GAO Advises Increased Stakeholder Involvement as VA Presses Forward with EHRM

In 2015, GAO designated VA health care as a high-risk area, in part due to IT challenges. VA’s $16B EHRM project to implement Cerner’s commercial health record system is meant to resolve current health IT challenges and better position the agency to provide care for veterans with a modernized EHR. Recently, GAO was tasked with reviewing VA’s EHRM configuration decision processes and decision-making procedures.

GAO’s research revealed that VA used a multi-step process to make EHR configuration decisions and assess system compatibility, including establishment of 18 councils composed of VA clinicians, staff, and other experts in various clinical areas.  The councils held eight national workshops between November 2018 and October 2019. At the workshops, the councils designed the functionality of the new EHR system to help clinicians deliver care. Additionally, local workshops were conducted at the first two initial go-live sites, Mann-Grandstaff VA Medical Center in Spokane, Wash. and the VA Puget Sound Health Care System in Seattle.

GAO found that by in large VA followed best practices for system configuration, but lacked wide communication to local stakeholders. The councils included stakeholders from a wide variety of geographic regions, but VA did not always effectively communicate information to stakeholders at the two local medical facilities to ensure local workshops had relevant representation. Additionally, representation at national workshops lacked representation from specialty areas, such as pulmonology and gastroenterology. VA’s summary from the last national workshop did state that additional subject matter experts should be included in the EHR system configuration decision process.

GAO recommended that VA communicate more effectively and clearly regarding future local workshops to facilitate appropriate stakeholder participation for additional sites.  VA agreed with GAO’s recommendation stating that it planned to design future workshops to enable collaboration between clinical and administrative experts. VA also said that it is refining local workshop agendas to facilitate subject matter expert identification and participation.

VA originally planned to go live with initial operating capability at the Mann-Grandstaff VA Medical Center in late March 2020, but announced in February that it would push back implementation due to needed system builds and user training. In early April 2020, VA announced that it was pausing the rollout to respond to the coronavirus pandemic.

At a June 4th GovernmentCIO Media & Research's virtual event, VA Special Advisor Alan Constantian and VA Executive Director of the Office of Technical Integration Paul Tibbits spoke about continued work on EHRM despite the pandemic. VA is using data sharing and telework to move the program forward. "Software development, cybersecurity, documentation, authority to operate, authority to connect, etc., is all continuing unabated,” stated Tibbits. On-site work such as server installation had to be paused. Tibbits said that work could resume as early as this month as things begin to open up.  “We’re in the middle of a lot of discussions about when the new go-live dates will be. We haven't quite settled on that yet," he said.