After years of preparations and a few false starts, the Department of Veterans Affairs is expecting to achieve a major milestone in its decade-long, multi-billion-dollar effort to adopt a modern electronic health record.

The department is set to roll out an initial set of EHR capabilities to its first site, the Mann-Grandstaff VA Medical Center in Spokane, Washington, on Saturday.

“This is the first full implementation of the EHR and a significant milestone for VA’s Electronic Health Record Modernization (EHRM) effort, as the department works to transform and improve how VA delivers care to veterans,” spokeswoman Christina Noel said in an email to Federal News Network.

VA has twice delayed the initial go-live in Spokane. First, development delays and training concerns pushed the timeline back from March to July. But the global pandemic forced another pause this spring, as VA staff in Washington shifted focus to prepare for COVID-19 and Cerner and other contractors postponed travel.

The pandemic delays bought VA valuable time to improve the EHR , even if the department won’t launch with a full suite of capabilities all at once. It plans to deploy a second of two capability sets in Spokane next spring.

“We worked on interfaces. We worked on improving our training posture,” Laura Kroupa, chief medical officer for VA’s Office of Electronic Health Record Modernization, said last week during Cerner’s 2020 virtual summit.

“We worked on converting some of this training to virtual. Looking forward, the mindset of everyone being together in one room for a go-live or for training, we have to relook at that and we don’t know when this is going to resolve,” she said. “We looked at other technical things we could do in the background to move forward instead of waiting for COVID to pass.”

Ultimately, members of Congress watching VA’s initial go-live believe the department is about as ready as it can be — and that staff in Spokane are anxious to move past the preparations and start using the new system.

The go-live itself may be “messy,” a congressional aide told Federal News Network, but it will come together. The aide said VA may have some scalability issues and instituted workarounds to get past them but doesn’t anticipate they will impact patient care.

In a statement issued Friday afternoon, House Veterans Affairs Committee Ranking Member Phil Roe (R-Tenn.) said “real progress is finally here with the go-live of the Cerner system in Spokane.” Technology Modernization Subcommittee Ranking Member Jim Banks (R-Ind.) said he was “cautiously optimistic” this weekend’s go-live would be a success.

As with any major launch of a new electronic health record, it will take VA staff in Spokane some time to wrap their arms around the new system. Problems plagued the Defense Department’s initial EHR rollout in 2018, but the congressional aide said VA’s initial go-live would be more successful.

Training end-users in Spokane on the new system has been a challenge, and the pandemic hasn’t helped.

At a hearing of the House Veterans Affairs Technology Modernization Subcommittee last month, Banks expressed some skepticism VA employees never trained on the final set of capabilities, but on a mock-up instead.

VA said Friday 96% of Spokane end users have received training on the Cerner solution.

John Windom, executive director of VA’s EHRM Office, said the department will have “tiger” teams ready to address any challenges that arise during the initial roll-out.

“We’ll be assessing how [well] we performed, how well the solution is performing in the active environment, and then we’ll be ready to make adjustment,” he said at Cerner’s virtual conference.

Long-term outlook for VA EHR modernization unclear

This weekend’s go-live is highly anticipated, yet Congress is still unclear what it will mean for the future of VA’s overall electronic health record modernization efforts.

The pandemic forced VA to rearrange the order of EHR deployments at other facilities. Kroupa described Mann-Grandstaff as a “lesser-complexity hospital,” and VA plans to focus upcoming deployments at similar hospitals.

“We’ve spent a lot of time pivoting,” Kroupa said last week.

The new plan has VA moving next to the Walla Walla medical center in Washington, where the infrastructure needed to support the new Cerner solution is “much worse” than Spokane, the congressional aide said.

“The Walla Walla medical center is tiny but it’s a mess,” the aide said. “So I don’t think a successful Spokane go-live portends very much in terms of future events, because we’re going to get it done and wait for most or all of next year to finish Walla Walla. Then they’ll go to White City and Roseburg, Oregon. Once we get those done we’re still pretty far off until we complete a large complex medical center like Seattle or Portland. I don’t believe that the program has completely demonstrated its viability until it produces a successful go-live including all the capability sets at a large medical center.”

In the meantime, VA told Congress it’s still on track to complete EHR modernization in 2028, and its overall budget projections haven’t evolved after the two delays.

Both VA and Cerner have said those estimates haven’t changed because future EHRs will eventually get faster and cheaper once they reach the point of cascading deployments, and the department will save money as it pulls away from the legacy system and adopts the modern one.

Still, Congress is concerned the budget for the project may spiral out of control before VA has the chance to deploy the new EHR at several large facilities and prove its long-term viability.

“It’s our sense that we ought to spend less now and start slow and spend more later when we’ve reached that point of cascading,” the congressional aide said.

The electronic health record modernization is expected to cost at least $16 billion. Banks previously described VA’s overall budget, timeline and sequence of EHR deployments as a “best guess.”

“Going forward, the Veterans Health Administration needs to determine an updated schedule in a transparent, bottom up fashion,” he said at last month’s hearing.

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