GAO Review of VA EHR Modernization Efforts Past and Present

The House Subcommittee on IT, under the Committee on Oversight and Government Reform, asked GAO to review VA’s prior and current efforts to modernize VistA, because the system is essential to the department’s ability to deliver quality health care services to veterans and their dependents.

VA operates the largest health care delivery system in America which has been dependent on VistA for more than 30 years.  However, the system is costly to maintain and doesn’t readily support VA’s need to electronically exchange health records with DoD and private health care providers. VA has attempted to modernize VistA over the years using contractor support, but in June announced that it would embark on a new effort to replace VistA with the same commercial EHR as DoD, Cerner’s Millennium solution. VA is calling the new initiative Electronic Health Record Modernization (EHRM).

GAO’s analysis of the past EHR modernization efforts (iEHR and VistA Evolution) shows the top 15 contractors that worked on the two initiatives “accounted for approximately $741 million—$411 million for the development of new system capabilities, $256 million for project management activities, and $74 million for operations and maintenance for iEHR and VistA Evolution.”

VA is in the process of transitioning from VistA Evolution to EHRM. However, implementation of the new Cerner system will take 10 years according to VA executives at AFCEA’s Health IT Day in mid-January.  While VA transitions to the new solution on a site-by-site basis, strategic investments will still need to be made to the existing VistA systems for the medical facilities who have not yet transitioned during the 10 year implementation period.

VA is still in the early stages of planning for EHRM, pending the contract award. The department has developed a preliminary description of the organizations that are to be responsible for governing the program. For example, the Executive Director for the EHRM system will report directly to VA’s Deputy Secretary. VA has also appointed a CTO from VA’s Office of Information and Technology (OI&T), and a Chief Medical Officer from VHA. Both will report to the Executive Director.

VA has also developed a preliminary timeline for deploying the new system. The Executive Director told GAO that “the department intends to complete a full suite of planning and acquisition management documents to guide the program, including a life cycle cost estimate and an integrated master schedule to establish key milestones over the life of the project.” In the interim, VA has awarded program management contracts to support the development of the planning documents to MITRE Corporation and Booz Allen Hamilton.

GAO made no recommendations to VA, due to the department’s “meaningful action” to develop appropriate plans and documentation to guide the new EHRM effort. The program’s Executive Director told GAO that the plans will be completed within 90 days of awarding the modernization contract.

Recent Congressional testimony from Secretary Shulkin indicates that contract negotiations with Cerner are on hold pending an independent review by MITRE of VA’s interoperability requirements for the commercial EHR. Shulkin indicated that he takes issue Cerner’s definition of interoperability in the contract language. Some lawmakers are concerned that planned savings and efficiencies to be gained by VA’s implementation closely following that of DoD, may be at risk due to the contract delay.