The Department of Veterans Affairs will implement a new, commercial, off-the-shelf patient scheduling system by 2025, two years later than VA originally advertised to Congress.

VA has chosen to implement a scheduling solution from Cerner, the same contractor that’s spearheading its electronic health record modernization efforts, which the department said will mirror a similar, successful pilot it launched several years ago.

For VA, the decision to implement Cerner’s scheduling solution just made financial and practical sense, especially as the department works to implement an electronic record that’s interoperable across multiple spaces.

“Interoperability objectives … are more readily achieved by being on the same common solution. There is a cost to integrating platforms,” John Windom, executive director of VA’s Office of Electronic Health Record Modernization (OEHRM), said last week at a hearing on VA’s scheduling system plans. “We paid for the Cerner licenses as part of the EHR contract. It made business sense to not duplicate that payment by installing another system.”

But Congress is still concerned VA is scrapping a successful scheduling pilot, which saw improved processing times, less overtime and less turnover among the department’s patient appointment schedulers.

VA piloted the Medical Appointment Scheduling System (MASS), a commercial solution from Epic, at its medical facility in Columbus, Ohio, back in 2015.

That same facility in Columbus will pilot the new Cerner scheduling system. VA said it chose that site because its contract with Epic for the MASS pilot ends in June 2020, and the department needs to find and implement a new solution by that point.

“We have to integrate into an existing solution and minimize the disruption that takes place to our care provisions,” Windom said. “This is a measure that minimizes that disruption.”

Still, leadership on the House Veterans Affairs Technology Modernization Subcommittee said they had “serious reservations” about VA’s “mid-flight” approach.

“Common business and management practice would dictate that VA would conduct an apples-to-apples comparison of off-the-shelf solutions, especially given the investment of resources and apparent success of the MASS pilot program,” Susie Lee (D-Nevada), chairman of the House subcommittee, said. “Second, I wonder why none of this would have been done before proceeding with the Cerner scheduling solution implementation. It just seems a little backward to me.”

VA has a long, storied history with this particular project. The department determined back in 2000 it needed to replace its aging Veterans Information Systems and Technology Architecture (VistA) scheduling system with a commercial product. VA spent $127 million over nine years to develop a replacement, but the project failed and the department had to start over.

It launched the VistA scheduling enhancement in 2014, which was supposed to be an interim upgrade until VA could find a more permanent replacement. But the department’s effectively managed the project to make sure users’ needs were met, the VA inspector general said.

A year later, VA awarded an indefinite-delivery, indefinite quantity contract for MASS for $624 million. That project was later downgraded to a pilot.

VA acknowledged the MASS pilot, which the department estimated it spent about $20 million on over the past few years, went well. The Cerner scheduling system, the department said, would achieve similar results.

The department, meanwhile, is still reviewing the estimated implementation costs for the new scheduling system. It will likely need to reallocate funds that have been set aside for later in the EHR modernization project lifecycle, but a specific plan hasn’t been determined.

VA, however, was confident it could take the lessons it learned from the MASS pilot and apply them to Cerner’s new scheduling solution.

“We have learned that it’s critical to have the software implemented right,” Michael Davies, senior adviser to the assistant deputy undersecretary for health access at the Veterans Health Administration, said. “We have teams doing site assessments, talking to the people that did the MASS contract in Columbus, the old contractor and connecting them with the new contractor to take advantage of the work that’s already been done. Secondly, [for] the training of the schedulers, we’re incorporating VA schedulers into the training going forward, because we learned how important it is to implement the new system in the VA environment.”

Where’s the FEHRM?

Subcommittee members seemed to accept the inevitably of VA’s move to a Cerner scheduling system.

Rep. Jim Banks (R-Ind.), the subcommittee’s ranking member, turned his attention to VA’s broader EHR modernization efforts. He continued to raise his concerns about VA’s cost estimates for the project, which he said haven’t seemed to change as much as he’d think they would.

“OEHRM seems to have reacted to the subcommittee’s oversight by zealously defending its funding,” he said. “The cost estimate is still very much a black box. It is clear that the actual spending rate is trending further below the original projection. While that seems positive at first glance, OEHRM seems to have achieved it by shifting more costs on to other organizations within VA, and I intend to monitor that very closely.”

It’s been a year since both the Defense Department and the VA signed a joint memo of understanding recognizing the two agencies’ common goal to achieve interoperable health records. Both departments were supposed to recharter their Interagency Program Office and rename it as the Federal Electronic Health Record Modernization Office (FEHRM).

Banks and other lawmakers see this entity as critical, as both departments need to ensure their two EHRs are synchronized as they deploy them over the next decade. DoD and VA announced plans to established the FEHRM back in June but didn’t give a timeline for the new office.

To date, the FEHRM isn’t up and running, Banks said.

Windom said both departments are working together, even though they haven’t stood up the official joint governance entity just yet. The two agencies had 27 joint decisions to make over the last two-to-three months, and DoD and VA made all but eight of them.

“That progress is fantastic,” Windom said. “This is just the challenge of integrating two major agencies with differing methodologies in many cases. We have been moving progressively in the right direction. The FEHRM has been involved in that process in facilitating those. The evolution that you wanted to see I think is happening. It never happens as fast as you’d like, but I think it’s happening.”

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