How the contractor thinks the new electronic records systems is going at the Department of Veterans Affairs

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Three departments are developing new electronic health records systems. At the heart of the efforts at Defense, Veterans Affairs and Homeland Security’s Coast Guard, is commercial technology from the Cerner Corporation. With how the company thinks things are going, the new general manager of the federal government business at Cerner, Brian Sandager, joined Federal Drive with Tom Temin.

Interview transcript:

Tom Temin: Mr. Sandager, good to have you on.

Brian Sandager: Thank you sir. It’s a pleasure to be here.

Tom Temin: So my sense is that there was a kind of a rocky start with the initial installations, mostly all out west, for some reason, in both VA and DoD, but the oversight reports show that there’s some real progress. How does the company see it?

Brian Sandager: We’re very excited about the progress being made. Any kind of transformation at this scale isn’t without its challenges. But we’re very pleased that our clients are doing a great job of really pushing forward with adopting modern technology on behalf of servicemembers, veterans and their families — and are very excited to see the great progress that the team has made together.

Tom Temin: Now there’s a difference, VA is contracting directly with Cerner. In the case of Defense, they’re going through a major integrator, Leidos. Does that complicate things, especially when it comes to the interoperability piece that both departments have been trying to do for 50 years or so?

Brian Sandager: Well, one of the great things is that for the first time ever in the history of the VA, the DoD or DHA, and the Coast Guard, they are all in a single integrated system as of last year. So one medical record system across all three agencies, which is a historic milestone, to your point on our partners, and who we work with any kind of transformation at this scale requires great partnerships and great collaboration. And we’re very fortunate to have been able to work not only with our agency partners, but also with folks like Leidos and dozens of other partners across the industry to really bring the best of the commercial capabilities to bear. So it’s been a very fruitful relationship across the board and very excited for the work that’s been done so far.

Tom Temin: Because you come from being the CEO of Cerner, and you also ran, I guess, their international business. So on the commercial side, is it also common for an integrator or third party installer, whatever you want to call it, to be the intermediary between your technology and the end customers? That’s something that’s fairly common on the commercial side.

Brian Sandager: It is on the commercial side in limited fashion, more so on our global and international clients. Yeah, there are government agencies and other countries that work with integrators. But we really believe in health care, that we can also do that role and be very successful at it. Healthcare integration is very complex and requires a high level of specialization which our teams provide and can provide a lot of value by working directly with customers as well.

Tom Temin: And at the VA, they have a lot of systems upgrades they’re doing. And I guess I’m just trying to get a sense of where the Cerner technology leaves off and their other systems for scheduling people and otherwise administering their health centers begins. Because in the Cerner technology, there is a lot of administrative and logistics function, as well as pure — this person had this shot on this date and was born on this date type of information.

Brian Sandager: Yeah, absolutely. We really believe health care needs to be an end to end solution focus, really from the time a person is born until their very last breath and beyond, you have to provide the full solution set. Cerner does a lot of that internally with the software that we have developed over the last 40 plus years and modernized over those decades. But really, we also do it with a number of partners. We don’t believe that we have the patent on innovation, we believe that healthcare transformation requires partnerships across the industry. And great ideas come from everywhere, our clients from the industry, from entrepreneurs. And so we really try and develop an open architecture that allows people to innovate at the edge. So a lot of the scheduling and things like that, that you mentioned, are done within the Cerner software. But there’s a lot of innovation that’s done at the edge that we open architecture and allow connectivity support that.

Tom Temin: And in the sense of being the repository of someone’s information from birth to death, that kind of puts you in competition with Facebook, only with Facebook it goes on after they’re dead.

Brian Sandager: Yeah, and that is true with veterans and with servicemembers as well. The data that exists in these systems does perpetuate and that’s very important as well, for the agencies and for the industry as a whole to access that information for research. The modernization of medicine and systems really does accelerate innovation. And by allowing the VA to have access to these modern systems will also accelerate their research. The VA has a long history of research, as does the DoD. And so those are really important things not just the electronic medical record, but access to the information data to help them manage their systems, but also their health systems but also to help them innovate in the way they conduct us, which is a big part of that trains in the transformation that we’re partnering for.

Tom Temin: Some of the nitty gritty here, in the installations that have taken place so far for the DoD, there’s again western oriented, and I guess there was a new wave of them in recent months. They’re still getting with their own oversight people say their own tests and evaluation people say is barely passable usability from the standpoint of users. What’s that all about?

