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The Department of Veterans Affairs set a new goal for the rollout of initial electronic health record capabilities at its first facility this year, after development delays pushed back the original March timeline.

July 2020 is the new goal for the initial rollout at the Mann-Grandstaff VA Medical Center in Spokane, Washington, though the department may deploy new EHR capabilities sooner, VA Secretary Robert Wilkie told Congress Thursday.

“We have a great relationship with our private sector partner,” Wilkie told the House Veterans Affairs Committee. “We have a great relationship with the Department of Defense. But I was not satisfied. I promised you and [Rep. Phil] Roe (R-Tenn.) that if I was not satisfied, we would not launch.”

Wilkie said he choose to delay the initial EHR rollout, which was originally scheduled for March 28, because the system wasn’t fully developed. It didn’t make sense to train VA employees on an unfinished system, he said.

“When I reviewed it, the two portions of the program that were not ready for our clinicians were programs that were incredibly important, particularly to the [Pacific North]west, were travel and community care,” Wilkie said. “Those programs weren’t ready.”

Rep. Mark Takano (D-Calif.), chairman of the Veterans Affairs Committee, specifically asked whether staff and change management concerns were behind the decision to delay.

But VA was clear.

“It is development,” Richard Stone, executive in charge of the Veterans Health Administration, said of the decision to delay the initial rollout. “There are about 1,000 work processes that need to be written. Those are substantially completed, but once you finish those work processes, you have to set that electronic medical record into a number of interfaces that plug into the rest of the system. There are 73 interfaces. Nineteen are completed as of today, and that is why we are delayed. This is [about] development.”

Now with a new timeline moving forward, Stone said VA may use the additional time to push forward the development of certain capabilities — like refilling prescriptions online — that were initially scheduled for the second release to the first in July.

Veterans in Spokane order prescription refills online at least 11,000 times a month, Stone said.

“We were going to lose that capability in capability set one, stand up a call center and do it all manually,” he said. “But as we take these couple of months extra, the debate has been ‘is the interface well-enough developed for our computerized pharmacies to draw that capability forward?’ That is a recommendation that we hope to be able to recommend to the secretary in what we call ‘capability set 1.1.'”

While members of the House Veterans Affairs Committee were relatively sympathetic to VA and its description of these challenges, the tone was different a few hours later at another committee.

At a hearing specifically on the EHR, Debbie Wasserman-Schultz (D-Fla.), chairman of the House Appropriations Subcommittee on Military Construction and Veterans Affairs, accused VA of leaving members of Congress in the dark as the department learned of the ongoing challenges with the project.

“This is high-risk stuff. There is extraordinary risk, and this is not a surprise to VHA,” Stone said.

“Unfortunately if it was not a surprise to VHA, it became a surprise to Congress,” Wasserman-Schultz said. “That means that there was a woefully inadequate, almost absent, line of communication to make us aware of the problems that had been encountered. This was not a last-minute awareness for you, but you made it a last-minute awareness for us. And that’s unacceptable.”

EHR, IT infrastructure budget to get a huge bump

Congress questioned whether VA’s new EHR timeline might impact its massive budget request for the project in 2021, though the department insisted nothing would change.

The department asked for $2.6 billion for VA’s Office of Electronic Health Record Modernization, a nearly $1.2 billion increase over the previous year’s request for this project.

The increase raised a few eyebrows in Congress.

“I am struggling a little bit with the size of the requested EHR increase,” Jim Banks (R-Ind.), ranking member of the House VA Subcommittee on Technology Modernization, said Thursday morning.

Stone said much of the increase will fund three years of infrastructure improvements across the VA enterprise, to the tune of $685 million each year.

“When I came on board in the summer of 2018, it was clear that the infrastructure was not prepared to accept the Cerner product,” he said. “We did a full infrastructure review, based on what Cerner told us they needed. [They] needed one gigabyte of capability in transmission data. We took a look at our closets. Many of our closets do not have the heating and cooling necessary to maintain switches effectively. The bill for that, to deliver 5E cable across our entire system, is $2.5 billion.”

Information technology initiatives have been underfunded for years, the department acknowledged, and VA needs a multi-million dollar investment to upgrade IT infrastructure for the new EHR — and several other projects —across the organization.

“VA has been underfunded on the IT front. Throughout the last several decades we were right at the bottom. That is a bipartisan criticism, both Republican and Democratic administrations,” Wilkie said. “Raising that IT infrastructure profile is absolutely the key. Moving things to the cloud, getting people away from actually having to touch a claim, that’s what we’re working on.”

To address infrastructure challenges, the department is asking for $250 million to launch an infrastructure readiness program. The program would refresh and replace outdated IT infrastructure across the VA.

Individual VA offices are supposed to identify their needs and propose strategies to refresh their own IT assets based on the age of the equipment, warranty expiration, support limitations, business requirements and financial considerations.

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