What’s driving VA’s EHR delay? Congress, IGs begin oversight in earnest this week

The Department of Veterans Affairs may face some tough questions this week, as Congress will attempt to better understand the real reasons behind the agency’s recent decision to delay the initial rollout of its electronic health record.

VA had previously assured members of Congress the initial rollout was on track, but members will soon question whether development and contracting issues, change management and staff concerns — or all of the above — are driving the delays with the department’s 10-year, $16 billion project.

Congress will begin its own oversight activities of the EHR modernization in earnest Thursday, with a hearing scheduled in the House Appropriations Subcommittee on Military Construction and Veterans Affairs on Thursday afternoon.

The House Veterans Affairs Subcommittee on Technology Modernization will host its own hearing on the recent EHR delays the following week.

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VA had planned to implement an initial set of electronic record capabilities from Cerner at its first site, the Mann-Grandstaff VA Medical Center in Spokane, Washington, on March 28.

But VA announced earlier this month it would pause the initial rollout, citing the need for more time to build the system and train clinicians on its capabilities.

House members have said all along they support VA’s decision to delay. Even when VA expressed high levels of confidence last November about its ability to meet the initial go-live deadline next month, members on the House Veterans Affairs Committee implored the department to take the time it needed to get the rollout right.

Now members are trying to get a better sense of the problems and challenges that prompted VA to delay.

On one hand, the committee has heard concerns from VA employees, who are still unaccustomed and possibly wary about using a commercial off-the-shelf product, a House Veterans Affairs Committee staff member told Federal News Network.

But on the other hand, the committee has also fielded concerns about the configuration and development of the Cerner system, which is supposed to meet VA’s needs.

“We’re hearing more and more that it is a development issue and they’re not satisfied with where the system is in terms of development, that they don’t think it matched the requirements that they set out,” the committee staffer said.

If it is a change management issue, the committee will more closely examine how VA is communicating with and training employees.

But if development or contracting challenges are the main driver of the recent delay, other questions will arise.

“[If it is] a development issue, that points to some major problems with the contract,” the committee staffer said. “How are you going to work with the contractor to fix those deficiencies, if that is, in fact, what it is. Sorting through that is our top priority right now.”

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VA’s Feb. 10 announcement that it would delay the rollout of an set initial set of Cerner capabilities in Spokane came at a key decision point for the department.

VA had planned the first round of EHR deployments in the Pacific Northwest to match the Defense Department’s initial rollouts of its MHS Genesis health record. Both systems are based on Cerner’s Millennium platform.

Employees were supposed to receive training on the new system starting Feb. 10. But since developers were still configuring the Cerner system for VA, employees would have been forced to learn on an unfinished product, another committee aide has previously told Federal News Network.

“In a way what happened is what was built into the process to happen,” a committee staffer said. “But the question is what they’re pointing to as missing from the system or not being ready in the system something that was agreed upon would be ready by the end of March for go-live, or are they adding things on that originally weren’t part of [the original plan].”

VA has often acknowledged the scope and significance of a major change management initiative like the EHR modernization. The department has held roundtable discussions with clinicians, which VA has said were supposed to inform requirements and best practices for both developing and later using the Cerner system.

But the possibility of “scope creep” is a concern, the committee staffer said. VA and the committee are now discussing the possibility of summer rollout of initial Cerner capabilities in Spokane, the staffer added.

Meanwhile, the inspectors general at the Defense Department and VA on Monday announced the start of a rare, joint audit of the departments’ efforts to launch a seamless, interoperable health record.

“The objective of this joint audit is to determine the extent to which the actions taken by the DoD and VA in acquiring and implementing a common, commercial electronic health record system and supporting architecture will achieve interoperability among the departments and with external health care providers,” Glenn Fine, the DoD inspector general, and Michael Missal, the VA IG, said in a Feb. 24 memo.

The joint memo was addressed to both DoD and VA officials. Work will begin on the audit this month, the IGs said.

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