Brian Sandager: So early in the initial deployment at DOJ, it’s always a learning experience for new clients in terms of what are the functionalities that they require, and that DoD had a set of requirements that they outlaid in their initial procurement. We’ve been working very closely with them and our partners with Leidos to really help post that initial implementation to reevaluate and expand on those capabilities. And really, when you look at the sites that have come live since then, the initial four sites at that initial operating capabilities have expanded now to 20 sites. And actually, by their reporting, that increase in functionality that they’ve expanded has really driven a high user adoption, not just from an anecdotal perspective, but also from a lot of the statistics that we track. There’s thousands of metrics in our systems that allow you to track and user adoption, time in the system, how long it takes doctors to perform different things. And we utilize all that data to help our clients make sure that they’re getting the maximum value from the system. So very happy to report that DoD and Coast Guard is really expanding their utilization of the system every day, and I’m really happy with the progress that they’ve made.

Tom Temin: And at VA, the latest GAO report said that initially there were all these, 530 I think they said, high severity items. I’m not sure bug is the right word, but maybe a configuration issue or a interoperability data exchange issue with some other system, whatever it was. What is the issue there? Who fixes those? How do you hammer those down?

Brian Sandager: Well, one of the key things about any large system implementation is to make sure that we’re doing really good testing, and good testing will find challenges, whether that’s a decision on configuration of the system to support a workflow, or whether it is a configuration change that needs to be made or a bug, as you said, with those findings from the GAO report that was prior to our go live at Mann-Grandstaff. Actually, all of those issues were either clarified, fixed, resolved or reconfigured prior to the go live. So those have all been addressed. But even with that, we continue to refine and take feedback, that’s part of the ongoing continuation of our partnership, we will never leave, we will always be making changes to the system to modernize and make sure we’re addressing any concerns. So that’s a normal part of our lives is making sure you’re doing good testing, and that you’re quickly resolving those issues.

Tom Temin: Because sometimes people do what they call workarounds, but it seems like for the permanent solution, you really don’t want to workaround, you want to fix such that it’s integrated into the final product.

Brian Sandager: Correct. And really, that’s where the system allows a lot of different configurations. And what you find in initial operating science very often is the way a client, whether that’s the commercial or here in the federal space, or global space, designs a system when they see it real live, despite all the testing and the training and everything you do. There’s new configurations or simplifications of workflows that can happen. When you design it prior, it may be a little bit more complex than you need in the real world. And so we’ll simplify those workflows, and go back towards more of a commercial standard. I mean, that’s really helpful for our clients. And that’s what we’re seeing at many sites when they initially go live.

Tom Temin: In software like this. I almost think it’s analogous to like the old SAP software where you have a basic functionality that’s very large, but every customer has to configure it to whatever it is they’re doing. How far from the commercial standard, or how close to it are the DoD-VA-Coast Guard configurations? And to the degree that they differ from the basic product? Is it only a matter of configuration or do they also do some coding in there too?

Brian Sandager: The answer is a little bit of both. One of the things that’s been great about our clients approach in the federal space has been they very much wanted to take advantage of those commercial capability sets and stay close to those standards. Where they varied from those standards is where their workflow is different because their patients are different. And I always use the vaccinations as an example. I’ve got a small son at home who’s three years old. And when we go in for his vaccinations, which is where most people get their vaccinations, mom and dad have a conversation with the pediatrician for 20-30 minutes, get the shot and off we go. In the military, that’s not a good workflow for them because they have dozens of people coming off the bus that need to be vaccinated very quickly.

Tom Temin: With no mom and dad with them either.

Brian Sandager: No mom and dad with it either, correct. And so part of that we had to take what was a 20 minute workflow and turn it into about a two minute workflow. The joy of that is now with the pandemic that we’ve gone through worldwide, the rest of our commercial bases benefiting from that because now with mass vaccination going on with COVID we’ve taken that same functionality that we built for the DoD and we’ve rolled it out to all of our commercial clients, so they benefit as well. So that’s one of the joys of this partnership is it is a two way street between our federal clients and our commercial and our global clients and benefiting from each other’s innovation.

Tom Temin: Brian Sandager is the general manager for federal business at Cerner Corporation. Thanks so much for joining me.

Brian Sandager: Thank you, sir. It’s been a pleasure.

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