The Department of Veterans Affairs has decided once again to pause the initial rollout of its multi-billion dollar electronic health record, as the agency focuses on fighting the coronavirus pandemic.
VA holds dual responsibilities during a pandemic like this one — caring for veterans and backing up overwhelmed civilian health systems.
“With VA medical centers reallocating staff to manage veteran patients with COVID-19, I directed the Office of Electronic Health Record Modernization (OEHRM) to immediately shift to a non-intrusive posture with VA health care operations to allow our frontline clinicians to focus on veteran care,” Secretary Robert Wilkie said last Friday in a letter addressed to congressional leaders.
VA was originally scheduled to roll out an initial set of EHR capabilities in March at the Mann-Grandstaff VA Medical Center in Spokane, Washington, but development delayspushed the timeline back to July.
Now the pandemic has paused those plans indefinitely, and there is no new timeline for the initial rollout in Spokane, according to a source briefed on the VA’s next steps.
Much of the software development work is complete at Mann-Grandstaff, with 72 out 73 interfaces finished and ready for testing, Wilkie said.
“There is still much work we can accomplish during this unprecedented time for our nation,” he told Congress. “We have completed interface design, build, connectivity and technical testing for all 72 interfaces required to support Go-Live for VA’s new EHR solution. We have also completed 99% of the new clinician training system.”
Travel to EHR rollout site stopped in March
The growing pandemic had forced Cerner, and then staff from VA’s central office, to begin limiting their travel to Mann-Grandstaff in early March, according to the source.
By mid-March, the medical center directed Cerner to end meetings, training preparation and change management activities with the staff. All travel stopped at that time.
Mann-Grandstaff converted the floor space it had used for those activities back to clinical use, the source said.
Ceasing travel and other engagements with VA staff in Spokane means Cerner can’t test system interfaces, train heavy-users of the new EHR or conduct an assessment to ensure they’re ready for the initial go-live — all necessary steps for a successful implementation.
The department believed it was on track to deploy the new scheduling solution before the pandemic, but training on the system stopped in March, according to the source.
VA and Cerner staff had completed eight interfaces for the scheduling system, and additional infrastructure upgrades were underway, Wilkie said.
The department’s original contract with Epic, which had successfully piloted a new scheduling system in Columbus, was supposed to run out this June. VA scrapped the Epic pilot in favor of Cerner’s scheduling solution.
There is no new timeline for deployment of Cerner’s centralizing scheduling system (CSS) in Columbus or any of VA’s other sites, the source said.
Joint Health Information Exchange still on track
However, VA and the Defense Department are on track to activate the Joint Health Information Exchange at the end of this month, Wilkie said,
Specifically, the departments will transfer their own existing health information exchanges to a Cerner platform, where they’ll be unified and improved.
Though VA has paused its initial EHR go-live in Spokane, it’s unclear what the delay will mean for the timeline at other sites. The department hasn’t yet paused the roll-out at the Puget Sound Health Care System, which was initially scheduled for later this fall, the source briefed on VA’s plans said.
It’s also unclear what the Spokane pause will mean for VA’s EHR deployment plans at the site. When the department announced its first delay back in February, VA leadership chose to roll forward some capabilities initially planned for its second EHR release into the first.
But the source familiar with VA’s next steps said the department isn’t yet sure whether it will eventually deploy all EHR capabilities at once, or if it will move ahead with two separate releases.
Leadership changes add challenge
Regardless, House VA Committee leadership said they support VA’s decision to pause the initial EHR rollout.
“If VA is not ready, the electronic health record modernization project should be delayed,” Reps. Mark Takano (D-Calif.), committee chairman, and Susie Lee (D-Nevada), chairwoman of the technology modernization subcommittee, said Wednesday in a statement. “The COVID-19 pandemic is a clear reason to postpone given the critical need to have EHRM staff on the frontlines in the fight against coronavirus.”
Rep. Phil Roe (R-Tenn.), the committee’s ranking member, said he too supported VA’s recent decision to delay.
“In these unprecedented times, it is imperative that VA remain laser-focused on their most important mission — providing our nation’s veterans with safe, high-quality care,” he said in a statement to Federal News Network. “I commend VA and the Cerner team for continuing work on the technical aspects of the system during the disruption to deliver a more complete, usable electronic health record once we have weathered this storm.”
Takano and Lee urged the department to prioritize communication with VA employees, who in February had expressed concern to Congress about their level of engagement with the project. Many employees were still wary about making the shift from a familiar, home-grown electronic record to a commercial off-the-shelf product.
The EHR delay comes as VA balances its coronavirus response with more leadership changes.
VA this week announced Pamela Powers, Wilkie’s long-time chief of staff, as the department’s acting deputy secretary. She’ll temporarily replace Jim Byrne, who was abruptly fired in January.
As deputy secretary, Byrne had served as the accountable point-person and key decision maker for the EHR modernization. After his removal, the department had designated Melissa Glynn, VA’s assistant secretary for enterprise integration, as the point-person for the EHR.
But Glynn recently left VA for the private sector, and it’s unclear who exactly will serve as the department’s key decision-maker for the electronic health record.
VA on Thursday announced Karen Brazell as Glynn’s temporary replacement. Brazell had been VA’s principal executive director and chief acquisition officer for two years.