VA’s EHRM Problems Stem from Governance and Management Challenges

Yesterday, the Senate Committee on Veterans Affairs held a hearing on VA’s Electronic Health Records Modernization (EHRM) and the path ahead. The committee heard testimony from VA Secretary, Denis McDonough;

VA Deputy Inspector General, David T. Case; and Chief Innovation Officer of Ellkay, Marc Probst.

McDonough testified that successful deployment of a modern EHR is essential in delivering “world-class health care and benefits” to the nation’s veterans. Creating a lifetime record for service members with unified, seamless, trusted information flow between VA and DoD will advance care and outcomes, and empower veterans and their families. McDonough stated, “…we will get this right.” He also iterated several times the department’s commitment to the Cerner platform.

McDonough ordered a 12-week strategic review of the Electronic Health Records Modernization (ERHM) program in March shortly after he assumed the helm of the department, due to ongoing concerns expressed by veterans, Veteran Service Organizations, VA employees and members of Congress. The review assessed the health of the program in number of areas including patient safety; productivity; governance and management; cost, schedule, and performance; patient portal; testing; data; change management and training. The review identified issues to overcome in all of these areas.

A summary of the strategic review was released to the press on Wednesday, entitled “Electronic Health Record Comprehensive Lessons Learned.” The 36-page document shows VA’s proposed objectives and performance measures in the following key areas:

1. Improving the Veteran Experience
2. Ensuring Patient Safety
3. Providing Extended Training to Frontline Employees
4. Building Confidence at VA Sites
5. Implementing Organizational & Program Improvements
6. Improving Operational Efficiencies
7. Making Governance Effective
8. Centralizing Data Management for Workers & Veterans

McDonough said, “On the basis of these initial findings, VA is reimagining our approach to Electronic Health Record Modernization.” In the coming weeks and months, there will be a large amount of activity focused on veteran experience, patient safety and employee engagement. Given the current findings, VA is planning a “technical-only” deployment of Cerner’s EHR in Veterans Integrated Service Networks (VISNs) 10 and 20. Taking this approach will assess “technical readiness without affecting veterans and frontline clinical employees.” At the same time, VA plans to fast-track necessary infrastructure upgrades, and setup an integrated test and training environment for evaluating system functionality.

VA will also re-evaluated its site-by-site deployment plan, which was originally geographically patterned after DOD’s deployment of MHS Genesis. VA will also conduct reviews of all facilities concurrently to assess enterprise readiness, both technically and qualitatively, and to provide information for an optimized deployment schedule for sites beyond VISN 10 and 20.  Previously these reviews were to take place sequentially, but the new approach will result in integrated enterprise readiness and planning. Additionally, prior to deploying to additional sites, VA will improve organizational structure and governance. VA is repurposing FY 2021 funds toward these goals.

McDonough stated that the EHRM deployment schedule and timeline will be refreshed. He said the initial geographic deployment plan was a mistake. In the future, VA will deploy based on site readiness. According to the secretary, facilities with the appropriate infrastructure, and properly trained leadership and employees will be given the greenlight to deploy.

VA’s Deputy Inspector General, David Case, told Senators that previous cost estimates of $16.1B for the project provided by VA were unreliable and likely inaccurate because they didn’t include all necessary IT and physical infrastructure upgrade costs. VA is in the process of developing new budget estimates for the total EHRM program, including both physical and IT infrastructure needs.

McDonough wasn’t able to detail what a new governance structure for the project might look like, partially due to the fact that by law the VA deputy secretary is in charge of the project and the nominee, Donald Remy, has not yet been confirmed. McDonough would like to consult with Remy on this issue, and assured Senators that they will see change and “most importantly, clear accountability among each of us to one another and to you, to ensure that decisions taken are decisions implemented.”