After development delays, training concerns and a global pandemic forced the Department of Veterans Affairs to postpone the initial rollout of its highly anticipated electronic health record modernization effort, the agency is on track to achieve a key milestone in three weeks.

The department plans to deploy a first round of EHR capabilities on Oct. 24 at the Mann-Grandstaff VA Medical Center in Spokane, Washington.

And though members of Congress are cautiously optimistic VA has made enough progress to succeed later this month, they’re concerned about the long-term scope, budget and timeline of the department’s 10-year, $16 billion modernization program.

VA was originally scheduled to deploy an initial set of capabilities in March at Mann-Grandstaff. But development delays and training concerns pushed the timeline back to July.

The pandemic delayed the initial rollout again this past spring. Leadership at Mann-Grandstaff directed Cerner to stop meetings, travel, training and other change management activities so VA staff could devote their complete attention to the health crisis.

Now, VA officials say the the first set of EHR capabilities are 99% complete. Testing and re-testing is ongoing. And most end-users at Mann-Grandstaff are beginning advanced training on the new system.

“Getting everyone trained is a challenge. We had the wildfires and had to cancel a couple days of training,” Laura Kroupa, chief medical officer for VA’s Office of Electronic Health Record Modernization, said Wednesday during a hearing on the EHR. “We have a couple weeks at the end of the training before the go-live to try to make those up. That’s going to be challenging, but we’re committed to that. In addition to that, we have adoption coaches and super-users who will be on site at the time of go-live. We’ll actually have adoption coaches there for the 90 days after go-live.”

Members of Congress hoped VA could capitalize on the extra time from the previous delays and roll forward capabilities that were planned for a second EHR rollout into the first.

“I am glad VA heeded our calls and pulled some key capabilities forward,” Jim Banks (R-Ind.), ranking member of the House Veterans Affairs Subcommittee on Technology Modernization, said. “I think this will meaningfully improve the system over what existed in March. That said, I hope future medical centers will have a single go-live with a complete Cerner EHR. All in all, I’m cautiously optimistic about the Spokane go-live.”

Ultimately though, VA is still planning to deploy two capability sets, with the second round scheduled for spring 2021.

As a result, the department reshuffled its go-live schedule and will deploy what’s known as EHR 1.1 to less-complex facilities in parts of the Midwest, said Susie Lee (D-Nevada), chairman of the technology modernization subcommittee.

“We need to understand how rapidly and thoroughly the VA will be able to complete the current state reviews for upcoming facilities, address infrastructure findings and prepare the staff at those facilities to implement a change that wasn’t expected for several years,” she said at Wednesday’s hearing.

VA preserves overall 10-year timeline, but pandemic prompts other changes

For Banks, he’s concerned VA’s rollout schedule has diverged from the path the Defense Department is taking. DoD is deploying an EHR based on the same commercial software, Cerner Millennium, in the same Pacific Northwest region of the country. After the initial rollout at Mann-Grandstaff, VA was supposed to follow DoD and begin other deployments in the same region.

“It is time to acknowledge that the sequence of 173 sites that was determined three years ago was an aspiration and a best guess. EHRM and MHS Genesis are now on completely different tracks. And because of the pandemic and the earlier decision to split the capability sets, VA has shifted its next region from California to the Midwest,” Banks said. “Despite all this change, our witnesses seem hesitant to adjust other aspects of the schedule because of the notion that members of Congress somehow insist on never modifying it. I share my colleagues’ interest in seeing the project finished as quickly as it’s feasible, but members of Congress did not and should not have a role in developing this schedule.”

The pandemic and other delays have caused VA to reconsider other pieces of the overall EHR modernization effort.

The department did go live with another Cerner platform, the centralized scheduling system (CSS), at the Columbus, Ohio VA medical center back in August.

VA initially wanted to decouple CSS from the Cerner Millennium platform and accelerate the scheduling system rollout across the VA health system. Those plans are on hold, though not completely off the table.

“The Cerner scheduling solution is not off the table to deploy separately and independently,” said John Windom, executive director of VA’s EHRM Office. “But in this Covid environment, we had to realistically look at numerous parameters, including social distancing and manpower availability. Social distancing has necessitated [the need for] additional trainers and additional people are used to augment what we need to do.”

“We thought the Cerner scheduling decision could wait,” he added. “I can ensure you the secretary and the deputy secretary are committed to getting as many capabilities out into the portfolio as soon as we possibly can.”

VA’s long-term budget projections for the 10-year EHR modernization efforts are also puzzling Congress.

“It defies reason that the budget would peak at $2.6 billion in fiscal year 2021… and 2022 and then rapidly declines,” Banks said. “Even under the best circumstances the next two years will see a gradual ramp-up of a few medical centers going live at a time. In contrast VA plans to juggle simultaneous go-lives of entire VISNs in the final year of the project. That will cost more, not less.”

But VA and Cerner dismissed those concerns. Both say VA needs to spend more up front to save more in the long run, even as the 10-year project nears completion.

“The bottom line is you get leverage and scale over time on a program of this size,” Travis Dalton, president of Cerner Government Services, said. “What we’ve seen commercially that bears that out is you do see your incremental costs go down per facility over time as you improve and become more efficient and get better at that work.”

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