VistA cost the agency $2.3 billion from 2015 to 2017, however, this figure is "neither reliable nor comprehensive," said Carol Harris, director for IT acquisition management at the GAO. That's partially because costs related to VistA's infrastructure and personnel were not well-documented, according to a report the GAO released Thursday.
The VA also didn't include some hosting and data-standardization costs in the $2.3 billion estimate, suggesting the actual figure is higher.
For a more accurate estimate, Harris said that the VA needs to define what VistA is. Since the system was developed in a decentralized and piecemeal way across the VA, with programmers able to customize the EHR with various functionalities, there are now at least 130 distinct versions of the EHR nationwide.
That makes it difficult to define what VistA and its associate costs entail, Harris said.
"VA lacks reliable information needed to make critical management decisions for sustaining the many versions of VistA over the next 10 years," she explained.
Tibbits said the VA is working with the Office of Management and Budget to implement a new framework to classify IT costs and stands by the VA's current $4.89 billion projection for the next 10 years. The framework is called the technology business management, or TBM, framework.
The VistA estimate for 2015 to 2017 was "the best we could do at the time," Tibbits said, and acknowledged that the VA in the past hadn't classified costs associated with individual IT systems—such as only documenting general personnel costs, without mapping personnel costs to specific systems.
"That will certainly improve over the future as we move further into implementation of this TBM framework," he said.