- The Department of Veterans Affairs isn't scheduling any more deployments of its new Cerner EHR for six months, an agency official told a House subcommittee on Wednesday. The pause follows recent watchdog reports highlighting snowballing spending and shoddy staff training at the record's first go-live at a VA medical center in Spokane, Washington.
- VA Assistant Undersecretary Carolyn Clancy told legislators the Mann-Grandstaff facility was not ready to go live when it did, though there's no clear evidence the EHR implementation resulted in direct harm to patients. To try to fix the beleaguered rollout of its Electronic Health Record Modernization program, the VA plans to shift from its previous site-by-site deployment to an enterprisewide readiness approach; create a simulated testing and training environment for veterans and providers to learn on the system before it's deployed; and have an independent body do a cost review of EHRM's spending, Clancy said.
- However, the VA is still ironing out how to measure readiness before site go-lives, and how many sites to take live each year. The new VA Secretary Donald Remy, who was sworn in just last week, plans to release an updated deployment schedule by the end of this year.
On Wednesday, legislators grilled VA and Cerner representatives on the status of the $16 billion EHRM program, the latest of many hearings about the drawn-out and increasingly expensive project launched in 2018.
Despite the already delayed timeline, members of the Subcommittee on Technology Modernization said they supported the decision to further pause the project, worried about potential patient safety risks and recent reports from the VA's Office of the Inspector General highlighting myriad issues.
"I applaud the decision to pause the program and hope it stays on pause until we see tangible progress," Ranking Member Matt Rosendale, R-Mont., said. "Otherwise this report is just more window dressing for business as usual."
Prior to bringing the new EHR online in Mann-Grandstaff in October, VA and Cerner failed to provide sufficient training for clinicians and administrative staff, VA-OIG said in a recent report. A majority (55%) of hospital staff surveyed said they weren't able to document patient care in the record without difficulty, while 65% said they couldn't navigate the EHR without having trouble.
Additionally, VA failed to calculate a reliable life cycle cost for the program, according to another recent VA-OIG document. Previously, the agency estimated the entire EHRM would cost $16.1 billion over 10 years, including $4.3 billion in IT infrastructure costs. However, OIG said that estimate wasn't accurate, completely leaving out at least $2.5 billion in "critical program-related IT infrastructure upgrade costs" from modernizing existing and outdated systems already in place at VA facilities.
Lawmakers on both sides of the aisle expressed frustration at the hearing about the inaccurate spending estimates.
"This must be addressed and the costs must be accounted for," Chairman Frank Mrvan, D-Ind., said.
Mrvan, along with Representatives Mark Takano, D-Calif., and Mike Bost, R-Ill., on Wednesday introduced the VA Electronic Health Record Transparency Act, which would force the VA to completely account for EHRM expenses and relate those to Congress.
VA's Clancy said the the agency planned to conduct an independent cost estimate of EHRM, but that it would take close to a year to reach and make public a true life cycle estimate.
“We are very very attentive to your concerns about fiscal oversight," Clancy said.
Brian Sandager, general manager of Cerner's government business, told legislators its original bid for the decadelong contract was an underestimation due to shoddy existing infrastructure and the shift to a virtual go-live during the COVID-19 pandemic. Sandager agreed the vendor's training had been insufficient, but said Cerner had been unable to implement its typical onsite training regimen because of COVID-19.
Sandager deferred to VA officials on whether Mann-Grandstaff had been safe for patients during the system implementation.
"It's met all the requirements we've been asked to meet," Sandager said, though he noted the vendor is still working to complete the facility's revenue cycle management system homed in Las Vegas. Since going live at Mann-Grandstaff, Cerner has made roughly 800 changes to its software, including increasing training, simplifying workflow and alerts and reducing how much time providers spend on the system, the company told Healthcare Dive.
On July 14, ex-Acting Secretary Denis McDonough testified to the Senate the EHR installed at Mann-Grandstaff was technologically sound following a months-long strategic review, though called his agency's missteps around program oversight "extremely disappointing."
Despite the testimony, some lawmakers appeared unconvinced as to the future of the EHRM.
"I've got major concerns about the amount of money that continues to flow out of Washington, D.C. to Cerner without having a fully functional facility in Mann-Grandstaff," Rosendale said. "I'm not convinced yet. Sorry."