- The Department of Veterans Affairs plans to restart its checkered systemwide implementation of a new electronic health record early next year, but has given its leadership team an overhaul following congressional ire, snowballing spending and concerns about patient safety, officials announced Wednesday.
- The changes came as the VA released the findings of a four-month investigation into the $16 billion project. Officials have made plans for more comprehensive worker training and scheduled deployment of the Cerner system throughout VA facilities until 2024.
- The project, meant to bring all VA, Department of Defense and Coast Guard facilities onto the same EHR system, has faced scrutiny from Congress and was paused in July following implementation issues at the Mann-Grandstaff VA Medical Center in Spokane, Washington.
Mann-Grandstaff went live in October of last year, the first site to cross the finish line in a project that's been plagued by delays, growing spending and operational issues since it launched in 2018. Following multiple delays during COVID-19, the VA elected to pause the program indefinitely over the summer pending a robust internal review, following watchdog reports highlighting the high spending and shoddy staff training at the record's first go-live.
VA Deputy Secretary Donald Remy said Wednesday his department had incorporated lessons learned during meetings with the Mann-Grandstaff team into the new direction.
"We will do everything we can to get electronic health records right for Veterans and our health care staff, with patient safety being the key driver and nonnegotiable," Remy said in a statement.
VA's Office of the Inspector General found earlier this year that VA and Cerner had failed to provide sufficient training for clinicians and administrative staff on the Cerner Millenium EHR prior to bringing it online, which could have compromised quality of patient care. A majority of hospital staff surveyed said they weren't able to document patient care in the record or navigate the EHR without having trouble.
And another report found VA had failed to calculate a reliable life cycle cost for the program. Previously, the agency estimated the entire project would cost $16.1 billion over 10 years. However, OIG said that estimate wasn't accurate, completely leaving out at least $2.5 billion in critical infrastructure upgrade costs from modernizing existing systems already in place.
Members of the congressional Subcommittee on Technology Modernization said they supported the pause in a July hearing. They were worried about potential patient safety risks and the findings from the reports.
In the VA's report published Wednesday, officials zeroed in on governance as an urgent need for the project. VA officials unveiled a leadership reorganization in a bid to streamline management, including a new executive director of the program to coordinate operations. Officials are also creating a new deputy chief information officer to oversee technology integration.
VA is also making plans for additional training on the new system, including more practice time for staff with the system before it's used in clinical settings. The agency is also introducing an EHR training environment to better familiarize clinicians with the system in a real-life setting.
Before the pause, the next site scheduled to go live was a VA medical center in Columbus, Ohio. That facility is still next on the docket. Rollout is scheduled to begin again there in March, followed a few weeks later by a VA medical center in Walla Walla, Washington.
Under the tentative new schedule, the Cerner Millenium system will be up and running in 12 VA medical centers by the end of next year, and 21 more by the end of 2023. Optimistically, the entire VA network, including 170 hospitals and more than 1,000 outpatient sites, should be live with the new system by 2028.
However "future deployments, adjustments, and/or modifications to the schedule will be made based on any additional clinical and technical findings and will continuously consider the effects of the ongoing COVID-19 pandemic," officials warned.