With about four months to go until the initial go-live date, the Department of Veterans Affairs insists it’s ready to deploy a new electronic health record at the first site on time.

The department is supposed to achieve initial operating capability on Cerner’s new, highly-anticipated EHR at the Mann-Grandstaff VA Medical Center in Spokane, Washington, on March 28, 2020.

Congress is “cautiously optimistic” VA will achieve that goal.

But the department has dozens of additional tasks and decisions to make ahead of the March go-live, and members say they’d rather see VA push back a “symbolic deadline” rather than rush the process and make a critical mistake.

And without a specific, joint VA-Pentagon governance and leadership structure, members are worried the department won’t know who to turn to if and when something goes awry.

Jim Byrne, VA’s deputy secretary, said he was “very confident” VA would have a smooth go-live in Spokane next year. If clinical staff at the Spokane facility believes they’re not ready, Byrne and other members of the VA leadership team said they’ll be ready to push the deployment back.

“If anything is going to impact patient safety, that is a no-go,” he told the subcommittee. “That rules over everything.”

John Windom, executive director of VA’s Office of Electronic Health Record Modernization, said he’d rely on Spokane’s clinical staff to advise him on whether the deployment should be pushed back.

Byrne said the department had already met several key milestones for EHR modernization.

The Spokane VA medical center, for example, is in the process of hiring 108 additional staff to “augment” the existing workforce and account for anticipated productivity losses during the initial go-live, the center’s director, Robert Fischer, said.

VA will conduct the first of two “dry-runs” with the new system in a few weeks.

But Congress is concerned these “dry runs” may reveal unexpected problems before the Spokane go-live.

To be clear, the March “go-live” won’t deploy the full-blown EHR. VA will launch an initial set of Cerner capabilities in March, meaning VA employees will need to navigate back and forth between the new system and the Veterans Information Systems and Technology Architecture (VistA).

“It is so important that the Spokane employees be able to train on the actual production system before go-live, not merely a mock-up training system. If a few more weeks are needed to make the training more meaningful, I urge VA to take it,” Jim Banks (R-Ind.), ranking member of the House Veterans Affairs Technology Modernization Subcommittee, said Wednesday at a hearing on the new EHR. “Similarly, if an interface cannot be completed in time or DoD does not grant an authority to connect when needed, I hope VA will seriously consider taking additional time to complete the task, rather than allowing that particular Cerner module to fall out of block one and until block two.”

DoD’s troubled, initial EHR deployment in the Pacific Northwest last year is front-and-center for VA as it prepares for its own rollout next March.

The Pentagon has been sharing their lessons-learned with VA since the beginning, Windom said. VA, for example, is ramping up its help desk capabilities following DoD reports that its own system was overwhelmed by a backlog of unresolved trouble tickets.

“We made sure we put in a robust help desk support mechanism, because we want end-users’ questions answered the first time, the right way,” Windom said. “That eliminates frustration.”

Training for VA Spokane employees is also critical, lawmakers said.

“I know that Cerner has been  engaged in testing individual modules, but we need the entire integrated system so it can be used for training. We cannot make the same mistake that DoD did in its IOC where it tested on a mocked up system,” Susie Lee (R-Nevada), chairman of the House subcommittee, said. “I’m concerned that the VA has not given itself enough time to fully test the system nor have they allowed time for all users to adequately train on it.”

The department said “no one will touch” the Cerner system unless they’ve been trained on the new EHR — and passed an examination to measure their competency.

Training requirements will depend on VA employees and their roles within the organization. Registration clerks, for example, may have fewer training hours to complete over a specialized cardiac nurse, said Laura Kroupa, chief medical officer for VA’s Office of Electronic Health Record Modernization.

Where’s the FEHRM?

It’s been more than 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).

Two individuals are leading the FEHRM on an interim basis, but no permanent leadership has been named.

“Not withstanding their tiny budget and shoestring staff, they have taken the initiative to unblock as many decisions as they can between VA and DoD,” Banks said of the interim leadership. “However, after several letters, staff meetings, a hearing and a roundtable discussion with leaders from both departments, I am still uncertain what the ultimate plan for the FEHRM is.”

VA and DoD plan to finalize the FEHRM’s organizational structure over the next six months, with additional governance processes coming later next year, Banks said.

The timeline is far later than what he initially expected, he added.

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