VA and Cerner Testify About Progress and Challenges with First Go-Live of New EHR
Published: April 21, 2021
VA’s Dr. Carolyn Clancy, Acting Deputy Secretary, and Cerner’s Brian Sandager, General Manager for Government Services, testified last week to successes and challenges with the first site rollout of the new EHR at Mann-Grandstaff VA Medical Center, as well as goals of the program’s strategic review.
- Challenges at the first go-live site are only partially related to the new technology, but are in large part related to new workflows.
- VA and Cerner are both optimistic about their ability to maintain the program’s budget and timeline.
- VA will not continue efforts for the next go-live at Columbus until the strategic review is finalized and findings are presented to the subcommittee.
VA is in the midst of a massive overhaul of its legacy Electronic Health Records (EHR) system, VistA, by replacing it with Cerner’s Millennium commercial EHR. The 10-year, $16B effort went live with its first site at Mann Grandstaff VA Medical Center in Spokane, WA in October 2020. VA initially indicated that the first go-live was successful, but acknowledged it was experiencing traditional change management challenges that are indicative of a cutover of a medical center to a new system. Subsequent complaints by medical staff at the Spokane center to lawmakers, raised concerns about veteran safety and staff productivity after the cutover.
In mid-March, Secretary McDonough ordered a pause to the rollout in order to conduct a 12-week strategic review of the program. A week later, McDonough told House lawmakers that performance and joint execution were driving the 12-week "strategic review." He also stated that he did not see the 12-week review as a precursor to a push to "fundamentally change the underlying program in Spokane.”
Last Wednesday, the House VA Subcommittees on Technology Modernization and Health held a hearing regarding concerns related to implementation of VA’s Electronic Health Record Modernization (EHRM) initiative. Dr. Carolyn Clancy, Acting Deputy Secretary at VA, and Brian Sandager, General Manager for Cerner Government Services were the main witnesses. Mann-Grandstaff’s Medical Center Director, Dr. Robert Fischer, also played a prominent role in the hearing.
Dr. Clancy reaffirmed VA’s commitment to the Cerner Millennium solution, but she assured lawmakers that VA would provide updates as the strategic review continued. “The strategic review covers a full range of program areas, including productivity and clinical workflow optimization, a human-centered design effort to understand what veterans want to see from VA’s patient portal and a sandbox environment that will allow employees at future implementation sites to conduct interdisciplinary, team-based rehearsals of these workflows in the new EHR solution,” she said.
Dr. Clancy also stated that it is not unusual for new leadership to review critical agency programs and bring “fresh eyes” to the initiatives when taking office. Part of the review will include tracking how long specific tasks take in the new EHR. Analyses of user experience and training are also being conducted.
According to Dr. Clancy, only about one-third of the challenges being experienced at Mann-Grandstaff are relate to the technology itself. Many of the problems and frustrations are not due to the EHR, but due to new workflows. “The rest is changing a whole lot of aspects of your everyday work. Many processes that you used to do on auto-pilot without thinking, now you have to think about,” she said. The new system and workflows, which were designed in conjunction with VA clinicians, take into account industry best practices which may be different than legacy VA clinical processes.
To date, Spokane clinicians have raised 247 patient safety concerns since the October rollout. According to Sandager, Cerner has implemented over 350 configuration changes since the go-live. “As with any healthcare IT transformation, we knew there would challenges. Sometimes what you design on paper is over-engineered and it doesn’t fit local workflows, and we need to modify those,” said Sandager.
When asked what keeps him up at night, Dr. Fischer stated, “staff morale,” not specifically due to the new EHR, but due to a combination of factors, a major one being COVID-19. However, he has not seen a jump in staff turnover in spite of the challenges.
Congressman Rosendale (R-MT) expressed concern over program spending in relationship to the implementation timeline, stating that VA has already received one-third of the money that Congress has appropriated for this effort, but only one of 170 sites has been deployed to date. He asked VA’s John Windom, Executive Director of the Office of Electronic Health Record Modernization to explain how costs and schedule will be maintained. Windom said that $3.8B has been obligated to date, but only $2.8B has been spent, because VA doesn’t pay the bill until the work is done. Windom believes the timeline is feasible stating that there are “substantial efficiencies to be gained for future deployments.” Cerner’s Sandager echoed Windom’s optimism regarding being able to maintain the 10 year deployment timeline.
Cerner and VA both acknowledged they have challenges to overcome and work ahead to position the next go-lives for successful outcomes.
Rosendale asked for VA’s commitment not to start any go-live activities at Columbus until the strategic review is completed and shared with the committee. Dr. Clancy gave her commitment.