- The Department of Defense and Department of Veterans Affairs continue to face challenges in their multibillion-dollar electronic health record implementation, according to news reports and a federal audit published last week.
- The goal of the effort, launched seven years ago, is to get the VA, the DOD and the Coast Guard on the same EHR and improve data flow between their medical facilities and external providers. The implementation, however, hasn't been able to consistently integrate patient information into the new Cerner system, the joint VA and DOD audit found.
- In addition, the Cerner EHR system at Mann-Grandstaff VA Medical Center in Spokane, Washington, has gone down more than 50 times since the VA implemented it in 2020, according to recent reporting from The Spokesman-Review.
The purpose of the joint VA and DOD audit was to see how well implementing the common EHR is helping data exchange between the departments and healthcare providers. The DOD and VA acquired Cerner's EHR in 2015 and 2018, respectively, and as of the end of 2021, Cerner's software had been deployed at 49 DOD healthcare facilities and one VA facility.
But the Cerner implementation hasn't been going as well as it could be to improve data exchange, as the departments "did not take all actions needed to achieve interoperability," the audit found.
The DOD and VA didn't consistently migrate patient data from legacy EHR systems into the new Cerner record; didn't develop interfaces from medical devices to Cerner's EHR so that patient data would automatically upload into the system; and didn't ensure that users had access to the EHR for only the information needed to perform their duties, according to the audit from the departments' offices of the inspector general.
The inaction was partially due to the implementation's oversight committee, called FEHRM, not taking an active role in the program. Instead, the office facilitated discussions when disputes arose between the DOD and VA, resulting in separate departmental actions to migrate data, develop interfaces and grant user access, the audit found.
The project has faced scrutiny from Congress and was paused last summer following implementation issues at the Mann-Grandstaff VA Medical Center.
Mann-Grandstaff went live in late 2020, the first site to cross the finish line in a project plagued by delays, growing spending and operational issues since it launched. Following multiple delays during COVID-19, the VA elected to pause the program indefinitely pending a robust internal review, following watchdog reports highlighting the high spending and concerns about staff training at the record’s first go-live.
The Cerner EHR in Spokane saw 42 “unplanned degradations” and eight “unplanned outages” between its launch and April 20, 2022, followed by two more outages late April, according to The Spokesman-Review.
The VA Office of the Inspector General has estimated the EHR modernization project will cost as much as $21 billion overall, plus another $2 billion each additional year it takes to finish.
Implementation resumed in early 2022, and the VA launched the EHR system at facilities in Walla Walla, Washington, in March and in Columbus, Ohio, in April. Next go-lives are scheduled for June.
The audit recommends the DOD and VA review FEHRM's actions and direct it to develop more standardized procedures moving forward, while addressing the data migration, interface and user access pain points.
VA and the DOD deputy secretaries agreed with the audit's recommendations, while the director of FEHRM noted the program office needed resources and authority from the DoD and VA to properly address them.